Chapter 056

Linton: Introduction to Medical-Surgical Nursing, 5
th
Edition
Chapter 56: Substance-Related Disorders
est !an"
M#LI$LE C%&ICE
1. A patient has been diagnosed with alcoholism. The nurse tells him that he has a physical
illness with a genetic predisposition to alcoholism, and the only effective treatment is
total abstinence from alcohol. This type of approach characterizes which one of the
following theories?
a. Biologic
b. Behavioral
c. Sociocultural
d. ntrapersonal
A!S" A
The Biologic approach is based on the theory that there is a faulty physiologic process
that causes a predisposition to an addiction. This theory includes the belief that such an
addition is incurable and only total abstinence will be effective.
#$" %ognitive &evel" %omprehension '($" p. 1)** +B," 1
T+-" (tiology and 'is. $actors /(0" !ursing -rocess Step" mplementation
1S%" !%&(2" 3ealth -romotion and 1aintenance" -revention and early detection of
disease
*. The nurse e4plains that according to the intrapersonal theory, addiction is caused by early
childhood re5ection. These substance abusers are thought to have common characteristics
that include"
a. +pen6boundary approach to life that li.es to party fre7uently
b. Attention see.ing, need for control, and self6centeredness
c. Shyness and an4iety
d. Stress and eagerness to be a part of the in6group
A!S" B
The intrapersonal theory identifies the common personality traits of self centeredness,
need for control, and attention see.ing as parts of the addictive personality.
#$" %ognitive &evel" Analysis '($" p. 1)*) +B," 1
T+-" (tiology and 'is. $actors /(0" !ursing -rocess Step" mplementation
1S%" !%&(2" -sychosocial ntegrity" %oping and adaptation
). #uring the ta.ing of a medical history, the patient who is addicted to heroin reports he
only uses the drug a few times a wee.. The nurse8s best response that would disclose
more precise information would be"
a. 9+/. 0ou only use heroin two times a wee.?:
b. 9;hat do you mean when you say <a few?8:
%opyright = *>1*, *>>?, *>>), *>>>, 1@@A by Saunders, an imprint of (lsevier nc.
Test Ban.
c. 9Are you saying that in a wee.8s time would you use heroin only two times?:
d. 9'ate your wee.ly usage on a scale of 1 to 1A.:
A!S" #
;hen trying to get a health history on a patient with a substance abuse problem, the best
method is an open discussion of the drug use. The discussion should be open and
non5udgmental. By re7uesting a scale, the patient8s response will be more informative.
#$" %ognitive &evel" Analysis '($" p. 1)*B +B," *
T+-" !ursing Assessment of the Substance Abuser
/(0" !ursing -rocess Step" Assessment
1S%" !%&(2" -hysiological ntegrity" -hysiological adaptation
B. A patient who is an alcoholic is brought to the inpatient psychiatric unit saying that he
does not .now where he is or what day it is. Because he has a history of heavy drin.ing,
you suspect that he is having"
a. #elirium
b. Alcoholic dementia
c. Blac.out
d. Amnesia
A!S" %
Blac.outs are common with heavy drin.ing over time. The patient data support that the
memory loss is associated with the alcohol use, and that blac.outs would be an e4pected
outcome.
#$" %ognitive &evel" Analysis '($" p. 1)*B +B," *
T+-" -atterns and %onse7uences of Abuse
/(0" !ursing -rocess Step" Assessment
A. The nurse is discharging a patient with a pulmonary disorder to return home with her
family. She has had a difficult time while in the hospital and has e4perienced withdrawal
from tobacco. ;hen the nurse tells her that community resources are available to help her
to stop smo.ing, she says, 9That8s +/. can stop whenever want to.: This is an
e4ample of"
a. 'ationalization
b. #enial
c. ntellectualization
d. -ro5ection
A!S" B
#enial is a common defense mechanism used by substance abusers.
#$" %ognitive &evel" Application '($" p. 1)*B +B," )
T+-" #efense 1echanisms /(0" !ursing -rocess Step"
AC6*
Test Ban.
Assessment
C. A patient with an alcohol addiction says, 91y drin.ing is all my wife8s fault. She ma.es
me so crazy 5ust have to have a drin..: This is an e4ample of"
a. 'ationalization
b. #enial
c. ntellectualization
d. -ro5ection
A!S" #
The patient in this scenario is pro5ecting. 3e is blaming his wife for his drin.ing problem,
rather than accepting that the drin.ing is his problem.
#$" %ognitive &evel" Application '($" p. 1)*A +B," )
T+-" #efense 1echanisms /(0" !ursing -rocess Step"
Assessment
?. Substance abuse might be suspected in a patient who has aDnE"
a. Abnormal liver function test and a gastrointestinal DFE bleed.
b. -ositive syphilis screen and varicose veins.
c. $ungal infection and a potassium level of B.*. m(7G&.
d. #ecreased albumin level and creatinine level of 1.* mgGdl.
A!S" A
An abnormal liver function test and a gastrointestinal F bleed indicate substance abuse.
#$" %ognitive &evel" Application '($" p. 1)*A +B," *
T+-" #iagnostic Tests /(0" !ursing -rocess Step" Assessment
H. A urine drug screen is ordered for a patient suspected of a driving while into4icated
D#;E. The nurse e4plains that the drugs that are being screened can include"
a. &ysergic acid diethylamide D&S#E, Ialium, and -ercocet.
b. %rac., heroin, and nonsteroidal antiinflammatory drugs D!SA#sE.
c. 1ari5uana, amphetamines, and (lavil.
d. &ibrium, cocaine, and Joloft.
A!S" A
&ysergic acid diethylamide D&S#E, Ialium, and -ercocet have the correct combination of
an illicit drug, an an4iolytic medication, and an opioid.
#$" %ognitive &evel" %omprehension '($" p. 1)*A +B," *
AC6)
Test Ban.
T+-" Krine #rug Screening /(0" !ursing -rocess Step"
mplementation
1S%" !%&(2" -hysiological ntegrity" -harmacological therapies
@. ;hen an alcoholic, who was brought in 1* hours earlier in an into4icated state, begins to
e4hibit tremors, has increased blood pressure, and is agitated, the nurse assesses that the
patient is in"
a. 1a5or withdrawal
b. (arly withdrawal
c. #elirium tremens
d. 1inor withdrawal
A!S" B
The signs of early withdrawal from alcohol are agitation and elevated vital signs. These
warning signs usually occur C to 1* hours after the last drin..
#$" %ognitive &evel" Application '($" p. 1)*C +B," )
T+-" Alcoholism /(0" !ursing -rocess Step" Assessment
1>. The nurse is aware that the alcoholic is at ris. for a syndrome related to thiamine
deficiency, which is"
a. $etal alcohol syndrome
b. ;ernic.e encephalopathy
c. /orsa.off psychosis
d. Alcoholic dementia
A!S" B
;ernic.e encephalopathy is a vitamin B1 DthiamineE deficiency. f not treated with
vitamin supplements, the condition can progress to a more serious form.
#$" %ognitive &evel" Application '($" p. 1)*C +B," )
T+-" 1edical %omplications /(0" !ursing -rocess Step" !GA
11. The wife of a long6term alcoholic wants to help her husband 7uit drin.ing. The nurse tells
her that an initial approach might be for a group of friends and family to confront the
patient with his alcoholism and tell him that"
a. 3e needs helpL his drin.ing is out of hand.
b. They are fed up with him and will no longer be his friend.
c. They re5ect his drin.ing but thin. he is a valuable person.
d. 3e is still their friend, even if he does not stop drin.ing.
A!S" %
AC6B
Test Ban.
The implementation for encouraging an alcoholic to go into treatment consists of a group
of people telling the alcoholic that they thin. his drin.ing is destructive, but they do not
re5ect him as a person.
#$" %ognitive &evel" Application '($" p. 1)*? +B," )
T+-" mplementation /(0" !ursing -rocess Step" mplementation
1S%" !%&(2" -sychosocial ntegrity" -sychosocial adaptation
1*. The nurse recommends to an alcoholic that he 5oin Alcoholics Anonymous because this
organization is"
a. Based on a 1*6step approach with a strong religious base.
b. A social group of e46drin.ers who befriend one another in the process of
maintaining sobriety.
c. A religious support group that assists alcoholics during rehabilitation.
d. An anonymous group of sponsors who offer help to alcoholics.
A!S" A
Alcoholics Anonymous is a group of people who come together to offer support to each
other to stay sober. t has a religious base, recognizes a higher power, and uses a 1*6step
approach to sobriety.
#$" %ognitive &evel" Analysis '($" p. 1)*H +B," )
T+-" 'ehabilitation /(0" !ursing -rocess Step"
mplementation
1S%" !%&(2" -sychological ntegrity" %oping and adaptation
1). The nurse cautions a patient who is ta.ing disulfiram DAntabuseE that MMMMMMMMMMMMMM
should be avoided to prevent the accidental activation of Antabuse.
a. Aged cheese
b. -ic.led foods
c. 1outhwash
d. %hocolate candy
A!S" %
1outhwash contains alcohol and can trigger the effect of an Antabuse reaction. The
alcoholic ta.ing Antabuse needs to be aware of the hidden alcohol in some commonly
used mouthwashes and other over6the6counter drugs.
#$" %ognitive &evel" Application '($" p. 1))> +B," )
T+-" 1edications /(0" !ursing -rocess Step" -lanning
1B. The nurse in the admissions unit is informed that a patient is being brought in who has
been using 9ice.: The nurse is aware that this patient may be"
a. (4tremely dehydrated
b. n a coma
AC6A
Test Ban.
c. #angerously hypertensive
d. Iiolent
A!S" #
-ersons who use 9ice,: a form of methamphetamine, are fre7uently violent while under
its influence. The effect of 9ice: can last as long as 1* to 1B hours.
#$" %ognitive &evel" Application '($" p. 1))B +B," B
T+-" Stimulants /(0" !ursing -rocess Step" -lanning
1A. n assisting with the development of a nursing care plan for a patient who has been using
cocaine for A years, the nurse will include provisions to deal with"
a. #epression
b. Iiolent behavior
c. !asal erosion
d. Suicide attempts
A!S" A
%ocaine users can be depressed for as long as * years after 7uitting drug use. An
antidepressant such as bupropion D;ellbutrinE is helpful in treating the depression.
#$" %ognitive &evel" Application '($" p. 1))B +B," ?
T+-" %ocaine /(0" !ursing -rocess Step" -lanning
1C. 1ari5uana is a hallucinogenic drug that can be used for positive effects in the treatment
of"
a. #iet control in the morbidly obese
b. %hemotherapy6induced nausea and vomiting
c. Air hunger in patients with end6stage emphysema
d. (arly diabetic6induced cataracts
A!S" B
1ari5uana has been studied for use to reduce nausea and vomiting in patients with cancer.
1arinol D#ronabinolE is a mari5uana derivative currently available to reduce
chemotherapy6induced nausea and vomiting.
#$" %ognitive &evel" Application '($" p. 1))A +B," B
T+-" 3allucinogens /(0" !ursing -rocess Step"
mplementation
AC6C
Test Ban.
1?. The nurse counsels a pregnant cocaine abuser that her cocaine use places the baby at ris.
for"
a. Severe allergies
b. !eurologic impairments
c. 3earing impairment
d. 3igher birth weights
A!S" B
Babies born to mothers who are addicted to cocaine have a higher incidence of
hyperactivity and neurologic problems.
#$" %ognitive &evel" Analysis '($" p. 1))B +B," H
T+-" #isorders Associated with %ocaine Kse
/(0" !ursing -rocess Step" mplementation
disease
1H. The rationale for using methadone in the treatment of heroin abuse as a substitute for
heroin is that methadone"
a. Substitutes one opioid for another.
b. s less constipating than heroin.
c. #oes not give the 9rush: that a person addicted to heroin is loo.ing for.
d. s a synthetic opioid, which ma.es it less addicting.
A!S" %
1ethadone, as an e4tended6release medication, does not give the 9rush: that addicts
en5oy. t maintains the opioid level in the body but does so at a steady state and decreases
cravings.
#$" %ognitive &evel" Application '($" p. 1))C +B," B
T+-" 1edications /(0" !ursing -rocess Step" !GA 1S%" !%&(2" !GA
1@. !arcan has been given to the person with respiratory depression who is addicted to
heroin. The nurse is alert for indications of"
a. Acute withdrawal symptoms
b. 'espiratory arrest
c. 3ypotensive crisis
d. %ardiac arrest
A!S" A
!arcan is an opioid antagonist that causes the opioid to fall from receptor sites. ;hen the
antagonist is given, the sudden loss of the opioid causes acute withdrawal to occur.
#$" %ognitive &evel" Analysis '($" p. 1))? +B," B
T+-" 1edications" !arcan /(0" !ursing -rocess Step"
Assessment
AC6?
Test Ban.
*>. The treatment plans for abusers of alcohol and drugs are similarN@> meetings in @> days
and 1*6step programs. The ma5or difference in the success of the two types of abusers is
that"
a. +ne program uses a 1*6step approach, and the other program has a religious base.
b. 3eroin addicts have a higher success rate.
c. Alcohol abusers have an easier time staying with the program.
d. 'elapse rates for patients using drugs other than alcohol alone are much higher.
A!S" #
+ne difference between alcohol and drug rehabilitation programs is that drug abusers will
have a lower success rate. Alcohol abusers have a higher rate of success when they follow
the Alcoholics Anonymous program.
#$" %ognitive &evel" Analysis '($" p. 1))? +B," C
T+-" 'ehabilitation /(0" !ursing -rocess Step"
(valuation
1S%" !%&(2" -sychosocial ntegrity" -sychosocial adaptation
*1. A nursing diagnosis that is appropriate for a patient with substance abuse is"
a. An4iety
b. %hronic or situational low self6esteem
c. 'is. for delayed development
d. Acute confusion
A!S" B
&ow self6esteem is related to a loss of control and guilt.
#$" %ognitive &evel" Application '($" p. 1))H +B," ?
T+-" !ursing #iagnosis" Substance Abuse
/(0" !ursing -rocess Step" -lanning
**. An implementation that can be used to help prevent relapse in a patient who has a
substance abuse problem is"
a. Self hypnosis
b. magery
c. Stress management
d. Bloc.ing
A!S" %
Teaching stress management techni7ues to patients who have a substance abuse problem
will assist them in managing the conflict and stress in their daily lives, which previously
triggered the substance abuse.
AC6H
Test Ban.
#$" %ognitive &evel" Application '($" p. 1))@ +B," ?
T+-" mplementation /(0" !ursing -rocess Step" mplementation
*). n some cases, patients will use drugs or alcohol to treat the disturbing symptoms of a
psychiatric disease. This scenario presents a problem, because the potential e4ists to"
a. %ause a mi4ed6drug reaction, which may heighten the effects of both drugs.
b. #ecrease psychiatric symptoms, which ma.es the psychiatric condition harder to
treat.
c. %ause an accidental overdose by mi4ing alcohol with an4iolytic medications,
antipsychotic medications, or antidepressant agents.
d. %ause an increase in psychiatric symptoms, because the psychiatric drugs become
less effective in the presence of alcohol.
A!S" %
%ombining alcohol and psychiatric drugs, an4iolytics, or antidepressants may cause an
accidental overdose by increasing the central nervous system D%!SE effects.
#$" %ognitive &evel" Analysis '($" p. 1)B1 +B," H
T+-" The #ually #iagnosed /(0" !ursing -rocess Step" Assessment
1S%" !%&(2" -sychosocial ntegrity" -harmacological therapies
M#LI$LE RES$&NSE
1. The nurse clarifies that when a urine sample is needed for screening in a case of #; or
other crime, the specimen should" (Select all that apply.)
a. Be collected and witnessed by a staff member of the same gender.
b. Be documented with a chain6of6custody form and signed by all who handle the
specimen.
c. Be .ept under secure conditions if temporary storage is necessary.
d. !ever be out of sight until someone from law enforcement ta.es it.
e. Be placed in a specially mar.ed container.
A!S" A, B, %
The specimen, if placed in secure storage, does not have to be in sight nor does it need a
specially mar.ed container.
#$" %ognitive &evel" Application '($" p. 1)*A +B," *
T+-" Krine Screening /(0" !ursing -rocess Step" mplementation
1S%" O!%&(2" Safe, (ffective %are (nvironment" -revention and early detection of
diseaseO
*. The nurse documents signs of ;ernic.e encephalopathy in a patient with long6term
alcoholism. These signs include" (Select all that apply.)
a. %onfabulation
b. Ata4ia
AC6@
Test Ban.
c. #elirium
d. #ecreasing level of consciousness
e. -ro5ectile vomiting
A!S" A, B, %, #
The signs of ;ernic.e encephalopathy do not include pro5ectile vomiting.
#$" %ognitive &evel" Application '($" p. 1)*C +B," A
T+-" ;ernic.e (ncephalopathy /(0" !ursing -rocess Step" Assessment
). The nurse ta.es into consideration that alcohol abuse in the older adult may place them at
ris. for" (Select all that apply.)
a. $alls
b. 1alnutrition
c. 'espiratory infections
d. Bone demineralization
e. %irrhosis
A!S" A, B, #, (
Alcohol abuse in the older adult ma.es the him or her at ris. for falls, malnutrition,
cirrhosis, and bone demineralization.
#$" %ognitive &evel" Application '($" p. 1))@ +B," H
T+-" Alcohol Abuse in the +lder Adult /(0" !ursing -rocess Step" -lanning
disease
B. The nurse clarifies that a hair analysis done on an alcoholic" (Select all that apply.)
a. 'e7uires sensitive technology.
b. s not reliable on treated or dyed hair.
c. %an determine addiction.
d. %an be informative in the treatment of a short6term abuser.
e. %an assess relapse.
A!S" A, (
3air analysis re7uires sensitive technology, can be used on treated or dyed hair, and can
assess a relapse. 3air analysis cannot confirm addiction, only use, and it is not
informative on short6term abusers.
#$" %ognitive &evel" Analysis '($" p. 1)*A +B," *
T+-" 3air Analysis /(0" !ursing -rocess Step" mplementation
disease
AC61>
Test Ban.
A. The adolescent is e4tremely vulnerable to substance abuse because the adolescent"
(Select all that apply.)
a. s egocentric.
b. %an use good 5udgment.
c. 3as poor impulse control.
d. s aware of possible conse7uences.
e. ;ants peer identification.
A!S" A, %, (
Adolescents are prone to substance abuse because of peer pressure and their basic
egocentrism, which interferes with good 5udgment, prediction of conse7uences, and
impulse control.
#$" %ognitive &evel" %omprehension '($" p. 1)B> +B," H
T+-" Adolescents /(0" !ursing -rocess Step" !GA 1S%" !%&(2" !GA
C&M$LEI&N
1. The nurse e4plains that a test that can detect substance abuse for up to 1 year after only *
or ) days of use is performed on MMMMMMMMMMMMMMMMMMMM.
A!S"
3air
3air can indicate drug abuse up to a year, even if the abuse was only a matter of days.
#$" %ognitive &evel" %omprehension '($" p. 1)*C +B," *
T+-" 3air Analysis /(0" !ursing -rocess Step" mplementation
disease
*. The nurse e4plains that because the drug disulfiram DAntabuseE is deemed inappropriate,
the patient has been put on the most reliable substitute, MMMMMMMMMMMMMMMMMMMM, which
causes similar but less severe side effects in the alcoholic who continues to drin..
A!S"
$lagyl
1etronidazole D$lagylE, similar to Antabuse, can also cause nausea and severe vomiting if
mi4ed with alcohol.
#$" %ognitive &evel" Application '($" p. 1))> +B," A
T+-" Kse of $lagyl /(0" !ursing -rocess Step" mplementation
AC611

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Linton: Introduction to Medical-Surgical Nursing, 5

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