eBay:testbanks_and_xanax

The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurse’s frustration with the patient.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-42, 75 (Box 22-3) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

9. A patient asks for information about AA. Select the nurse’s best response. “AA is a a. form of group therapy led by a psychiatrist.” b. self-help group for which the goal is sobriety.” c. group that learns about drinking from a group leader.” d. network that advocates strong punishment for drunk drivers.”

ANS: B

AA is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-48, 50, 51 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

10. Police bring a patient to the emergency department after an automobile accident. The patient demonstrates poor coordination and slurred speech but the vital signs are normal. The blood alcohol level is 300 mg/dL (0.30 g/dL). Considering the relationship between the assessment findings and blood alcohol level, which conclusion is most probable? The patient a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has ingested both alcohol and sedative drugs recently.

ANS: B

A nontolerant drinker would have sleepiness and significant changes in vital signs with a blood alcohol level of 300 mg/dL (0.30 g/dL). The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patient’s body is tolerant. If disulfiram and alcohol are ingested together, an entirely different clinical picture would result. The blood alcohol level gives no information about ingestion of other drugs.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 22-6, 30, 31, 33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 37

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity a. Denial b. Projection c. Introjection d. Rationalization

11. A patient admitted to an alcohol rehabilitation program tells the nurse, “I’m actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening.” The patient is using which defense mechanism?

ANS: A

Minimizing one’s drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for one’s faults or problems. Rationalization involves making excuses. Introjection involves incorporating a quality of another person or group into one’s own personality.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 69 (Table 22-5)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. Bromocriptine b. Methadone c. Disulfiram d. Naltrexone

12. Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?

ANS: D

Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-22, 72 (Table 22-6) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. “While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol.” b. “It will be important for you to structure life to avoid as much stress as you can and provide social protection.” c. “Addiction is a lifelong disease of self-destruction. You will need to observe your spouse’s behavior carefully.” d. “It is good that you are supportive of your spouse’s sobriety and want to help maintain it.”

13. During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, “After this treatment program, I think everything will be all right.” Which remark by the nurse will be most helpful to the spouse?

ANS: A

During recovery, patients identify and use alternative coping mechanisms to reduce reliance on substances. Physical adaptations must occur. Emotional responses were previously dulled by alcohol but are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who need anticipatory guidance and accurate information.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 40, 41, 51

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

14. The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should a. provide long-term care for the patient in a residential facility. b. withdraw the patient from cannabis, then treat the schizophrenia. c. consider each diagnosis primary and provide simultaneous treatment. d. first treat the schizophrenia, then establish goals for substance abuse treatment.

ANS: C

Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-8, 9, 48, 49

TOP: Nursing Process: Planning eBay: testbanks_and_xanax

MSC: Client Needs: Psychosocial Integrity a. Empathetic, supportive b. Skeptical, guarded c. Cool, distant d. Confrontational

15. Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction.

ANS: A

Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defenses.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 40, 41

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. Simple and safe b. Active and bright c. Stimulating and colorful d. Confrontational and challenging

16. Which features should be present in a therapeutic milieu for a patient experiencing a hallucinogen overdose?

ANS: A

Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a “bad trip.”

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-16, 58 (Table 22-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Tolerance has developed. b. Antagonistic effects are evident. c. Metabolism of the alcohol is now delayed. d. Pharmacokinetics of the alcohol have changed.

17. When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred?

ANS: A

Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects account for this change.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-6, 33 (Case Study and Nursing Care Plan, Alcohol Use Disorder)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

18. At a meeting for family members of alcoholics, a spouse says, “I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work.” The nurse assesses these comments as a. codependence. b. assertiveness. c. role reversal. d. homeostasis.

ANS: A

Codependence refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. The other options are not supported by information given in the scenario.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 38

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/minute, and respirations at or above 12 breaths/minute. c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d. Within 6 hours, the patient’s breath sounds will be clear bilaterally and throughout lung fields.

19. In the emergency department, a patient’s vital signs are BP 66/40 mm Hg; pulse 140 beats/minute; respirations 8 breaths/minute and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to opioid intoxication. Select the priority outcome.

ANS: B

The correct short-term outcome is the only one that relates to the patient’s physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The patient’s respirations are slow and shallow, but there is no evidence of congestion.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-20, 58 (Table 22-1) | Page 22-69 (Table 22-5)

TOP: Nursing Process: Planning/Outcomes Identification

MSC: Client Needs: Physiological Integrity a. “Alcoholism is a lifelong disease. Relapses are expected.” b. “Use search and destroy tactics to keep the home alcohol free.” c. “It’s important that you visit your family member on a regular basis.” d. “Make your loved one responsible for the consequences of behavior.”

20. Family members of an individual undergoing a residential alcohol rehabilitation program ask, “How can we help?” Select the nurse’s best response.

ANS: D

Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviors or are of no help.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 39, 69 (Table 22-5),

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. Learn about addiction and recovery. b. Develop alternate coping strategies. c. Develop a peer support system. d. Achieve physiological stability.

21. Which goal for treatment of alcohol use disorder should the nurse address first?

ANS: D

The individual must have completed withdrawal and achieved physiological stability before he or she is able to address any of the other treatment goals.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 40

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Physiological Integrity a. 1-week detoxification program b. Long-term outpatient therapy c. 12-step self-help program d. Residential program

22. A patient diagnosed with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate?

ANS: D

Residential programs and therapeutic communities help patients change lifestyles, abstain from drugs, eliminate criminal behaviors, develop employment skills, become self-reliant, and practice honesty. Residential programs are more effective for patients with antisocial tendencies than outpatient programs.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-20, 21, 48, 49 TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.

23. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines.

ANS: A

An overdose of stimulants, such as amphetamines, can produce respiratory and circulatory dysfunction as well as hyperthermia. Concentration is impaired. This patient will be hypervigilant; it is not necessary to awaken the patient.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 22-58 (Table 22-1) | Pages 22-39, 69 (Table 22-5), 74 (Box 22-2)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

24. Symptoms of withdrawal from opioids for which the nurse should assess include a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.

ANS: B

The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 22-58 (Table 22-1) | Pages 22-39, 69 (Table 22-5), 73 (Box 22-1)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

25. A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes a. cross-tolerance. b. substance abuse. c. substance addiction. d. substance intoxication.

ANS: C

Nicotine meets the criteria for a “substance,” the criterion for addiction is present, and withdrawal symptoms are noted with abstinence or reduction of dose. The scenario does not meet criteria for substance abuse, intoxication, or cross-tolerance.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 22-5 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speech

26. Which assessment findings are likely for an individual who recently injected heroin?

ANS: D

Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-19, 58 (Table 22-1), 73 (Box 22-1)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

27. An adult in the emergency department states, “Everything I see appears to be waving. I am outside my body looking at myself. I think I’m losing my mind.” Vital signs are slightly elevated. The nurse should suspect a. a schizophrenic episode. b. hallucinogen ingestion. c. opium intoxication. d. cocaine overdose.

ANS: B

The patient who is high on a hallucinogen often experiences synesthesia (visions in sound), depersonalization, and concerns about going “crazy.” Synesthesia is not common in schizophrenia. CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviors. Phencyclidine (PCP) use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-16, 58 (Table 22-1) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Substance Abuse and Mental Health Services Administration (SAMHSA) b. Institute of Medicine (IOM)–National Research Council c. National Council of State Boards of Nursing (NCSBN) d. American Society of Addictions Medicine

28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information?

ANS: A

The SAMHSA is the official resource for comprehensive information regarding addictions. The other resources have relevant information, but they are not as comprehensive.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 22-2, 3 TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. PCP b. Heroin c. Barbiturates d. Amphetamines

29. A patient is thin, tense, jittery, and has dilated pupils. The patient says, “My heart is pounding in my chest. I need help.” The patient allows vital signs to be taken but then becomes suspicious and says, “You could be trying to kill me.” The patient refuses further examination. Abuse of which substance is most likely?

ANS: D

The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behavior. Barbiturates and heroin would result in symptoms of CNS depression.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 22-58 (Table 22-1) | Pages 22-39, 69 (Table 22-5), 74 (Box 22-2)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

30. Select the priority outcome for a patient completing the fourth alcohol detoxification program in the past year. Prior to discharge, the patient will a. state, “I know I need long-term treatment.” b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.

ANS: A

The correct response recognizes the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not give enough information to determine whether anger has been identified as a problem. A trusting relationship, while desirable, should have occurred earlier in treatment.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-5, 33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 40, 51

TOP: Nursing Process: Planning/Outcomes Identification

MSC: Client Needs: Psychosocial Integrity a. Perform a thorough assessment of the patient. b. Verify that security services are immediately available. c. Self-assess personal attitude, values, and beliefs about this health problem. d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

31. A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse’s best first action?

ANS: C

The nurse should show compassion, care, and helpfulness for all patients, including those with addictive diseases. It is important to have a clear understanding of one’s own perspective. Negative feelings may occur for the nurse; supervision is an important resource. The activities identified in the distracters occur after self-assessment.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 38

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A patient undergoing alcohol rehabilitation decides to begin disulfiram therapy. Patient teaching should include the need to (Select all that apply) a. avoid aged cheeses. b. avoid alcohol-based skin products. c. read labels of all liquid medications.