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d. wear sunscreen and avoid bright sunlight.

e. maintain an adequate dietary intake of sodium.

f. avoid breathing fumes of paints, stains, and stripping compounds.

ANS: B, C, F

The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions. The other options do not relate to hidden sources of alcohol.

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

REF: Page 22-72 (Table 22-16) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

2. The nurse can assist a patient to prevent substance abuse relapse by (Select all that apply) a. rehearsing techniques to handle anticipated stressful situations. b. advising the patient to accept residential treatment if relapse occurs. c. assisting the patient to identify life skills needed for effective coping. d. advising isolating self from significant others until sobriety is established. e. informing the patient of physical changes to expect as the body adapts to functioning without substances.

ANS: A, C, E

Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals. Anticipatory problem solving and role playing are good ways of rehearsing effective strategies for handling stressful situations and helping the patient evaluate the usefulness of new strategies. The nurse can provide valuable information about physiological changes expected and ways to cope with these changes. Residential treatment is not usually necessary after relapse. Patients need the support of friends and family to establish and maintain sobriety.

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

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 40, 42, 43

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. Refer the nurse to a peer assistance program. b. Confront the nurse in the presence of a witness. c. Immediately terminate the nurse’s employment. d. Relieve the nurse of responsibilities for patient care. e. Require the nurse to undergo immediate drug testing.

3. After discovering discrepancies and missing controlled substances, the nursing supervisor determines that a valued, experienced staff nurse is responsible. Which actions should the nursing supervisor take? (Select all that apply.)

ANS: A, D

Registered nurses may have personal substance use problems. The nursing supervisor should provide for safe patient care by relieving the nurse of responsibility for patient care. For those nurses experiencing addictions, there are nonpunitive alternatives to discipline programs in the form of peer assistance. Many state boards of nursing have developed an alternative to discipline program to help impaired nurses. Terminating the nurse’s employment and confronting the nurse in the presence of a witness are punitive actions. The peer assistance program will manage drug testing.

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

REF: Page 22-38 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. “I see,” and use interested silence. b. “I think you are drinking more than you report.” c. “Social drinkers have one or two drinks, once or twice a week.” d. “You describe drinking steadily throughout the day and evening.” e. “Your comments show denial of the seriousness of your problem.”

4. A new patient beginning an alcohol rehabilitation program says, “I’m just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening.” Which responses by the nurse will be most therapeutic? (Select all that apply.)

ANS: C, D

The correct answers give information, summarize, and validate what the patient reported but are not strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program.

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

REF: Pages 22-33 (Case Study and Nursing Care Plan, Alcohol Use Disorder), 41, 42

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