Chapter 50: Substance Abuse

Chapter 50: Substance Abuse

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. At an annual well-woman examination, the primary care nurse practitioner (NP) asks a patient about alcohol consumption. The woman reports she usually consumes six glasses of wine per week and occasionally will consume three or four glasses at a party. The NP smells alcohol on the woman’s breath. The woman says she is hung over today. The NP should:

ANS:  B

Patients with alcohol on their breath should be assessed for alcohol abuse. The woman describes an amount of drinking that would put her at low risk, but alcoholics often minimize their drinking. A first step would be to get more information about how much she is drinking. The laboratory work may be indicated when the degree of suspicion is confirmed. Once alcoholism is diagnosed, she should be referred for treatment.

DIF:    Cognitive Level: Applying (Application)                           REF:   566

2. A mother brings her a college-age son to the primary care NP and asks the NP to talk to him about alcohol use. He reports binge drinking on occasion and drinking only beer on weekends. The NP notes diaphoresis, tachycardia, and an easy startle reflex. The NP should:

ANS:  A

He is showing signs of alcohol withdrawal and possible delirium tremens and so should be admitted to the hospital. Asking him about drinking and suggesting outpatient counseling would be useful for a less emergent condition. The NP should not prescribe a medication to treat delirium tremens on an outpatient basis.

DIF:    Cognitive Level: Applying (Application)                           REF:   566

3. A patient who is an alcoholic is seen in the clinic, and the primary care NP admits the patient to the hospital for acute withdrawal. The patient has elevated liver enzymes. The NP should expect the inpatient provider to prescribe:

ANS:  A

Benzodiazepines are used to treat alcohol withdrawal because they demonstrate cross-tolerance with alcohol. Short-acting benzodiazepines are used in patients with liver damage. Lorazepam is a short-acting benzodiazepine. Acamprosate is used to reduce voluntary intake of alcohol and is not used for withdrawal symptoms.

DIF:    Cognitive Level: Applying (Application)                           REF:   566

4. A patient is brought to the clinic by a spouse because of increased somnolence and disorientation. The spouse tells the primary care NP that the patient has been taking oxycodone for postoperative pain. The NP notes a respiratory rate of 8 to 10 breaths per minute. The NP should:

ANS:  C

The patient shows signs of opiate toxicity. Naltrexone is given to reverse the respiratory depression caused by opiate toxicity. The NP would activate EMS if the patient’s symptoms worsen. Methadone is used to assist patients addicted to narcotics to withdraw from the drug. Buprenorphine is used to aid with withdrawal symptoms.

DIF:    Cognitive Level: Applying (Application)                           REF:   568