Chapter 48: Substance Abuse

Chapter 48: Substance Abuse

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A 16-year-old male has been referred to the community mental health center following legal charges of driving under the influence. Which screening tests would be appropriate to use on this patient?

ANS:  B

The adolescent patient has legal problems associated with alcohol use. The AAIS screening instrument would be appropriate to use. DAST is a comprehensive screening and assessment instrument. ADAD is an adolescent drug abuse diagnosis instrument. MMPI is a personality inventory.

DIF:    Cognitive Level: Comprehension     REF:   Page 777        OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Psychosocial Integrity

NOT:  CONCEPT(S): Clinical Judgment; Addiction

2. A patient admitted 48 hours ago has a diagnosis of gastrointestinal (GI) bleeding and is receiving IV hydration and transfusions. When making rounds, the nurse observes the patient to be having a tonic-clonic seizure. What may be the cause of the seizure?

ANS:  B

Alcohol withdrawal symptoms can begin within a few hours of discontinuation of drinking and may continue for 3 to 10 days. Withdrawal symptoms may be severe and include visual and auditory hallucinations and tonic-clonic seizures. The patient’s admitting diagnosis, GI bleeding, may be associated with alcohol abuse. Denial is a common symptom associated with alcoholism, and the patient may not have been honest about alcohol intake when the health care provider took the history on admission. History may be obtained from the patient’s family or significant other. It is unlikely that the blood loss is significant enough to induce seizures. Alkalosis is not likely the cause of seizures in this case; the patient is more likely to be acidotic from the combined dehydration and withdrawal. Common causes in the setting of alcohol withdrawal include alcoholic ketoacidosis and ingestion of alcohols or medications that result in metabolic acidosis (e.g., methanol, ethylene glycol, salicylate). Inadequate nutrition is not likely to cause seizures in this patient.

DIF:    Cognitive Level: Application           REF:   Page 780        OBJ:   5

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Psychosocial Integrity

NOT:  CONCEPT(S): Clinical Judgment; Addiction

3. A nurse working the night shift suspects that a colleague is abusing alcohol. Which action by the nurse is most important?

ANS:  D

In some states, when substance abuse of a colleague is suspected, reporting is mandatory. Professionals must be loyal to their patients and protect them from harm. “Good faith” reporting should not be viewed as disloyalty to a colleague. Licenses are often not revoked when a colleague self-reports or is reported for substance abuse. Health professionals may be named in a civil lawsuit if they fail to report suspected impairment of another professional.

DIF:    Cognitive Level: Analysis                REF:   Page 778        OBJ:   3

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

NOT:  CONCEPT(S): Clinical Judgment; Addiction; Health Care Law

4. What does a urinalysis that is positive for the drug tested indicate?

ANS:  D

Positive urinalysis simply indicates the presence of the drug being tested for in the urine specimen. The person may have a prescription for a substance found in the urine or may have been accidentally dosed with it. Presence of the substance in the urine does not indicate dependence because the person may only be an episodic user of the substance. Asking for the person’s permission to collect a specimen and examine it does not violate the person’s constitutional rights. The Supreme Court has ruled that drug screening does not violate one’s constitutional right to privacy or represent an unreasonable search.

DIF:    Cognitive Level: Comprehension     REF:   Page 779        OBJ:   N/A

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Addiction