Chapter 26: Clients With Substance Abuse Disorders

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 26: Clients with Substance Abuse Disorders
MULTIPLE CHOICE
1. The theory that describes substance abuse as a learned behavior is called the
a. psychological model.
b. biologic model.
c. family system model.
d. sociocultural model.
ANS: a
The psychological model suggests that persons have learned the addictive behavior and that they
can learn not to be addicted.
DIF: Cognitive Level: Comprehension REF: Text Reference: 539

TOP: Nursing Process Step: N/A
MSC: NCLEX: N/A
2. A client who was admitted 2 days ago for assessment after a fall in his home has become
increasingly irritable and now says there are bugs on his bed. He is diaphorectic and has a
temperature of 100.2° F. The nurse assesses
a. alcohol-induced psychosis.
b. delirium tremens.
c. neurologic injury related to the fall.
d. Post-traumatic stress reaction.
ANS: b
During the 2 days after cessation of alcohol, clients may experience delirium tremens (DTs), as
evidenced by disorientation, nightmares, abdominal pain, nausea, and diaphoresis, as well as
elevated temperature, pulse, and blood pressure and visual and auditory hallucinations.
DIF: Cognitive Level: Application REF: Text Reference: 545

TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
3. To prevent a severe withdrawal reaction from alcohol, the nurse explains that the use of the
drugs from the benzodiazepine group are given because these agents
a. Raise the blood pressure.
b. cause less nausea and vomiting.
c. cause less respiratory depression.
d. inhibit the urge to drink.
ANS: c
Chapter 26: Clients with Substance Abuse Disorders 2
The benzodiazepines are often used because these drugs cause less respiratory depression and
hypertension.
DIF: Cognitive Level: Analysis REF: Text Reference: 545

TOP: Nursing Process Step: Intervention
4. For a client experiencing alcohol withdrawal, the action that the nurse would include in the
client’s plan of care is to
a. maintain a dark, quiet room.
b. encourage the client to watch television or listen to the radio.
c. encourage significant others to sit and talk with the client.
d. explain all procedures to the client in a calm manner.
ANS: d
The major nursing interventions for a client experiencing withdrawal focus on continuous
monitoring of clinical manifestations and promoting a safe, calm, and comfortable environment.

MSC: NCLEX: Psychosocial Integrity
5. The assessment by the nurse that would be significant to help prevent a complication from
amphetamine use is to
a. Keep the lights on continuously.
b. measure intake and output.
c. perform neurologic assessments.
d. check oxygen levels frequently.
ANS: c
The nurse should closely monitor the client taking amphetamines for changes in cardiac or
neurologic status, since myocardial infarction and cerebral hemorrhage have occurred from
amphetamine use.

6. The nurse reminds the client that in the United States, the most widely used psychoactive
substance is
a. marijuana.
b. alcohol.
c. amphetamines.
d. caffeine.
ANS: d
The most frequently used psychoactive substance in the United States is caffeine.
Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 546

MSC: NCLEX: Health Promotion and Maintenance
7. The nurse evaluates that the client has learned an important fact about cocaine use when he
says
a. “Cocaine is not addictive. I can use it as a recreational drug.”
b. “Cocaine withdrawal is relatively easy. There is only mild fatigue.”
c. “Since cocaine is a depressant, one should not drive under its influence.”
d. “I know a young person can have a heart attack from using cocaine.”
ANS: d
Cocaine is a stimulant and can cause myocardial infarction in young people. Cocaine is highly
addictive, and withdrawal results in excessive exhaustion or “crashing.”

TOP: Nursing Process Step: Evaluation
8. A young man is brought to the emergency department with nausea, vomiting, cramps,
diarrhea, diaphoresis, and incapacitating tremors. Routine interview and physical assessment
show blood pressure and temperature in the high normal range and respirations of 20. The
nurse notes that the hair on the client’s arms is raised and that his nose is running. The nurse
would introduce an appropriate approach with the statement
a. “Have you been to Mexico in the last 2 days?”
b. “Have you ever used cocaine?”
c. “Do you take amphetamines or ‘uppers’?”
d. “Are you using any opioids such as heroin?”
ANS: d
The essentially normal physical findings and the severity of the manifestations rule out an
infectious disease and allergy. The classic manifestations of opioid withdrawal, which occur
about 72 hours after the last dose, should alert the nurse to possible drug abuse.

9. During history taking, a client tells the nurse that he is addicted to caffeine and that he drinks
10 to 12 cups of coffee a day as well as several cola drinks and iced tea. The nurse would
warn the client that during his NPO status for surgery, he should expect to experience
a. euphoria.
b. diarrhea.
c. itching.
d. headache.
ANS: d
Headache is a major withdrawal manifestation of caffeine.


10. The school nurse is called into an art class by the teacher to observe a student who is smiling
and giggling as he sprays fixative on his charcoal picture. The student’s eyes and nose are
red, and he is coughing. The school nurse assesses that the student may be experiencing
a. an allergic reaction.
b. a seasonal cold.
c. use of an opioid.
d. inhalant abuse.
ANS: d
Manifestations of inhalant abuse are euphoria, red nose and mouth, and coughing. Common
solvents are glue, paint thinner, and aerosols.

11. When the school nurse hears a student conversation that is centered on “having some hog,”
the nurse knows the students are referring to
a. going on a cigarette break.
b. inhaling nitrous oxide.
c. injecting heroin.
d. taking phencyclidine (PCP).
ANS: d
“Hog” is the street name for PCP.
DIF: Cognitive Level: Application REF: Text Reference: 542, Table 26-2;
12. The nurse explains that disorienting flashbacks may be experienced by a client under the
influence of
a. alcohol.
b. cocaine.
c. heroin.
d. LSD.
ANS: d
Suicide, homicide, and other acts of violence have been reported in persons under the influence
of hallucinogenic drugs, such as lysergic acid diethylamide (LSD). Some users also experience
flashbacks.


13. The nurse recognizes a potential health threat to an alcoholic client who is using the drug
disulfiram (Antabuse) when the nurse reads in the health record that the client is also taking
a. Coumadin.
b. daily doses of Milk of Magnesia.
c. penicillin.
d. Benadryl tablets.
ANS: a
Antabuse increases the effect of anticoagulants such as warfarin (Coumadin).
DIF: Cognitive Level: Analysis REF: Text Reference: 552, Table 26-5;
MSC: NCLEX: Safe, Effective Care Environment;
14. The client who enters the emergency department with a sedative overdose can be lavaged if
the ingestion was no more than
a. 30 minutes ago.
b. 60 minutes ago.
c. 2 hours ago.
d. 6 hours ago.
ANS: d
Lavage for the treatment of a sedative overdose is an option if the drug was ingested no more
than 6 hours earlier.

15. A client taking the drug ReVia for alcohol abuse tells the nurse that he wants to join AA as an
added support for his recovery. The nurses’s best response would be
a. “That’s sounds like a very good idea. Shall we try to locate a chapter near you?”
b. “AA has been able to help many people stay sober, but it does require that you
have a sponsor. Do you know of someone who is a member?”
c. “Although AA is a support toward sobriety, the fact that you are presently taking
ReVia would probably make you ineligible for membership.”
d. “Joining AA is going to involve your family to some degree. Have you discussed
your plans with them?”
ANS: c
At present, Alcoholics Anonymous (AA) philosophy maintains that its members must be “drug
free” and practice total abstinence.


16. The nurse teaching a client taking disulfiram (Antabuse) should focus on
a. emotional support for the family.
b. abstaining from alcohol ingestion.
c. daily exercise.
d. skin care.
ANS: b
Instruct the client taking disulfiram not to ingest any alcohol or use any products containing
alcohol for 12 hours before taking Antabuse, while taking Antabuse, and for at least 14 days after
discontinuing Antabuse.
DIF: Cognitive Level: Comprehension REF: Text Reference: 552, Box 26-5;

Chapter 26: Clients With Substance Abuse Disorders

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What are some nursing interventions for a client experiencing alcohol withdrawal?

What are some nursing interventions for a client experiencing alcohol withdrawal?

What are some common signs and symptoms of alcohol withdrawal?

What are some common signs and symptoms of alcohol withdrawal?

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 26: Clients with Substance Abuse Disorders

DIF: Cognitive Level: Comprehension REF: Text Reference: 539

DIF: Cognitive Level: Application REF: Text Reference: 545

DIF: Cognitive Level: Analysis REF: Text Reference: 545

DIF: Cognitive Level: Application REF: Text Reference: 543

DIF: Cognitive Level: Application REF: Text Reference: 546

Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 546

DIF: Cognitive Level: Application REF: Text Reference: 547

DIF: Cognitive Level: Analysis REF: Text Reference: 549

Elsevier items and derived items Ó 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 547

DIF: Cognitive Level: Application REF: Text Reference: 548

DIF: Cognitive Level: Knowledge REF: Text Reference: 548

Elsevier items and derived items Ó 2005 by Elsevier Inc.

TOP: Nursing Process Step: Intervention

DIF: Cognitive Level: Knowledge REF: Text Reference: 549

DIF: Cognitive Level: Analysis REF: Text Reference: 546

Elsevier items and derived items Ó 2005 by Elsevier Inc.

MSC: NCLEX: Health Promotion and Maintenance

Elsevier items and derived items Ó 2005 by Elsevier Inc.

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