Chapter 17: Substance Abuse

Test Bank

MULTIPLE CHOICE

1. A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels
strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which
statement by the nurse is correct?
a. “It’s possible that these cravings will never stop.”
b. “These cravings may persist for several months.”
c. “The cravings tell us that you are still using nicotine.”
d. “The cravings show that you are about to experience nicotine withdrawal.”
ANS: B
Cigarette cravings may persist for months after nicotine withdrawal. The other statements are
false.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 289

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms.

The nurse expects to administer which drug as part of the treatment?
a. diazepam (Valium)
b. methadone
c. disulfiram (Antabuse)
d. bupropion (Zyban)
ANS: B
Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam
and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with
smoking cessation.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 283

TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin.
The nurse expects that the naltrexone will have which therapeutic effect for this patient?
a. Naltrexone prevents the cravings for opioid drugs.
b. Naltrexone works as a safer substitute for the heroin until the patient completes
withdrawal.
c. The patient will experience flushing, sweating, and severe nausea if he takes
heroin while on naltrexone.
d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus,
the opioid’s desired effects are lost.
ANS: D
Naltrexone works to eliminate the euphoria that occurs with opioid drug use; therefore, the
reinforcing effect of the drug is lost.
 DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 284
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is presenting a substance-abuse lecture for teenage girls and is asked about
“roofies.” The nurse recognizes that this is the slang term for which substance?
a. cocaine
b. flunitrazepam
c. secobarbital
d. methamphetamine
ANS: B
Flunitrazepam is a benzodiazepine that has recently gained popularity as a recreational drug
and is commonly called roofies (the “date-rape” drug). The other drugs are not known as
roofies.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 286

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

5. A 29-year-old male patient is admitted to the intensive care unit with the following symptoms:
restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria,
tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking
which substance?
a. Opioids
b. Alcohol
c. Stimulants
d. Depressants
ANS: C
The adverse effects listed may occur with use of stimulants and are commonly an extension of
their therapeutic effects. Opioids, alcohol, and depressants do not have these effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 285

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will
keep in mind that chronic use of alcohol might result in which condition?
a. Renal failure
b. Cerebrovascular accident
c. Korsakoff’s psychosis
d. Alzheimer’s disease
ANS: C
A variety of serious neurologic and mental disorders, such as Korsakoff’s psychosis and
Wernicke’s encephalopathy, as well as cirrhosis of the liver, may occur with chronic use of
alcohol. Renal failure, cerebrovascular accident, and Alzheimer’s disease are not associated
directly with chronic use of alcohol.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 287

TOP: NURSING PROCESS: Assessment
 MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will
include which information when teaching him about disulfiram (Antabuse) therapy?
a. He should not smoke cigarettes while on this drug.
b. He needs to know about the common over-the-counter substances that contain
alcohol.
c. This drug will cause the same effects as the alcohol did, without the euphoric
effects.
d. Mouthwashes and cough medicines that contain alcohol are safe because they are
used in small amounts.
ANS: B
The use of disulfiram (Antabuse) with alcohol-containing over-the-counter products will elicit
severe adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive
person. Cigarette smoking does not cause problems when taking disulfiram. Disulfiram does
not have the same effects as alcohol.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 288

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is conducting a smoking-cessation program. Which statement regarding drugs used
in cigarette-smoking–cessation programs is true?
a. Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
b. Quick relief from withdrawal symptoms is most easily achieved by using a
transdermal patch.
c. Compliance with treatment is higher with use of the gum rather than the
transdermal patch.
d. The nicotine gum can be used only up to six times per day.
ANS: A
Quick or acute relief from withdrawal symptoms is most easily achieved with the use of the
gum, because rapid chewing of the gum produces an immediate dose of nicotine. However,
treatment compliance is higher with the use of the transdermal patch system. Nicotine gum
can be used whenever the patient has a strong urge to smoke.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 289

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of
a smoking-cessation program. Which teaching points are appropriate for a patient taking this
medication? (Select all that apply.)
a. This drug is available as a chewing gum that can be taken to reduce cravings.
b. Use caution when driving because drowsiness may be a problem.
c. There have been very few adverse effects reported for this drug.
d. Notify the prescriber immediately if feelings of sadness or thoughts of suicide
occur.
 e. Avoid caffeine while on this drug.
ANS: B, D
Patients taking varenicline have reported drowsiness, which has prompted the FDA to
recommend caution when driving and engaging in other potentially hazardous activities until
the patient can determine how the drug affects his or her mental status. In addition, the FDA
has warned about psychiatric symptoms including agitation, depression, and suicidality.
Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache,
and insomnia. There are no cautions about taking caffeine while on this drug.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 290

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

2. A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However,
this evening, he attended a party and drank half a beer. As a result, he became ill and his
friends took him to the emergency department. The nurse will look for which adverse effects
associated with acetaldehyde syndrome? (Select all that apply.)
a. Euphoria
b. Severe vomiting
c. Diarrhea
d. Pulsating headache
e. Difficulty breathing
f. Sweating
ANS: B, D, E, F
Acetaldehyde syndrome results when alcohol is taken while on disulfiram (Antabuse) therapy.
Adverse effects include CNS effects (pulsating headache, sweating, marked uneasiness,
weakness, vertigo, others); GI effects (nausea, copious vomiting, thirst); and difficulty
breathing. Cardiovascular effects also occur; see Table 17-2. Euphoria and diarrhea are not
adverse effects associated with acetaldehyde syndrome.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 288

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are
signs and symptoms of severe ethanol withdrawal? (Select all that apply.)
a. Agitation
b. Drowsiness
c. Tremors
d. Systolic blood pressure higher than 200 mm Hg
e. Temperature over 100° F (37.7° C)
f. Pulse rate 110 beats/minute
ANS: A, C, D
Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood
pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate
higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and
agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 288

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation