Chapter 28: Substance-Related Disorders

Morrison-Valfre: Foundations of Mental Health Care, 7th Edition

Multiple Choice

1. Abused substances are those chemicals that alter the person’s perception by affecting the: a. central nervous system. b. autonomic nervous system. c. cardiorespiratory system. d. peripheral nervous system.

ANS: A

Abused substances are chemicals that affect the central nervous system (CNS). They often enhance or depress moods or emotions.

DIF: Cognitive Level: Knowledge REF: p. 329

OBJ: 1

TOP: Definition of Terms KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

2. Children who are smaller at birth, have small heads (microcephaly), and fail to develop normally have characteristics of: a. parents who smoke. b. fetal alcohol syndrome. c. fetal alcohol intoxication. d. fetal accumulation syndrome.

ANS: B

These are some of the effects of fetal alcohol syndrome, which occurs with excessive alcohol use during pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 329

OBJ: 2

TOP: Drugs in Pregnancy KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

3. With children younger than 12 years of age, drug abuse: a. does not exist. b. is never a problem. c. occurs infrequently. d. occurs more often than is suspected.

ANS: D

The number of admissions of children younger than 12 to substance treatment units is increasing.

DIF: Cognitive Level: Comprehension REF: p. 330

OBJ: 2

TOP: Substance Use and Age KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

4. The drug most often abused by adolescents is: a. alcohol. b. cocaine. c. tobacco. d. marijuana.

ANS: A

Alcohol is the most frequently abused drug among adolescents.

DIF: Cognitive Level: Knowledge REF: p. 330 OBJ: 2

TOP: Substance Use and Age KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Clarity of mind b. Suicidal wishes c. Concurrent substance use d. Using someone else’s medications

5. The client has frequent drug reactions to, and side effects from, his medications. He is 72 years old and lives alone. What should he be assessed for?

ANS: C

More than 40% of all drug reactions occur in persons older than 65, which suggests the possibility of substance abuse.

DIF: Cognitive Level: Comprehension REF: p. 330 OBJ: 2

TOP: Substance Use and Age KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

6. The main active ingredient in coffee, black teas, most cola drinks, and many other bottled beverages that stimulates the nervous system, relieves fatigue, increases alertness, and increases the body’s metabolic rate is: a. alcohol. b. cocaine. c. caffeine. d. amphetamines.

ANS: C

Caffeine is the main active ingredient in coffee, black teas, most cola drinks, and many other bottled beverages.

DIF: Cognitive Level: Knowledge REF: p. 332 OBJ: 4

TOP: Chemicals of Abuse KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity a. The early stage b. The middle stage c. The late stage d. The chronic stage

7. One begins to prefer being high to other activities during which stage of addiction?

ANS: A

These behaviors are typically seen in the early stage of addiction. Tolerance to the substance develops in the middle stage. The late stage is also known as the chronic stage, in which the need for the substance causes loss of control over one’s behavior.

DIF: Cognitive Level: Knowledge REF: p. 337 OBJ: 6

TOP: Stages of Addiction KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

8. Significant complications such as sudden death due to cardiac dysrhythmia or respiratory depression are associated with the use of: a. alcohol. b. cocaine. c. inhalants. d. hallucinogens.

ANS: C

Significant complications of inhalant use include sudden death caused by cardiac dysrhythmia and respiratory depression. Inhalant use is most prevalent in adolescents and young adults.

DIF: Cognitive Level: Knowledge REF: p. 333 OBJ: 5

TOP: Inhalants KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

9. For a substance-related disorder to be diagnosed, the pattern of substance use must lead to: a. significant costs involved with the habit. b. significant disturbances in social functioning. c. significantly impaired functioning and distress. d. significant physical changes related to the abused substance.

ANS: C

The pattern of substance use must be disabling and must lead to significantly impaired functioning and distress. The person must demonstrate signs of tolerance, withdrawal, and dependence.

DIF: Cognitive Level: Comprehension REF: p. 338 OBJ: 7

TOP: Criteria for Diagnosis KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

10. Before treatment of an addiction can actually begin, many persons first must go through the process of removing the substance from their bodies under medical supervision. This is known as: a. abstinence. b. withdrawal. c. detoxification. d. intoxication.

ANS: C

Before treatment actually can begin, many persons first must go through detoxification, the process of withdrawing from a substance under medical supervision. Abstinence refers to not engaging in an activity; withdrawal refers to the signs and symptoms experienced when an individual stops taking a substance that he or she is dependent on; and intoxication is a state of behavioral or psychological change that results from exposure to a chemical.

DIF: Cognitive Level: Knowledge REF: p. 340 OBJ: 9

TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

11. A drug that is taken daily to help reduce the desire for alcohol is: a. hydroxyzine (Atarax). b. disulfiram (Antabuse). c. methadone (Dolophine). d. meclizine (Antivert).

ANS: B

Disulfiram (Antabuse) is a medication that is taken daily by recovering alcoholics because it causes a very unpleasant physical reaction when combined with alcohol.

DIF: Cognitive Level: Knowledge REF: p. 340 OBJ: 9

TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention

MSC: Client Needs: Physiological Integrity

12. Typical central nervous system responses when an individual has drunk five or more alcoholic beverages or has a blood alcohol content of 0.20% within a 4-hour period include: a. thought, restraint, reaction time, and judgment are slowed, and the individual usually is more at ease socially. b. the entire motor area of the brain is depressed; the individual is staggering, easily angered, and emotional and feels fatigued. c. comatose; the medullary area of the brain is severely depressed, and respiratory failure can result in death. d. confused, unresponsive to most external stimuli; loss of ability to control involuntary responses and decreased vital signs.

ANS: B

These responses can vary somewhat among individuals. Slowed reaction time usually is seen with one or two drinks or with a blood alcohol content of 0.05%; a comatose state occurs with seven or more drinks or 0.40% to 0.50% alcohol blood content; and confusion and unresponsiveness to most external stimuli occur with six to seven drinks or a blood alcohol content of 0.30%.

DIF: Cognitive Level: Application REF: p. 332 | Table 28.1

OBJ: 4 TOP: Chemicals of Abuse

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity a. Heroin b. Opioids c. Cocaine d. Crack

13. is a processed stimulant that reaches the brain immediately and produces an intense but short-lived high.

ANS: D

Crack is a processed cocaine that is extremely addicting because of the immediate high it produces. Cocaine is a natural stimulant. Heroin is an opioid, which is a central nervous system depressant.

DIF: Cognitive Level: Knowledge REF: p. 335 OBJ: 4

TOP: Chemicals of Abuse KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

14. A male client takes ibuprofen twice a day, every day, for his arthritis. He becomes very anxious when he does not take his normal doses. This client is experiencing: a. physical tolerance. b. substance dependency. c. psychological tolerance. d. early-stage addiction.

ANS: C

Because ibuprofen is not a chemical that causes physical dependency, this client is experiencing psychological tolerance. Physical tolerance occurs when an individual’s body has adjusted to living and functioning with the substance in the system; substance dependency refers to the need to take a substance to prevent withdrawal symptoms; and early-stage addiction is characterized by an individual who is enjoying the effects of the substance.

DIF: Cognitive Level: Application REF: p. 338 OBJ: 6

TOP: Stages of Addiction KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Alcohol b. Heroin c. Cocaine d. Analgesics

15. The nurse assessing a newborn shortly after delivery notes that the infant is very jittery, irritable, and has a high-pitched cry. The nurse suspects that the mother took which substance during pregnancy?

ANS: C

Infants who were exposed to cocaine in utero have sleeping and eating problems, unusual levels of irritability, and high-pitched cries.

DIF: Cognitive Level: Application REF: p. 329 OBJ: 2

TOP: Substance Use and Age KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Ibuprofen b. Penicillin c. Ritalin d. Valium

16. The school nurse reports that a student who was brought to her appears to be tense and angry, and her speech is rapid. She denies use of illegal substances. What does the nurse suspect the student has ingested?

ANS: C

A recent study has shown that 1 in 5 adolescents have abused prescription drugs. Tension, anger, and rapid speech are common to use of stimulants such as diet pills, amphetamines, and Ritalin.

DIF: Cognitive Level: Application REF: p. 337 OBJ: 2

TOP: Substance Use and Age KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. The anorexic adolescent suffering from depression b. The school-age child suffering from a learning disorder and asthma c. The older adult suffering from hypertension and diabetes d. The young adult suffering from psychosis who smokes marijuana regularly

17. Which of the following persons is said to have a dual diagnosis?

ANS: D

People with serious mental illness who also are addicted to or use chemicals are said to have a dual diagnosis. It is estimated that as many as 75% of the mentally ill population have a dual diagnosis.

DIF: Cognitive Level: Application REF: p. 331 OBJ: 1

TOP: Scope of the Problem Today KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Al-Anon b. Alcoholics Anonymous c. Families Anonymous d. Narcotics Anonymous

18. The family of a 35-year-old alcoholic who refuses to seek treatment reaches out to the community health center for assistance. Which organization should the nurse refer them to for counseling?

ANS: A

It is important to provide support for the family and refer them to group counseling. Al-Anon is a self-help group for families of alcoholics. Alcoholics Anonymous is a self-help group for alcoholics. Families Anonymous is a self-help group for parents, relatives, and friends of drug addicts, and Narcotics Anonymous is a self-help group for individuals recovering from drug abuse.

DIF: Cognitive Level: Application REF: p. 340 | Box 28.2

OBJ: 9 TOP: Self-Help Groups for Recovering Abusers

KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. The breathing in of volatile substances has become popular with adolescents and young adults because such inhalants are: (Select all that apply.)

a. legal.

b. illegal.

c. harmless.

d. expensive.

e. inexpensive.

f. easily obtained.

g. undetectable in the body.

ANS: A, E, F

Reasons that adolescents and young adults abuse inhalants include the legality of the substances, their inexpensiveness, and how easily they can be obtained.

DIF: Cognitive Level: Comprehension REF: p. 333 OBJ: 5

TOP: Inhalants KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Watery eyes b. Constricted pupils c. Clammy skin d. Drowsiness e. Euphoria f. Sweating

2. Which are signs and symptoms most commonly associated with heroin use? (Select all that apply.)

ANS: B, D, E

These are common signs and symptoms of heroin use. Watery eyes and sweating are characteristic of heroin withdrawal, and clammy skin is seen most commonly with heroin overdose.

DIF: Cognitive Level: Knowledge REF: p. 335 | Table 28.3

OBJ: 4 TOP: Categories of Abused Substances

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity a. High blood pressure b. Headache c. Blurred vision d. Nausea e. Double vision f. Vomiting g. Chills

3. It is important for the nurse to ensure that the client understands the physical reactions associated with drinking alcohol while taking disulfiram (Antabuse). Which of the following are reactions that may result from ingesting alcohol while taking Antabuse? (Select all that apply.)

ANS: B, C, D, F

Headache, blurred vision, nausea, and vomiting occur with concomitant use of alcohol and Antabuse. Additional reactions include flushing and low blood pressure.

DIF: Cognitive Level: Knowledge

REF: p. 340

OBJ: 9

TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention

MSC: Client Needs: Physiological Integrity