Alcohol, Tobacco, and Other Drug Problems in the Community

1. Which of the following approaches has research suggested is the most effective way to approach drug addiction?

a.
Criminal justice system
b.
Harm reduction
c.
Punishment approach
d.
Substance abuse education

ANS: B

The harm reduction model is a health care approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 434

2. A woman has just delivered a baby and is lamenting that the baby’s father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, “It’s so sad. He’s clearly no good.” Which of the following would be the best response by the nurse?

a.
“I’m so sorry to hear that. Is your mother able to be with you?”
b.
“It’s good that you and the baby are safe from him.”
c.
“Is there anyone to help you with the baby until the baby’s father can be released and encouraged to get treatment for his addiction?”
d.
“You must hate him for leaving you alone with a new baby!”

ANS: C

The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 435

3. A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing?

a.
Drug abuse
b.
Drug addiction
c.
Drug dependence
d.
Substance abuse

ANS: C

Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful.

DIF: Cognitive Level: Apply (Application) REF: p. 435

4. A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include?

a.
Alcoholism is determined primarily by the family environment.
b.
Alcoholism is determined partly by genetic factors.
c.
Persons who are alcoholics are usually women.
d.
Persons born with fetal alcohol syndrome are alcoholics from birth.

ANS: B

Research has shown conclusively that familial transmission of alcoholism is at least in part genetic and not just the result of family environment.

DIF: Cognitive Level: Apply (Application) REF: p. 436

5. A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to “win” the drinking contest when the other passes out and cannot continue?

a.
If their drinks are the same size, they’ll both pass out about the same time.
b.
If they play fair, they’ll probably both vomit before passing out.
c.
The man will win.
d.
The woman will win.

ANS: C

Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men (except for males with chronic alcoholism).

DIF: Cognitive Level: Apply (Application) REF: p. 436

6. Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break?

a.
A discussion of which drugs are commonly used on campus
b.
How students can learn to “just say no” when offered drugs or drinks
c.
How to recognize and overcome peer pressure to continue bad habits
d.
The fact that tobacco smoking causes more deaths than any other behavior in the
United States

ANS: D

Although all these options are worthy of discussion, the most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States.

DIF: Cognitive Level: Apply (Application) REF: p. 436

7. A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother’s arms. Which of the following information should the nurse share with the parents?

a.
Fetal nicotine syndrome may cause complications in the newborn.
b.
The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves.
c.
The baby will eventually develop tolerance to tobacco smoke.
d.
The parents should switch to chewing tobacco as long as the child lives in the home.

ANS: B

Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than does mainstream smoke.

DIF: Cognitive Level: Apply (Application) REF: p. 437

8. Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States?

a.
Beer
b.
Caffeine
c.
Cigarettes (nicotine)
d.
Mixed alcoholic beverages

ANS: B

Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 438

9. A home health client has been taking 50 mg of meperidine, a narcotic analgesic, every 4 hours for pain. Which of the following statements made by a nurse to the client’s physician indicates a need for further education on narcotics?

a.
“You need to decrease the time interval between doses to every 3 hours so that my client will maintain pain relief.”
b.
“You need to discontinue that order before my client becomes addicted.”
c.
“You need to increase the meperidine so that my client will achieve adequate pain relief.”
d.
“You need to give my client something in addition to the meperidine.”

ANS: B

Opiates are by far the most effective drugs for pain relief. When these drugs are used for pain control, only approximately 0.1% of those clients will develop addiction, and therefore, fear of addiction should not be used as a reason to undertreat pain.

DIF: Cognitive Level: Apply (Application) REF: p. 439

10. A school nurse stops a student in the hall and asks whether the student has been having trouble with her eyes, which look rather red and dry. The female student yawns and says that she hasn’t noticed any eye problems. However, she does confess to the school nurse that she has gained 15 pounds since she began smoking “special cigarettes.” Which of the following is the student most likely smoking?

a.
Tobacco
b.
Crack cocaine
c.
Ice methamphetamine
d.
Marijuana

ANS: D

Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness.

DIF: Cognitive Level: Apply (Application) REF: p. 439

11. Which of the following is an accurate concern about the use of marijuana?

a.
Marijuana has painful withdrawal symptoms.
b.
Marijuana may damage the respiratory tract.
c.
Marijuana can often reduce pain but physicians refuse to prescribe it.
d.
Marijuana quickly leads to psychological and physiological dependence.

ANS: B

Marijuana is the most widely used illicit drug in the United States. It may reduce pain but is currently illegal with national efforts at total prohibition. It is not highly toxic except for possible damage to the respiratory tract from smoking. It does not quickly lead to dependence, and withdrawal symptoms are mild.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 439

12. A teacher sends a student to the school nurse because the student does not seem to be thinking clearly. The nurse notes that the student is having palpitations, as well as elevated pulse, blood pressure, temperature. Which of the following would most likely cause these symptoms?

a.
Alcohol
b.
Ecstasy (MDMA)
c.
Heroin
d.
Marijuana

ANS: B

Ecstasy raises the body’s temperature, pulse rate, and blood pressure. The other drugs listed would have a depressant effect.

DIF: Cognitive Level: Apply (Application) REF: p. 440

13. A home health nurse believes a client may be a drug addict. However, the client denies the use of drugs when questioned by the nurse. Which of the following is the most likely cause of the client’s denial?

a.
Confusion resulting from dementia
b.
History of compulsive lying
c.
Mental status changes
d.
Use of addictive drugs

ANS: D

Denial is a primary symptom of drug addiction.

DIF: Cognitive Level: Apply (Application) REF: p. 443

14. Three women were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances?

a.
Alcohol blood level
b.
Cardiac workup
c.
Pregnancy test
d.
STD tests

ANS: A

Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries.

DIF: Cognitive Level: Apply (Application) REF: p. 444

15. A male IV drug abuser admits to the nurse that he has no desire to stop using drugs, so rather than lecture him on the dangers of drug addiction, the nurse counsels him on how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? (Select all that apply.)

a.
Primary prevention by educating about safe injections
b.
Primary prevention by avoidance of future legal complications
c.
Secondary prevention to reduce the risk for infection or other complications
d.
Tertiary prevention to reduce the transmission of blood-borne diseases

ANS: D

Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Abstinence is ideal, but it is unrealistic for many addicts. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens.

DIF: Cognitive Level: Apply (Application) REF: p. 445

16. A man is addicted to alcohol. In which of the following scenarios is a family member enabling the man to continue drinking?

a.
The wife asks the nurse to explain why her husband’s continued drinking is dangerous.
b.
The son threatens to leave home because he finds the father’s behavior embarrassing.
c.
The teenage daughter turns to a favorite teacher for emotional support.
d.
The wife tells her husband’s boss that her husband is sick when he is actually inebriated.

ANS: D

Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction.

DIF: Cognitive Level: Apply (Application) REF: p. 446

17. Which of the following statements accurately describes why methadone is used to treat heroin addiction?

a.
Addicts come to prefer methadone instead of heroin.
b.
Methadone blocks the effects of heroin and reduces the craving.
c.
Methadone prevents further dependence on drugs.
d.
Methadone gives an enjoyable high, so addicts continue treatment.

ANS: B

Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long-acting and effective when taken orally, it does not produce a “high,” it is inexpensive, and it has few known side effects.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 447

18. A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client?

a.
A combination of interventions, beginning with changing the environment
b.
Acupuncture to reduce the nicotine cravings
c.
Behavior modification through hypnosis
d.
Nicotine replacement products

ANS: A

The most effective way to get people to stop smoking and prevent relapse involves multiple interventions and continuous reinforcement, and most smokers require several attempts at cessation before they are successful. Making changes to the smoker’s environment helps by eliminating cues to smoking, such as ash trays, lighters, and cigarette cases.

DIF: Cognitive Level: Apply (Application) REF: p. 448

19. A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client states, “I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal.” Which of the following would be most appropriate response from the nurse?

a.
“I’m so glad you’re beginning to recognize the need to control your blood sugar.”
b.
“Now you just have to make sure you don’t give that habit up!”
c.
“Sounds like you’re not ready to really plan your eating yet.”
d.
“That is great. You’ve started to take action and make changes.”

ANS: D

There are five stages of change: (1) precontemplation—or resisting that there is a problem, (2) contemplation—or thinking about the problem, (3) preparation—preparing for action and taking some initial steps, (4) action—or making modification in behavior and environment, and (5) maintenance—or preventing relapse. As the client learns how to eat and recognizes what she is eating, she is preparing for action. Therefore, the nurse should be encouraging and recognize that the client has begun serious change.

DIF: Cognitive Level: Apply (Application) REF: p. 449

20. At a county board meeting, a nurse reports statistics on drug use in the school. The nurse then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action?

a.
Help prevent obesity and boredom.
b.
Offer alternatives to being “on the streets.”
c.
Prevent children from getting in trouble before their parents get home from work.
d.
Promote healthy lifestyles with physical activity.

ANS: D

The nurse is engaging in primary prevention efforts against substance abuse by helping to promote healthy lifestyles and resiliency factors.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 441

21. A school health nurse is conducting drug screening to detect drug use by students before problems develop. Which of the following levels of prevention does this action represent?

a.
Primary prevention
b.
Secondary prevention
c.
Tertiary prevention
d.
Primary and secondary prevention

ANS: B

One means of secondary prevention is to institute early detection (screening) programs in schools, the workplace, and other areas in which people gather to determine the presence of substance abuse.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 442

MULTIPLE RESPONSE

1. A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the following strategies would the nurse suggest the mother implement? (Select all that apply.)

a.
Provide opportunities for her daughter to develop her talents.
b.
Provide realistic feedback to the daughter about her performance at school.
c.
Encourage her daughter to become involved in extracurricular activities.
d.
Encourage her daughter to develop new friendships.

ANS: A, B, C

Prevention guidelines to teach parents and teachers how to increase resiliency in youths include the following strategies: help them develop an increased sense of responsibility for their own success; help them identify their talents; motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers; provide realistic appraisals and feedback, stress multicultural competence, and encourage and value education and skills training; and increase cooperative solutions to problems rather than competitive or aggressive solutions.

DIF: Cognitive Level: Apply (Application) REF: p. 441

2. A nurse is helping a client’s family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client’s family members would be most effective? (Select all that apply.)

a.
“Express your love and your belief that he can change.”
b.
“Point out that his behavior is his choice and his responsibility.”
c.
“Let him know that you understand how much he loves being with his drinking pals and that you agree that their friendship is important.”
d.
“Remind him that entering treatment is better than going to prison.”

ANS: A, B

Using FRAMES as a guideline, the nurse would provide Feedback about problems with using drugs, emphasize the person’s own personal Responsibility for any changes made, and giveAdvice on how to change behaviors, including a Menu of options from which to choose while expressing Empathy. Finally, the nurse would provide encouragement and belief that the person can change, hence increasing feelings of Self-efficacy.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 448

3. A nurse is screening a client for ATOD problems. Which of the following actions would the nurse most likely complete? (Select all that apply.)

a.
Assist with identifying help or resources.
b.
Advise about the need to enter a treatment program.
c.
Ask about how relationships with family members and friends have been affected.
d.
Assess amount and pattern of use.

ANS: A, D

The nurse should use the 5 As when screening for ATOD problems: ask about use (how taken, how much, how long and how often); assess amount and pattern of use; advise about safe use as appropriate; and assist with identifying help or resources.

DIF: Cognitive Level: Apply (Application) REF: p. 443