Medications
A patient is brought to the ED unconscious. The RN suspects and opioid overdose. What medication will the nurse administer in this scenario?
A. Naloxone
B. Methadone
C. Buprenorphine
D. Naltrexone
A. Naloxone (NARCAN)-opioid antagonist, reverses effects of opioids during an overdose.
B (methadone) and C (buprenorphine) are used for opioid withdrawal or maintenance therapy, not for acute overdose reversal.
D (naltrexone) is used for relapse prevention and must not be given during overdose or in patients with opioids in their system.
True or False?
cocaine withdrawal requires no inpatient care?
TRUE!
-cocaine withdrawal usually does NOT require inpatient medical care, because it is not medically dangerous the way alcohol or benzodiazepine withdrawal can be.
Withdrawal treatment:
-Group and individual therapy
-Possible diazepam for agitation
-no drugs reduce symptoms
-Depression treatment once withdrawal is complete (e.g., bupropion)
A 24 y/o patient who abuses heroin states, “I’ve been using more heroin lately because I’ve begun to need more to feel high.” What effect does this statement describe?
A. Intoxication
B. Withdrawal
C. Addition
D. Tolerance
Correct Answer: D Tolerance
Tolerance- needing increasing greater amounts of a substance to receive the desired result.
Intoxication is the effect of the drug or feeling high,
Withdrawal- is a set of symptoms patients experience when they stop taking the drug
Addiction-loss of behavioral control with craving and inability to abstain from substance
The Clinical Opiate Withdrawal Scale (COWS) is a standardized assessment tool used to monitor patients undergoing opioid detoxification. Which of the following does the COWS scale primarily assess?
A. Severity of alcohol withdrawal symptoms
B. Presence of cognitive impairment
C. Intensity of opioid withdrawal symptoms
D. Risk for suicide ideation
Correct Answer: C. Intensity of opioid withdrawal symptoms
Rationale:
A pt with a hx of drug abuse presents with severe dental problems including severe tooth decay & loose teeth his drug of choice was likely?
A. Heroin
B. Cocaine
C. Ketamine
D. Meth
D. Meth
D is correct: Methamphetamine use is strongly associated with “meth mouth,” characterized by severe tooth decay, enamel erosion, gum disease, and loose or broken teeth due to dry mouth, teeth grinding, poor hygiene, and acidic drug components.
A (heroin) may cause poor hygiene but is not specifically linked to severe dental destruction.
B (cocaine) can cause nasal septum damage and cardiovascular effects, not the classic dental pattern.
C (ketamine) is associated with bladder issues and dissociation, not dental decay.
Methadone, clonidine, buprenorphine/naloxone (Saboxone) & Lofexidine are meds used for which type of withdrawal ETOH or Opioid?
Opioid Withdrawl
A nurse is providing community education about the legal definition of alcohol intoxication in most U.S. states. At what blood alcohol concentration (BAC) is an individual legally considered intoxicated?
A. 0.02 g/dL (20 mg/dL)
B. 0.05 g/dL (50 mg/dL)
C. 0.08–0.10 g/dL (80–100 mg/dL)
D. 0.15 g/dL (150 mg/dL)
C is correct: Most states define legal intoxication as a BAC of 0.08 to 0.10 g/dL, which is equivalent to 80–100 mg/dL.
A and B are below the legal threshold for intoxication, though impairment may still occur.
D represents a significantly elevated BAC but exceeds the legal definition.
The CAGE questionnaire is a screening tool commonly used in healthcare settings. For which of the following conditions is the CAGE scale primarily designed to assess?
A. Depression
B. Anxiety disorders
C. Alcohol abuse and dependence
D. Eating disorders
Correct Answer: C. Alcohol abuse and dependence
Rationale: C. Alcohol abuse and dependence: The CAGE questionnaire is a widely used screening tool specifically designed to identify individuals who may have problems with alcohol.
The CAGE-AID questionnaire is a modified version of the original CAGE tool. In addition to alcohol (ETOH) abuse and dependence, what other substance use disorder does the CAGE-AID screen for?
A. Nicotine dependence
B. Prescription medication misuse
C. Illicit drug use
D. Caffeine dependence
Correct Answer: C. Illicit drug use
Rationale: C. Illicit drug use: The CAGE-AID (Adapted to Include Drugs) was developed to expand the original CAGE questionnaire to screen for problematic drug use in addition to alcohol abuse.
A patient with opioid use disorder tells the nurse he wants to begin methadone treatment to help manage cravings and withdrawal. The nurse explains that methadone for opioid use disorder can only be dispensed through which type of program?
A. Any physician
B. Only a psychiatrist
C. A Substance Abuse and Mental Health Services Administration (SAMHSA)–certified opioid treatment program
D. Any drug rehabilitation program
C is correct: Methadone for opioid use disorder can only be dispensed through a SAMHSA‑certified Opioid Treatment Program (OTP) that meets federal regulatory standards.
A is incorrect because individual physicians cannot prescribe methadone for OUD outside an OTP.
B is incorrect because psychiatrists must also work within an OTP to dispense methadone for OUD.
D is incorrect because not all rehab programs are certified OTPs.
A nurse is providing education to a patient who wants to quit smoking. Which medications may be prescribed to help reduce nicotine cravings and support smoking cessation?
A. Varenicline and Bupropion
B. Methadone and Naloxone
C. Disulfiram and Acamprosate
D. Fluoxetine and Haloperidol
A is correct:
Varenicline -(Chantex) is a partial nicotinic receptor agonist that reduces cravings and withdrawal symptoms.
Bupropion is an antidepressant that decreases nicotine cravings and helps with withdrawal.
B is used for opioid withdrawal or dependence, not nicotine cessation.
C is used for alcohol use disorder.
D treats anxiety or depression but is not indicated for smoking cessation.
A nurse is teaching a health promotion class about commonly used psychoactive substances. Which substance is the most widely used psychoactive drug in the world and can cause intoxication, overdose, and withdrawal?
A. Nicotine
B. Alcohol
C. Caffeine
D. Cannabis
Correct Answer: C
Rationale
C is correct: Caffeine is the most widely consumed psychoactive substance globally. Excessive intake can lead to intoxication (restlessness, tachycardia, GI upset), overdose (severe agitation, arrhythmias), and withdrawal (headache, fatigue, irritability).
A, B, and D are psychoactive substances but are not the most widely used worldwide.
A nurse is providing education on alcohol‑use patterns during a community health class. Which statement correctly differentiates binge drinking from heavy drinking?
A. Binge drinking refers to drinking every day, while heavy drinking refers to drinking only on weekends.
B. Binge drinking is consuming a large amount of alcohol in a short period, while heavy drinking is drinking excessively on multiple days per week.
C. Binge drinking and heavy drinking both refer to daily alcohol use.
D. Heavy drinking refers to consuming 4–5 drinks in 2 hours, while binge drinking refers to drinking more than 14 drinks per week.
B is correct:
Binge drinking refers to drinking too much alcohol quickly. For women, this amount is four or more drinks within 2 hours; for men, this amount is five or more drinks within 2 hours.
Heavy drinking is characterized by drinking too much, too often. Eight or more drinks in a week constitutes heavy drinking in women. Men who drink more than 14 drinks in a week are considered heavy drinkers.
A nurse is caring for a patient experiencing alcohol withdrawal. The provider has ordered benzodiazepines to be administered according to the CIWA‑Ar protocol. Which action by the nurse demonstrates correct understanding of this order?
A. Administering a fixed dose of lorazepam every 4 hours regardless of symptoms
B. Giving benzodiazepines only when the patient reports anxiety
C. Assessing the patient using the CIWA‑Ar scale and administering the benzodiazepine dose based on the score
D. Holding benzodiazepines until the patient shows signs of delirium tremens
Correct Answer: C
Rationale:
CIWA‑Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised) is a symptom‑triggered tool used to determine when and how much benzodiazepine to give.
The nurse must assess the CIWA‑Ar score first, then dose according to agency protocol.
Fixed dosing (A) is not CIWA‑based.
Giving meds only for anxiety (B) ignores other withdrawal symptoms.
Waiting for DTs (D) is unsafe; benzodiazepines are used to prevent severe withdrawal.
Which of the following medications are classified as benzodiazepines? Select all that apply.
A. Diazepam
B. Alprazolam
C. Chlordiazepoxide
D. Zolpidem
E. Clonazepam
F. Lorazepam
Correct Answers: A, B, C, E, F
Rationale
Diazepam, alprazolam, chlordiazepoxide (Librium), clonazepam, and lorazepam are all benzodiazepines used for anxiety, alcohol withdrawal, seizures, and sedation.
Zolpidem is not a benzodiazepine; it is a non‑benzodiazepine hypnotic (“Z‑drug”) used for insomnia.
A nurse is providing education to a patient beginning treatment for alcohol use disorder. Which medication works by producing a sensitivity to alcohol, causing an unpleasant physical reaction if even small amounts of alcohol are consumed?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Topiramate
C. Disulfiram (ANTABUSE)
C is correct: Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde buildup when alcohol is consumed. This leads to flushing, nausea, vomiting, palpitations, and hypotension — a deterrent effect.
A (naltrexone) reduces cravings but does not cause an aversive reaction.
B (acamprosate) helps maintain abstinence by reducing post‑acute withdrawal symptoms.
D (topiramate) may reduce cravings but does not produce alcohol sensitivity.
Which medication should the nurse expect to administer once delirium appears in alcohol withdrawal?
A. Oral diazepam
B. Oral chlordiazepoxide
C. Intravenous lorazepam
D. Intramuscular haloperidol
Correct Answer: C
Rationale: IV lorazepam is the treatment of choice for severe withdrawal and DTs. Oral benzodiazepines are used earlier for prevention.
Delirium Tremens (DTs), is a medical emergency that can result in the death in 20% of untreated patients, usually as a result of medical problems such as pneumonia, renal disease, hepatic insufficiency, or heart failure
A nurse is caring for a patient experiencing moderate opioid withdrawal symptoms, including anxiety, diaphoresis, abdominal cramping, and tachycardia. Which medications may be prescribed to manage opioid withdrawal and support stabilization during detoxification?
A. Methadone, clonidine, buprenorphine/naloxone, and lofexidine
B. Naloxone, diazepam, haloperidol, and disulfiram
C. Acamprosate, naltrexone, propranolol, and gabapentin
D. Flumazenil, phenobarbital, nicotine replacement therapy, and sertraline
A is correct:
Methadone: Long‑acting opioid agonist used to reduce withdrawal severity.
Clonidine: Alpha‑2 agonist that decreases autonomic symptoms (sweating, tachycardia, anxiety).
Buprenorphine/naloxone (Suboxone): Partial opioid agonist/antagonist combination that reduces cravings and withdrawal.
Lofexidine: Alpha‑2 agonist FDA‑approved specifically for opioid withdrawal symptom relief.
B, C, and D include medications used for other conditions (alcohol use disorder, benzodiazepine overdose, psychiatric disorders) and are not first‑line for opioid withdrawal.
What physical signs of recent cocaine intoxication would the RN expect to find in a 56 y/o man being admitted to the inpatient unit?
A. B/P 190/100, P 135, RR 30 muscle twitching evident and paranoid
B. B/P 90/50, P 100, RR 22 Withdrawn, insists on getting to bed to calm down
C. B/P 142/102, P 86, RR 26 Alogia, Flat affect, keeps eyes closed bc of seeing “God looking at me.”
D. B/P 100/70, P 99, RR 16, marked tooth decay, multiple lesions and needle prick venous tracks
A. B/P 190/100, P 135, RR 30 muscle twitching evident and paranoid
Which physiological response is common when patients are undergoing acute withdrawal from opioids?
A. Hypertension
B. Hypotension
C. Somnolence
D. Constipation
A is correct: Hypertension, along with tachycardia, diaphoresis, anxiety, and dilated pupils, is a hallmark of acute opioid withdrawal due to sympathetic nervous system overactivation.
B (hypotension) is more associated with opioid intoxication, not withdrawal.
C (somnolence) is also characteristic of opioid intoxication, not withdrawal.
D (constipation) occurs with ongoing opioid use, while withdrawal typically causes diarrhea.
A nurse is educating a patient in treatment for alcohol use disorder who also has a history of opioid dependence. Which medication helps reduce cravings associated with both alcohol and opioid use?
A. Disulfiram
B. Methadone
C. Naltrexone
D. Acamprosate
C is correct: Naltrexone is an opioid antagonist that reduces the reinforcing effects and cravings associated with both alcohol and opioids.
A (disulfiram) creates an aversive reaction to alcohol but does not reduce cravings.
B (methadone) is used for opioid withdrawal and maintenance, not alcohol cravings.
D (acamprosate) helps maintain abstinence from alcohol but does not affect opioid cravings.
A nurse is preparing to start a patient on naltrexone for the treatment of opioid dependence. To prevent precipitated withdrawal, the nurse should verify that the patient has been opioid‑free for at least how long before initiating therapy?
A. 3 days
B. 5 days
C. 7 days
D. 10 days
D is correct: Patients must be opioid‑free for a minimum of 10 days before starting naltrexone to avoid precipitated withdrawal.
A, B, and C represent insufficient opioid‑free intervals and increase the risk of severe withdrawal symptoms.
A nurse is assessing a patient who stopped drinking alcohol 7 hours ago. Which assessment finding is most consistent with early alcohol withdrawal?
A. Bradycardia and decreased body temperature
B. Tremors, agitation, and elevated blood pressure
C. Visual hallucinations and disorientation
D. Seizures and severe hyperthermia
Correct Answer: B
Rationale:
The classic early sign of alcohol withdrawal is tremulousness (“the shakes” or “jitters”), which begins 6–8 hours after cessation.
Mild to moderate withdrawal also includes agitation, nausea, vomiting, insomnia, impaired cognition, and mild perceptual changes, along with increased pulse, blood pressure, and temperature.
Hallucinations, seizures, and severe autonomic instability occur later and indicate more severe withdrawal.
Which patient is the best candidate for acamprosate therapy?
A. A patient who is still drinking daily
B. A patient who has been abstinent from alcohol for 5 days
C. A patient with severe renal impairment
D. A patient who wants a medication to treat acute withdrawal symptoms
Correct Answer: B
Rationale: Acamprosate is started after abstinence begins and is not used for acute withdrawal.
Campral (acamprosate) is FDA-approved to maintain alcohol abstinence in adults with alcohol dependence who have already stopped drinking. It works by restoring neurotransmitter balance (reducing glutamate/increasing GABA) to reduce cravings.
A patient is found unresponsive with shallow respirations and pinpoint pupils. The patient’s friend reports that the patient recently injected heroin. Which medication should the nurse prepare to administer?
A. Lorazepam
B. Naloxone
C. Acamprosate
D. Naltrexone
B is correct: Naloxone is the emergency opioid antagonist used to rapidly reverse respiratory depression caused by opioid overdose.
A (lorazepam) is a benzodiazepine and would worsen respiratory depression.
C (acamprosate) is used for alcohol abstinence maintenance.
D (naltrexone) is used for relapse prevention, not acute overdose reversal.