Drugs
A patient asks, “What is the major difference between conventional health care and complementary and alternative medicine (CAM)?” The nurse’s best reply is that conventional health care
a. focuses on what is done to the patient, whereas CAM focuses on body–mind interaction with an actively involved patient.
b. has been tested by research so less regulation is needed, but CAM is religiously based and highly regulated.
c. is controlled by the health care industry, but CAM is the people’s medicine and not motivated by profit.
d. is holistic and focused on health promotion, whereas CAM treats illnesses and is symptom specific
ANS: A
Conventional health care focuses primarily on curative actions implemented on a mostly passive patient, whereas CAM focuses more on the mind–body aspects of health, along with the active involvement of the patient. Conventional health care is largely grounded in scientific research, and its various components are heavily regulated; the opposite tends to be true of CAM. Some forms of CAM have their roots in religious or cultural practices, but this is not characteristic of CAM as a whole. Both conventional health care and CAM can focus on health promotion and treatment of illness. Although critics express concern about the role of profit in conventional health care, the profit motive can also apply in CAM.
Select the best desired outcome for a patient who uses valerian. The patient will report
a. stress level is lower.
b. undisturbed sleep throughout the night.
c. increased interest in recreational activities.
d. early morning waking without an alarm clock.
ANS: B
Valerian decreases sleep latency, nocturnal waking, and leads to a subjective sense of good sleep. Sleeping through the night is the best indicator the herb was effective. Although the patient’s stress level may be lowered by use of valerian, the problem is insomnia; outcomes should relate to the problem. Early morning waking is indicative of depression or anxiety.
A nurse cares for a patient experiencing an opioid overdose. Which focused assessment has the highest priority?
a. Cardiovascular
b. Respiratory
c. Neurological
d. Hepatic
ANS: B
Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority.
Which scenario best demonstrates a healthy family?
a. One parent takes care of children. The other parent earns income and maintains the home.
b. A family has strict boundaries that require members to address problems within the family.
c. A couple requires their adolescent children to attend church services three times a week.
d. A couple renews their marital relationship after their children become adults.
ANS: D
Revamping the marital relationship after children move out of the family of origin indicates the family is moving through its stages of development. Strict family boundaries or roles interfere with flexibility and use of outside resources. Adolescents should have some input into deciding their activities.
A hospitalized patient diagnosed with alcohol use disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n)
a. narcotic analgesic, such as hydromorphone.
b. sedative, such as lorazepam or chlordiazepoxide.
c. antipsychotic, such as olanzapine or thioridazine.
d. monoamine oxidase inhibitor antidepressant, such as phenelzine.
ANS: B
Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.
The parent of an adolescent diagnosed with mental illness asks the nurse, “Why do you want to do a family assessment? My teenager is the patient, not the rest of us.” Select the nurse’s best response.
a. “Family dysfunction might have caused the mental illness.”
b. “Family members provide more accurate information than the patient.”
c. “Family assessment is part of the protocol for care of all patients with mental illness.”
d. “Every family member’s perception of events is different and adds to the total picture.”
ANS: D
The identified patient usually bears most of the family system’s anxiety and may have come to the attention of parents, teachers, or law enforcement because of poor coping skills. The correct response helps the family understand that the opinions of each will be valued. It allows the nurse to assess individual coping and prepares the family for the experience of working together to set goals and solve problems. The other responses are either incorrect or evasive.
A wife believes her husband is having an affair. Lately, he has been disinterested in romance and working late. The husband has an important, demanding project at work. The mother asks her teen, “What have you noticed about your father?” The teen later mentions this to the father, who says, “Tell your mother that I can’t deal with her insecurities right now.” Which family dynamic is evident?
a. Multigenerational dysfunction
b. Triangulation
c. Enmeshment
d. Blaming
ANS: B
Triangulation is a family dynamic wherein a pair relationship (usually the parents) is under stress and copes by drawing in a third person (usually a child) to align with one or the other members of the pair relationship. Multigenerational dysfunction is any dysfunction that exists within or across multiple generations of a family, such as child abuse or alcoholism. Blaming is distracting attention from one’s own dysfunction or reducing one’s own anxiety by blaming another person. Enmeshment refers to blurred family boundaries or blending together of the thoughts, feelings, or family roles of the individuals so that clear distinctions among members fail to emerge.
A patient says, “I have taken mega doses of vitamins for 3 months to improve my circulation, but I think I feel worse.” Which action should the nurse take first?
a. Explain to the patient that vitamin mega doses may be harmful and advise caution.
b. Assess the patient for symptoms and signs of toxicity from excess vitamin exposure.
c. Assess for signs of circulatory integrity to determine whether improvement has occurred.
d. Educate the patient that research has not shown that megadoses of vitamins produce benefits.
ANS: B
Mega doses of many vitamins, especially when taken over long periods, may produce dangerous side effects or toxicity. The priority for the nurse is to assess for signs of any dangerous consequences of the patient’s use of such a regimen. Secondary interventions would include patient education about research findings related to the practice, along with any benefits and undesired effects associated with the practice. A health care provider should also assess the patient for cardiovascular concerns.
Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?
a. Bromocriptine
b. Methadone
c. Disulfiram
d. Naltrexone
ANS: D
Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.
Which goal for treatment of alcohol use disorder should the nurse address first?
a. Learn about addiction and recovery.
b. Develop alternate coping strategies.
c. Develop a peer support system.
d. Achieve physiological stability.
ANS: D
The individual must have completed withdrawal and achieved physiological stability before he or she is able to address any of the other treatment goals.
A patient diagnosed with major depressive disorder tells the nurse, “I want to try supplementing my selective serotonin reuptake inhibitor (SSRI) with St. John’s wort.” Which action should the nurse take first?
a. Advise the patient of the danger of serotonin syndrome.
b. Suggest that aromatherapy may produce better results.
c. Assess the patient for depression and risk for suicide.
d. Suggest the patient decrease the antidepressant dose.
ANS: A
Research has suggested that St. John’s wort is a mild inhibitor of serotonin reuptake and could lead to serotonin syndrome; this risk is increased if the patient is taking other medications that increase serotonin activity. Assessing the depression would be a secondary intervention. Aromatherapy has not been shown to be an effective adjunct or treatment for depression. Although a dosage reduction in her SSRI medication might reduce the risk of serotonin syndrome, this intervention is not in the nurse’s scope of practice.
A parent is admitted to a unit for treatment of addictions. The patient’s spouse and adolescent children participate in a family session. What is the most important aspect of this family’s assessment?
a. Spouse’s codependent behaviors
b. Interactions among family members
c. Patient’s reaction to the family’s anger
d. Children’s responses to the family
ANS: B
Interactions among all family members are the raw material for family problem solving. By observing interactions, the nurse can help the family make its own assessments of strengths and deficits. The other options are narrower in scope when compared with the correct option.
Parents of a mentally ill teenager say, “We have never known anyone who was mentally ill. We have no one to talk to because none of our friends understand the problems we are facing.” Select the nurse’s most helpful intervention. a. Refer the parents to a support group.
b. Build the parents’ self-concept as coping parents.
c. Teach the parents techniques of therapeutic communication.
d. Facilitate achievement of normal developmental tasks of the family.
ANS: A
The need for support is evident. Referrals are made when working with families whose needs are unmet. A support group will provide the parents with support of others with similar experiences and with whom they can share feelings and experiences. The distracters are less relevant to providing a network of support.
A group is in the working phase. One member says, “That is the stupidest thing I’ve ever heard. Everyone whines and tells everyone else what to do. This group is a total waste of my time.” Which comment by the group leader would be most therapeutic?
a. “You seem to think you know a lot already. Since you know so much, perhaps you can tell everyone why you are back in the hospital?”
b. “I think you have made your views clear, but I wonder if others feel the same way. How does everyone else feel about our group?”
c. “It must be hard to be so angry.” Direct this comment to another group member, “You were also angry at first but not now. What has helped you?”
d. “I would like to remind you that one of our group rules is that everyone is to offer only positive responses to the comments of others.”
ANS: C
The member’s comments demean the group and its members and suggest that the member is
very angry. Labeling the emotion and conveying empathy would be therapeutic. Focusing on
members who are likely to be more positive can balance the influence of demoralizing
members. “You seem to know a lot …” conveys hostility from the leader, who confronts and
challenges the member to explain how he came to be readmitted if he was so knowledgeable,
implying that he is less knowledgeable than he claims. This comment suggests
countertransference and is non-therapeutic. Shifting away from the complaining member to
see if others agree seeks to have others express disagreement with this member, but that might
not happen. In the face of his anger, they might be quiet or afraid to oppose him, or they could
respond in kind by expressing hostility themselves. A rule that only positive exchanges are
permitted would suppress conflict, reducing the effectiveness of the therapy group.
A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse’s best first action?
a. Perform a thorough assessment of the patient.
b. Verify that security services are immediately available.
c. Self-assess personal attitude, values, and beliefs about this health problem.
d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.
ANS: C
The nurse should show compassion, care, and helpfulness for all patients, including those with addictive diseases. It is important to have a clear understanding of one’s own perspective. Negative feelings may occur for the nurse; supervision is an important resource. The activities identified in the distracters occur after self-assessment.
A patient is thin, tense, jittery, and has dilated pupils. The patient says, “My heart is pounding in my chest. I need help.” The patient allows vital signs to be taken but then becomes suspicious and says, “You could be trying to kill me.” The patient refuses further examination. Abuse of which substance is most likely? a. PCP
b. Heroin
c. Barbiturates
d. Amphetamines
ANS: D
The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behavior. Barbiturates and heroin would result in symptoms of CNS depression.
A parent was recently hospitalized with severe depression. Family members say, “We’re falling apart. Nobody knows what to expect, who should make decisions, or how to keep the family together.” Which interventions should the nurse use when working with this family? SATA
a. Help the family set realistic expectations.
b. Provide empathy, acceptance, and support.
c. Empower the family by teaching problem solving.
d. Negotiate role flexibility among family members.
e. Focus planning on the family rather than on the patient.
ANS: A, B, C, D
The correct answers address expressed needs of the family. The distracter is inappropriate.
1. A patient asks, “What are neurotransmitters? My doctor said mine are imbalanced.” Select the nurse’s best response.
a. “How do you feel about having imbalanced neurotransmitters?”
b. “Neurotransmitters protect us from harmful effects of free radicals.”
c. “Neurotransmitters are substances we consume that influence memory and mood.”
d. “Neurotransmitters are natural chemicals that pass messages between brain cells.”
ANS: D
The patient asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The distracters either do not answer the patient’s question or provide untrue, misleading information.
Which scenario best illustrates scapegoating within a family?
a. The identified patient sends messages of aggression to selected family members.
b. Family members project problems of the family onto one particular family member.
c. The identified patient threatens separation from the family to induce feelings of isolation and despair.
d. Family members give the identified patient nonverbal messages that conflict with verbal messages
ANS: B
Scapegoating projects blame for family problems onto a member who is less powerful. The purpose of this projection is to distract from issues or dysfunctional behaviors in the members of the family
Which assessment findings are likely for an individual who recently injected heroin?
a. Anxiety, restlessness, paranoid delusions
b. Muscle aching, dilated pupils, tachycardia
c. Heightened sexuality, insomnia, euphoria
d. Drowsiness, constricted pupils, slurred speech
ANS: D
Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use.
Symptoms of withdrawal from opioids for which the nurse should assess include
a. dilated pupils, tachycardia, elevated blood pressure, and elation.
b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.
c. mood lability, incoordination, fever, and drowsiness.
d. excessive eating, constipation, and headache.
ANS: B
The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis.
The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should
a. provide long-term care for the patient in a residential facility.
b. withdraw the patient from cannabis, then treat the schizophrenia.
c. consider each diagnosis primary and provide simultaneous treatment.
d. first treat the schizophrenia, then establish goals for substance abuse treatment.
ANS: C
Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.
The nurse can assist a patient to prevent substance abuse relapse by (Select all that apply)
a. rehearsing techniques to handle anticipated stressful situations.
b. advising the patient to accept residential treatment if relapse occurs.
c. assisting the patient to identify life skills needed for effective coping.
d. advising isolating self from significant others until sobriety is established.
e. informing the patient of physical changes to expect as the body adapts to functioning without substances.
ANS: A, C, E
Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals. Anticipatory problem solving and role playing are good ways of rehearsing effective strategies for handling stressful situations and helping the patient evaluate the usefulness of new strategies. The nurse can provide valuable information about physiological changes expected and ways to cope with these changes. Residential treatment is not usually necessary after relapse. Patients need the support of friends and family to establish and maintain sobriety.
Family members of an individual undergoing a residential alcohol rehabilitation program ask, “How can we help?” Select the nurse’s best response.
a. “Alcoholism is a lifelong disease. Relapses are expected.”
b. “Use search and destroy tactics to keep the home alcohol free.”
c. “It’s important that you visit your family member on a regular basis.”
d. “Make your loved one responsible for the consequences of behavior.”
ANS: D
Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviors or are of no help.
A patient undergoing alcohol rehabilitation decides to begin disulfiram therapy. Patient teaching should include the need to (Select all that apply)
a. avoid aged cheeses.
b. avoid alcohol-based skin products.
c. read labels of all liquid medications.
d. wear sunscreen and avoid bright sunlight.
e. maintain an adequate dietary intake of sodium.
f. avoid breathing fumes of paints, stains, and stripping compounds.
ANS: B, C, F
The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions. The other options do not relate to hidden sources of alcohol.