(Osborn) Chapter 16: Learning Outcomes (Number and Title)

[Osborn] chapter 16
Learning Outcomes [Number and Title]

Learning Outcome 1
Explain the major theories about substance-related disorders.
Learning Outcome 2
List why some groups are at risk for substance-related
disorders.
Learning Outcome 3
Discuss how the physical, psychological, and withdrawal
effects of the major categories of substances manifest
themselves.
Learning Outcome 4
Incorporate nursing assessment components to detect patients
who have substance-related disorders.
Learning Outcome 5
Demonstrate knowledge of a variety of short-term and longterm nursing intervention strategies for clients who have
substance-related disorders.
Learning Outcome 6
Develop outcome criteria for clients who have substancerelated disorders.
Learning Outcome 7
Establish what impact your own feelings and attitudes about
clients with substance-related disorders have on your nursing
care.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. The nurse is assessing a patient with a substance-related disorder. Which of the

following personality characteristics are most often seen in substance disorders?
1.
2.
3.
4.
Anxious and irritable

Introverted and shy
Satisfied with present life situation and alert
Pleasant and calm
Correct Answer: Anxious and irritable

Rationale: Anxiety and irritability are personality characteristics associated with
substance abuse. Extroverted behavior, rather than introverted, is more associated with
substance abuse. Persons with substance abuse are found to be less satisfied with their
present life situation and are more easily fatigued than are those without substance abuse.
Persons with substance abuse are less pleasant and tend to act rashly when distressed.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Psychosocial Integrity
LO: 1
2. A patient tells the nurse that as long as he has his bag of weed, he does not need
anything else. The nurse realizes this patient is describing:
1.
2.
3.
4.
The drug as a partner in a relationship.

Behavior learned from friends.
The use of drugs to avoid side effects of medications.
How the drugs make him feel smarter.
Correct Answer: The drug as a partner in a relationship.

Rationale: According to the psychosocial theory of drug use, the substance abuser may
develop an attachment to the drug much like an attachment to another person. The
patients drug use may or may not be learned from friends. The nurse does not have
enough information to know if the patient is taking the drug to avoid side effects of
medications or if the drugs make him feel smarter.
LO: 1
3. A patient tells the nurse that he does not want to attend his wifes family events
because he is expected to drink alcohol and he prefers not to. The nurse realizes this
patient is describing behaviors found within the __________ theory of substance
disorders.
1.
2.
3.
4.
Sociocultural
Biological
Psychological
Metaphysical
Correct Answer: Sociocultural

Rationale: In a sociocultural framework, the roles different family members play and the
importance of family rituals contribute to the problem of substance abuse and its
treatment. The wifes family has events where those in attendance are expected to drink,
contrary to the patients preference. The biological theory supports a biological
explanation for substance abuse. The psychological theory explains how the
psychological underpinnings of experiences and behaviors come together to form
motivation to use drugs in a destructive manner. There is no metaphysical theory for
substance abuse.
LO: 1
4. The mother of a patient admitted with alcohol abuse tells the nurse that alcohol is not
consumed at home and the patient is adopted. The nurse realizes that:
1.
2.
3.
4.
The patients biological parents might have abused alcohol.

The patient spent time drinking with friends.
Consuming alcohol is a symptom of stress.
Alcoholism is a learned behavior.
Correct Answer: The patients biological parents might have abused alcohol.
Rationale: Substance abuse prior to conception and during pregnancy has a significant
biological impact that can damage the genetic makeup of the child. Research notes that
children of people who abuse alcohol have four times the risk of abusing alcohol
themselves. There is no evidence to support that the patient is spending time drinking
with friends or the patient is consuming alcohol as a symptom of stress. There is also not
enough evidence to support this patients alcohol use as being a learned behavior.
LO: 2
5. A young adult patient tells the nurse that he periodically uses uppers to keep awake
while studying for college classes, so he does not understand why he has been feeling so
depressed lately. The nurse realizes this patient is describing:
1.
2.
3.
4.
Symptoms of a crash.
Expected effects of the drug.
Abstinence syndrome.
Hallucinations.
Correct Answer: Symptoms of a crash.

Rationale: Amphetamines or uppers are used to control appetite, treat depression, and
increase alertness. The patient uses the drug to keep alert to study. Tolerance for
amphetamines develops rapidly, and withdrawing the substance can lead to a depressive
episode or a crash. Depression is not an expected effect of amphetamines. Abstinence
syndrome is seen in patients who use cocaine. Hallucinations are associated with drugs
such as peyote and LSD.
LO: 2
6. A patient is admitted with a history of cocaine and alcohol abuse. The nurse realizes
that this patient is prone to also having an addiction to which of the following
substances?
1.
2.
3.
4.
Nicotine
Caffeine
Methamphetamine
Amphetamine
Correct Answer: Nicotine

Rationale: People with substance abuse problems have higher rates of smoking and show
a lack of responsiveness to smoking cessation treatments. There is no evidence to suggest
that people who use cocaine and alcohol are prone to caffeine, methamphetamine, or
amphetamine abuse.
LO: 2
7. A patient tells the nurse that he avoids all narcotic pain medications because he has
experienced flashbacks while taking them. The nurse realizes this patient is most likely
describing the effects of:
1.
2.
3.
4.
LSD.
Cocaine.
Marijuana.
Alcohol.
Correct Answer: LSD.

Rationale: Flashbacks are a spontaneous reliving of the experiences the person felt while
under the influence of the drug, even though the person is currently drug free. Flashbacks
occur less frequently over time and may be induced by stress, fatigue, and drug or alcohol
ingestion. Flashbacks are not typically associated with cocaine, marijuana, or alcohol
abuse.
Cognitive Level: Applying
LO: 3
8. The nurse realizes the patient is describing tolerance when the patient states:
1.
2.
3.
4.
I seem to need an increasing amount of alcohol each evening just to unwind.

I think I have the flu. My stomach is upset and my hands are shaking.
If I have my drink before I go home, I dont lose my patience so easily.
I had a really good time at the party. At least my friends told me I did, but I dont
remember much of it.
Correct Answer: I seem to need an increasing amount of alcohol each evening just to
unwind.
Rationale: Tolerance is a cumulative state in which a particular dose of the chemical
elicits a smaller response than before. With increasing tolerance, the individual needs
higher and higher doses to obtain the desired effects. Withdrawal symptoms of alcohol
include nausea, vomiting, gastritis, headache, irritability, and the shakes. Substance abuse
is a term used to describe a physical and psychological dependency on a substance to
escape stress or change behavior. Overdose symptoms are the physical and/or
psychological effects of ingesting too much of the substance at once.
LO: 3
9. The family of a patient who is admitted for detoxification for an amphetamine

addiction is concerned that the patient is excessively fatigued and very depressed. Which
of the following is the most appropriate response to the familys concerns?
1. The staff is monitoring his condition regularly for behaviors that require
additional care.
2. Has he ever been suicidal before?
3. These are normal behaviors during amphetamine withdrawal.
4. Would you like me to talk to his doctor about your concerns?
Correct Answer: The staff is monitoring his condition regularly for behaviors that
require additional care.
Rationale: A crash from amphetamine abuse may last for weeks and is often associated
with suicidal symptoms. Reassuring the family that the staff is regularly monitoring the
patient to evaluate the need for additional care is the most appropriate response to help
alleviate their concerns. While the remaining questions or statements may be appropriate,
they do not directly address the familys concerns.
Cognitive Level: Application
Nursing Process: Implementation
LO: 3
10. A patient involved in a minor accident reports taking Xanax prior to the accident.
Which of the following should the nurse assess in this patient?
1.
2.
3.
4.
Alteration in vital signs and diaphoresis

Sense of increased strength
Paranoia
Hallucinations of grandeur
Correct Answer: Alteration in vital signs and diaphoresis

Rationale: Xanax is a benzodiazepine that produces the same withdrawal symptoms as
barbiturate withdrawal. Onset of withdrawal can occur within 24 to 72 hours of the last
dose and symptoms include alterations in vital signs and diaphoresis. Crank, a form of
methamphetamine, will cause the patient to feel a sense of increased strength and
intelligence. Paranoia and hallucinations of grandeur are not associated with
benzodiazepine withdrawal.
Cognitive Level: Application
Client Needs: Physiological Integrity
LO: 4
11. The nurse observes a patient exhibiting excessive lacrimation, rhinorrhea, yawning,
and diaphoresis. The nurse recognizes that these findings suggest that the patient is
experiencing withdrawal from:
1.
2.
3.
4.
Heroin.
Nicotine.
Amphetamine.
Marijuana.
Correct Answer: Heroin.

Rationale: Initial withdrawal symptoms from heroin include drug craving, lacrimation,
rhinorrhea, yawning, and diaphoresis, which last up to 10 days since the last dose of the
drug. Lacrimation, rhinorrhea, yawning, and diaphoresis are not seen in nicotine,
amphetamine, or marijuana withdrawal.
Client Need: Physiological Integrity
LO: 4
12. A patient with a long history of substance abuse is experiencing hallucinations as a

result of withdrawal. Which of the following nursing diagnoses would be most
appropriate for the manifestations being reported?
1.
2.
3.
4.
Thought Processes, Disturbed

Low Self-Esteem
Deficient Knowledge
Risk for Injury
Correct Answer: Thought Processes, Disturbed

Rationale: Disturbed Thought Processes would apply to the patient who is demonstrating
an alteration in the perception of reality, as in hallucinations. Low Self-Esteem and
Deficient knowledge will likely factor into the plan of care, but do not specifically
address the hallucinations being experienced. Risk for Injury might be appropriate;
however, the primary issue is the patient experiencing disturbed thought processes with
the hallucinations.
LO: 4
13. A patient is admitted with symptoms of alcohol withdrawal. Which of the following
would be of the highest priority for this patient?
1.
2.
3.
4.
Support respiratory and cardiac statuses.

Keep the room dimly lit.
Encourage verbalization of feelings.
Encourage taking fluids by mouth.
Correct Answer: Support respiratory and cardiac statuses.

Rationale: Substance abusers who are acutely ill are often treated in the medicalsurgical
unit of a general hospital. Life-threatening physiological symptoms are addressed first.
When the patient is out of danger, the alcoholism addiction issues can be addressed.
Although important, keeping the room dimly lit, encouraging verbalization of feelings,
and encouraging fluids by mouth should all be attempted after the patients cardiac and
respiratory statuses are stabilized.
Nursing Process: Planning
LO: 5
14. A patient tells the nurse that he plans to stop smoking within the next 6 months. The
nurse realizes this patient is in the __________ stage of behavior change.
1.
2.
3.
4.
Contemplation
Precontemplation
Preparation
Maintenance
Correct Answer: Contemplation

Rationale: In the contemplation stage of behavior change, the patient intends to change
the behavior in the next 6 months. In precontemplation, the patient does not intend to
change the behavior in the near future. In preparation, the patient intends to make the
change within the next month. In maintenance, the patient works to prevent a relapse to
the previous behavior.
LO: 5
15. A patient tells the nurse that he gets off of the drugs for awhile and then in a few
months finds himself hanging out in the same places where he knows he can easily get
drugs. With which of the following statements should the nurse respond to this patient?
1. This is drug-seeking behavior and is in response to a craving. What can you do
instead of going to the places where you can get drugs?
2. This is because you are an addict and need the drugs.
3. This will happen for the rest of your life. There isnt anything that you can do to
change it.
4. Have you considered using a less addictive type of drug instead of the same kind
that you used to use?
Correct Answer: This is drug-seeking behavior and is in response to a craving. What can
you do instead of going to the places where you can get drugs?
Rationale: The patient is describing drug-seeking behavior and the nurse should suggest
ways for the patient to cope with the behavior by asking the patient what he can do
instead of going to the places where he knows he can get drugs. The nurse should not
confront the patient and say that he is an addict and needs the drugs. The nurse has no
way of knowing if this behavior will continue for the rest of the patients life. The patient
can learn coping mechanisms to use instead of the drug-seeking behavior. The nurse
should not suggest that the patient use a less addictive drug.
LO: 5
16. A patient tells the nurse that hes stopped hanging out with his former friends and
has started going to the gym after work to avoid the temptation of taking drugs. The nurse
realizes this patient is achieving which of the following outcomes?
1.
2.
3.
4.
Risk reduction with lifestyle changes

Total and permanent abstinence from drugs
Live a drug-free life
Deny the existence of drugs in society
Correct Answer: Risk reduction with lifestyle changes

Rationale: The outcome risk reduction with lifestyle changes is demonstrated by this
patients going to the gym and avoiding his previous friends to reduce the temptation of
taking drugs. Although the outcome of total and permanent abstinence may be
achievable for some patients with some abuse disorders, for others it may be an
unattainable goal. Each situation must be assessed individually. Make sure outcomes can
be measured so the treatment team is aware of progress and relapse. Living a drug-free
life and denying the existence of drugs in society are not realistic and may not be
measurable for this patient.
Nursing Process: Evaluation
LO: 6
17. The nurse has determined the outcome criteria for a male patient who has a history of
using marijuana to be impulse control as exhibited by abstinence. Which of the
following would indicate that the patient has achieved this outcome?
1. Patient states that he has not used any marijuana since being in the hospital.
2. Patient states that he used marijuana only on the weekends.
3. Patients mother tells the nurse that she found marijuana in the dresser drawer in
the patients room at home.
4. Patients older brother tells the nurse that he witnessed his brother smoking
marijuana one time since he was hospitalized.
Correct Answer: Patient states that he has not used any marijuana since being in the
hospital.
Rationale: Outcome criteria for substance abusers include impulse control as exhibited
by abstinence. For this outcome to be achieved, the patient must not use any marijuana.
The patient stated that he has not used any marijuana, which is evidence of achievement.
Using marijuana on the weekends would not be evidence of achievement of the outcome.
The mother finding marijuana in the patients dresser drawer at home could mean that the
patient continues to use marijuana. The patients older brother stating that he observed his
brother using marijuana would indicate that the outcome was not achieved.
LO: 6
18. The nurse who is caring for a patient with a history of heroin abuse is assisting the
patient to determine ways to avoid the ongoing use of the drug. Which of the following
outcomes would best determine that the patient has been successful in not taking heroin?
1. Patient has had no hospital admissions for heroin use and has graduated from the
methadone program.
2. The patient was seen in the emergency room one time in the last 6 months for
heroin-related symptoms.
3. The patient continues to work and engage in previous social activities.
4. Patient has not returned to live with wife and continues to hold part-time
employment.
Correct Answer: Patient has had no hospital admissions for heroin use and has graduated
from the methadone program.
Rationale: The best evidence that the patient has been successful in not using heroin
would be that the patient has not been admitted to the hospital for heroin use and has
graduated from the methadone program. Methadone alleviates the cravings associated
with the drug and allows addicts to lead productive lives. Graduation from the methadone
program means the patient no longer needs methadone to control cravings. The patient
being in the emergency room for heroin-related symptoms would mean that the patient
had still been using heroin. Individuals who have substance abuse problems need to
change their previous lifestyle, habits, and associations. Patients who continue to work
and engage in previous social activities may still access heroin. The patient who has not
returned to life with his wife and continues to hold part-time employment may still access
heroin.
LO: 6
19. A patient with heroin addiction has a central line for antibiotic administration to treat
an infection. After seeing the patient inject a dose of heroin through the line, the nurse
provides sterile syringes and needles for the patient to use in the future. The nurses
action would be considered:
1.
2.
3.
4.
Supportive of the patients needs at this time, though not recommended long term.
Punishable by immediate termination from the health care facility.
Criminal, and should be reported to the security department and the local police.
Something that a nurse would never do.
Correct Answer: Supportive of the patients needs at this time, though not recommended
long term.
Rationale: The nurse realizes the patient is being treated for an infection even though the
patient is heroin addict. The nurse is determining what could be done to support the
patients most pressing need. Because of the current infection, the patient could be
making the situation worse by using nonsterile needles and syringes to dose with heroin.
Therefore, the nurse made the decision to help reduce the onset of infection by providing
sterile needles and syringes. There is not enough information about the situation to
suggest the nurse should be punished by immediate termination or be reported to the
police for actions taken. This situation would most likely need to be addressed by the
organizations ethics committee.
Nursing Process; Implementation
Client Need: Safe Effective Care Environment
LO: 7
20. The nurse, whose husband had been killed by an intoxicated driver, is assigned to
provide care to a patient with alcoholism. Which of the following should be done to
support this nurse and patient?
1.
2.
3.
4.
Discuss with the nurse her ability to plan and provide nonjudgmental care.
Have the patient transferred to another care area.
Discharge the patient to home with outpatient treatment scheduled.
Admit the patient to a 28-day rehabilitation facility.
Correct Answer: Discuss with the nurse her ability to plan and provide nonjudgmental
care.
Rationale: The nurse has a personal event that might hinder her ability to provide care to
the patient with alcoholism. The nurse should be given an opportunity to discuss her
feelings and ability to provide nonjudgmental care to this patient. Moving the patient,
discharging the patient, or admitting the patient to a rehabilitation facility might all be
unnecessary measures at this time.
Nursing Process: Planning
Client Need: Safe Effective Care Environment
LO: 7
21. A patient with a history of substance abuse is seen for chronic lower back pain. The
patient tells the nurse that the only medication that alleviates his pain is Oxycontin, and
once he gets the medication, he will leave the clinic. Which of the following should the
nurse do?
1. Acknowledge the patients dependence on the medication and discuss other pain
management approaches.
2. Inform the health care provider that the patient wants Oxycontin and provide with
the prescription once it is written.
3. Tell the patient that Oxycontin is an addictive substance and that he will need to
find another place to get a prescription.
4. Ask what other substances the patient uses, such as alcohol or marijuana.
Correct Answer: Acknowledge the patients dependence on the medication and discuss
other pain management approaches.
Rationale: The patient has a history of substance abuse and is currently asking for an
opiate to control chronic lower back pain. The nurse should acknowledge the patients
history of drug dependency and discuss other pain management approaches for the back
pain. The nurse should not ask the health care provider for a prescription for Oxycontin
and give it to the patient without other interventions. The nurse should not turn the patient
away or confront the patient by asking what other substances he uses such as alcohol or
marijuana.
LO: 7
22. The nurse caring for a patient experiencing alcohol withdrawal had observed the same
symptoms in her father in the past. Which of the following actions would indicate that the
nurse is providing empathetic care to the patient?
1. Providing antiemetic medication as prescribed and protecting the patient from
harm caused by delirium tremens
2. Checking on the patient every 2 hours when necessary
3. Keeping the overhead lights and the television on in the room
4. Delaying the administration of prescribed Valium
Correct Answer: Providing antiemetic medication as prescribed and protecting the patient
from harm caused by delirium tremens
Rationale: The nurse has a personal history of alcohol withdrawal with her father. This
could negatively impact this nurses ability to provide empathetic care to the patient with
the same symptoms. The nurse is providing empathetic care when she provides
antiemetic medication as prescribed and protects the patient from harm. Checking on the
patient every 2 hours is too infrequent and would not be safe for the patient. Keeping the
overhead lights and the television on in the room would be too much stimulation for the
patient experiencing alcohol withdrawal symptoms. Delaying the administration of
prescribed Valium would also not be evidence of empathetic care by the nurse.
Client Need: Physiological Integrity
LO: 7

(Osborn) Chapter 16: Learning Outcomes (Number and Title)

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(Osborn) Chapter 16: Learning Outcomes (Number and Title)

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[Osborn] chapter 16

Learning Outcomes [Number and Title]

1. The nurse is assessing a patient with a substance-related disorder. Which of the

Anxious and irritable

Correct Answer: Anxious and irritable

The drug as a partner in a relationship.

Correct Answer: The drug as a partner in a relationship.

Correct Answer: Sociocultural

The patients biological parents might have abused alcohol.

Correct Answer: Symptoms of a crash.

Correct Answer: Nicotine

Correct Answer: LSD.

I seem to need an increasing amount of alcohol each evening just to unwind.

9. The family of a patient who is admitted for detoxification for an amphetamine

Alteration in vital signs and diaphoresis

Correct Answer: Alteration in vital signs and diaphoresis

Correct Answer: Heroin.

12. A patient with a long history of substance abuse is experiencing hallucinations as a

Thought Processes, Disturbed

Correct Answer: Thought Processes, Disturbed

Support respiratory and cardiac statuses.

Correct Answer: Support respiratory and cardiac statuses.

Correct Answer: Contemplation

Risk reduction with lifestyle changes

Correct Answer: Risk reduction with lifestyle changes

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