Test Bank Substance Abuse Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which preventable health problem is the cause of
... [Show More] more deaths, illnesses, and disabilities than any other?
a. Use of tobacco
b. Obesity
c. Sexually transmitted diseases (STDs)
d. Substance abuse
ANS: D
Perhaps no other health-related condition has as many far-reaching consequences in contemporary Western society as substance abuse. These consequences include a wide range of social, psychological, physical, economic, and political problems. Drug abuse and addiction have negative consequences for individuals, families, and communities. Estimates of the total overall costs of substance abuse in the United States, including productivity and health- and crime-related costs exceed $700 billion annually. This includes approximately
$193 billion for illicit drugs, $295 billion for tobacco, and $224 billion for alcohol. These numbers in dollars do not describe the extent of public health and safety implications.
DIF: Cognitive Level: Remember (Knowledge)
2. A female student was extremely upset over her test results. She thought she had studied
thoroughly, but her test grade would be totally unacceptable to her parents. Her friend said, “Come on, it’s just the first couUrseStestN. YoTu’ll doObetter on the next one. Let’s go out and have
a drink. You’ll feel much better.” After the first drink, how will the upset student most likely feel?
a. A bit nauseous
b. More relaxed and comfortable
c. Ready to have a second
d. Very thirsty
ANS: B
If one expects a certain effect, such as relief, one is more likely to feel it after use of a drug. The satisfied expectancies may set up neural pathways that are interpreted as pleasurable. It is unlikely that the student will feel nauseous or very thirsty after the first drink. The student may feel ready to have a second, but that would be related to the relaxation and comfort experienced with the first drink.
DIF: Cognitive Level: Apply (Application)
3. Which mood-altering substances are considered acceptable to use by current Western society?
a. Alcohol
b. Amphetamines
c. Barbiturates
d. Nicotine
ANS: A
In general, alcohol use has gained more social acceptance than other drug use. Because of the known harmful effects of tobacco, it is not acceptable to use tobacco products, which contain nicotine. The use of amphetamines and barbiturates are not acceptable in Western society.
DIF: Cognitive Level: Remember (Knowledge)
4. Which best explains why most states have the legal drinking age set at 21 years old?
a. At 21 years of age, most Americans consider a person an adult.
b. College is completed, and employment has begun by 21 years of age.
c. Most 21-year-olds are self-supporting and no longer dependent on parents.
d. The alcohol-related death rate rose alarmingly when drinking age was lowered to 18 years.
ANS: D
Alcohol use was highest during the 1980s, when states lowered the drinking age to 18 years of age. Lawmakers became alarmed at the increased rate of drinking and the increased number of alcohol-related deaths among 18- to 25-year-olds after lowering the drinking age and therefore reversed the decision. During the late 1980s, alcohol use declined after the minimum drinking age was reinstated to 21 years of age. Thus, the significance of the legal drinking age of 21 has to do with the problems experienced when the legal drinking age was lowered to 18, not that 21-year-olds are considered to be “adults”, employed, or self-supporting by this age.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best explains what experts believe is the causative factor in the decline in total alcohol consumption?
a. Americans prefer less dangerous mood-altering substances
b. Increased “sin” taxes on alcUohoSl anNd toTbacco nOationwide
c. Less social tolerance and no-drinking-while-driving campaigns
d. So many movies about teenaged drinking make alcohol look adolescent
ANS: C
The decline in alcohol consumption through the 1990s and into the 21st century is attributed to less tolerant national attitudes toward drinking, increased societal and legal pressure and action against drinking and driving, and increased health concerns among Americans. The decline does not have to do with Americans choosing other mood-altering substances, increased taxation, or the media.
DIF: Cognitive Level: Understand (Comprehension)
6. Which legislation has increased funding for treatment and rehabilitation for substance abuse?
a. Drug Abuse Prevention and Control Act
b. Anti-Drug Abuse Acts of 1986 and 1988
c. Omnibus Transportation Employee Testing Act
d. Harrison Narcotic Act of 1914
ANS: B
The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation and also stiffened penalties for drug offenses; the 1988 act created the Office of National Drug Control Policy.
DIF: Cognitive Level: Remember (Knowledge)
7. Which age group has the highest prevalence of binge drinking and heavy drinking?
a. Adults aged 45 to 65 years
b. Adult business persons, aged 25 to 45 years
c. Both genders of depressed elderly, aged 65 years and up
d. Young adults aged 18 to 25 years
ANS: D
Nearly 66.7 million of persons aged 12 or older participated in binge drinking. Heavy drinking was reported by 6.5% of the population aged 12 or older, or 17.3 million people. Among young adults aged 18 to 25 in 2015, the rate of binge drinking was 39%. The rate of alcohol use among youths aged 12 to 17 was 9.6% in 2015. Youth binge and heavy drinking rates in 2011 were 7.4 and 1.5%, respectively. Binge and heavy drinking is less likely to occur in adults aged 25 to 65 years or the elderly who are 65 years old and older.
DIF: Cognitive Level: Remember (Knowledge)
8. Which is the most commonly used illegal mood-altering substance?
a. Cocaine or crack ecstasy
b. Heroin
c. Marijuana
d. Methamphetamine or speed
ANS: C
Marijuana was the most commonly used illicit drug. In 2015, there were 22.2 million current users. The proportion of people aged 12 or older who were current marijuana users in 2015 was similar in proportion to 2N0U14R, SbuIt NitGwTasBh.igChOerMthan the percentages from 2012 to 2013.
DIF: Cognitive Level: Remember (Knowledge)
9. Which best explains why experts are now distinguishing between use and misuse?
a. It is easier to discuss use than to accuse persons of being drug addicts.
b. Expansion of drug treatment programs has prevented some people from becoming totally addicted.
c. Persons using prescription drugs are “users,” not “misusers.”
d. Some persons may use drugs and not become dependent on them.
ANS: D
Research has revealed that problems associated with substance use may or may not relate to classically or clinically defined dependence or addiction. Many are turning to recovery before they have developed physiological dependence. Thus, many in the field have begun to differentiate between use and misuse (misuse being interchangeable with abuse), and these terms now appear in the literature. Drug treatment programs are far fewer than the need.
DIF: Cognitive Level: Understand (Comprehension)
10. Which trend in illicit drug use is being seen among adults over age 50?
a. The rate of illicit drug use increased until 2011 but has shown a recent decline.
b. The rate of illicit drug use has remained stable for the past several years.
c. The rate of illicit drug use is increasing.
d. The rate of illicit drug use is decreasing.
ANS: C
Among adults aged 50 to 64, the rate of illicit drug use increased from 2.7% to 6.0% in 2013; for those ages 50 to 54, the rate increased from 3.4% to 7.9% in 2013. Among those aged 55 to 59, the rate of current illicit drug use increased from 1.9% in 2002 to 5.7% in 2013. In those aged 60 to 64, the rate of current illicit drug use increased from 1.1% in 2003 and 2004 to 3.9% in 2013 (USDHHS, 2014).
DIF: Cognitive Level: Understand (Comprehension)
11. Which drug is being widely manufactured within the United States?
a. Cocaine
b. Heroin
c. Marijuana
d. Methamphetamine
ANS: D
Marijuana is grown, not manufactured. Methamphetamine is easily made from the fertilizer anhydrous ammonia. Cocaine and heroin are grown elsewhere and smuggled into the United States.
DIF: Cognitive Level: Remember (Knowledge)
12. In which way is methamphetamine different from and more dangerous than other mood-altering substances?
a. The drug itself is highly combustible, so both makers and users have suffered severe burns when injectiNng iRt. I G B.C M
b. Methamphetamine helps users become more productive and energetic, so people
find it helpful at work and home and want to continue using it.
c. It provides more pleasurable effects more quickly than other mood-altering drugs, so persons become addicted more quickly.
d. Severe neurological changes occur in the brain very quickly, often even with the first dose.
ANS: D
Methamphetamine appears to damage the brain in ways that are different from, and more severe than, damage from using other drugs. Currently, there is a rudimentary understanding of ways it affects the brain, but it is known that profound neurological changes occur even with first administration. Methamphetamine is highly combustible, and makers have suffered severe burns when manufacturing it. The pleasurable effects of methamphetamine lead to users having increased energy, a sense of euphoria, and increased productivity. However, it also causes an increased heart rate, insomnia, excessive talking, excitation, aggressive behaviors, anxiety, convulsions, paranoia, and brain damage. Prolonged use results in tolerance and physiological dependence. Because of the physiological dependence, users may feel powerless in having a choice in whether they use the drug or not. Its increased popularity is related to it appearing in mass quantities because of the ease in which fertilizer anhydrous ammonia can be converted to methamphetamine.
DIF: Cognitive Level: Understand (Comprehension)
13. A woman was bragging about her 12-year-old son who was quiet and spent a lot of his time in his room building model airplanes, and gluing and painting pieces. Which may be concerning to the nurse?
a. Being preadolescent, he needs education on sexual growth and development.
b. He may be inhaling fumes from the aerosol paints and glues.
c. Twelve-year-olds are not usually quiet; he needs a mental health consult.
d. Twelve-year-olds need physical exercise, and he is not getting any sitting around.
ANS: B
Inhalants are fumes from a range of substances such as glues, aerosols, butane, and paint thinner. These products are inexpensive, legal, and easy to obtain, making them attractive to younger adolescents who have less access to illicit drugs. The nurse should first consider the age and safety of the child. Thus, it is appropriate for the nurse to consider that the child may be inhaling the fumes while working with these products. This should be the immediate concern of the nurse. Once this issue has been addressed, the nurse may want to consider the child’s need for additional physical activity, limited interactions with peers, and need for education about growth and development.
DIF: Cognitive Level: Apply (Application)
14. From who is a person aged 12 or older most likely to obtain pain relievers for nonmedical use?
a. Free from a friend or relative
b. Purchased from a friend or relative
c. Through a prescription from a physician
d. Purchased on the Internet
ANS: A
NURSINGTB.COM
Among persons aged 12 or older in 2012 to 2013 who used pain relievers nonmedically in the past 12 months, 53.0% obtained the drug they used most recently from a friend or relative for free; 10.6% bought the drug from a friend or relative, and another 21.2% reported that they obtained the drug through a prescription from one doctor. An annual average of 4.3% people got pain relievers from a drug dealer or other stranger, and 0.1% bought them on the Internet (USDHHS Substance Abuse and Mental Health Services Administration, 2017).
DIF: Cognitive Level: Remember (Knowledge)
15. Which best describes why it is crucial to never use the label of “addiction”?
a. Labeling invites ridicule by other people.
b. Labeling someone avoids actually taking action to correct the behavior.
c. Labels have a tendency to remain throughout the person’s life.
d. Labels influence self-perception, and behavior will begin to fulfill the label.
ANS: D
It is becoming increasingly evident that specific interventions may be needed for each separate addictive problem (e.g., overeating and gambling). Moreover, in each specific group, there is wide individual diversity.
DIF: Cognitive Level: Understand (Comprehension)
16. Which best explains why anyone would ever experiment with an illegal substance?
a. As a way of rebelling against parental authority
b. Because it is forbidden
c. For the thrill of it—without getting caught
d. Friends are encouraging it
ANS: D
Users often describe a progression that began with initiation through social interactions. Particularly among adolescents and young adults, evidence suggests that substance use and abuse often occur in the context of social interactions. Thus, it is likely that friends are encouraging it. This response is more likely than experimentation because of getting a thrill, doing something that is forbidden, or a way to rebel against parental authority.
DIF: Cognitive Level: Understand (Comprehension)
17. A man had managed not to drink for over 2 years, but today, when he was told his position was being eliminated, he drank himself into a stupor. Which approach should the nurse take with this client?
a. Admit the man is an alcoholic and always will be
b. Consider the relapse a learning opportunity and discuss options for coping with problems
c. Have him arrested for disorderly conduct in the hope that jail will get his attention and scare him into avoiding future use
d. Suggest inpatient treatment, where he will not be able to access alcohol
ANS: B
Abstinence is difficult to maintain on a long-term basis. Therefore, an important area is relapse prevention, which aims to prepare the client for the relapse situation in the hope of preventing it or minimizing iNtsUimRpSaIctNonGrTeBco.veCryO.MRelapses are reframed as learning
opportunities, and the client makes plans for coping with negative mood states, meeting the
challenge of craving, and stopping a relapse quickly if it should occur.
DIF: Cognitive Level: Apply (Application)
18. Which is crucial during the detoxification phase of the addiction process?
a. Controlling the environment, so drugs cannot be obtained
b. Maintaining a therapeutic relationship with the client
c. Maintaining communication with the client’s family
d. Managing the acute withdrawal symptoms
ANS: D
Detoxification is best described as a short-term treatment intervention designed to manage acute withdrawal from the substance. It involves medical management to reduce the adverse side effects of the substance and help stabilize the client. Addressing acute withdrawal symptoms is of utmost importance in detoxification.
DIF: Cognitive Level: Understand (Comprehension)
19. Which best explains why drug abusers so often relapse?
a. Drugs are widely available.
b. They lack a supportive environment.
c. They remember how fantastic they feel immediately after using.
d. Drugs make them feel better about life.
ANS: B
Because many abusers lack a supportive environment, the potential for relapse is increased. The availability of drugs, remembering the immediate fantastic feeling of using, or feeling better about life while using are not the primary explanations for why drug abusers relapse.
DIF: Cognitive Level: Understand (Comprehension)
20. Which is the treatment of choice for treating heroin addicts during withdrawal?
a. Acamprosate
b. Benzodiazepines
c. Methadone
d. Naltrexone
ANS: C
Methadone is the treatment of choice in withdrawal from heroin or other opiates. As a detoxification agent, methadone is dispensed over an 8-day period in a tapering dose. Dosage is dependent on the degree of opiate withdrawal symptoms present. Benzodiazepines are used for alcohol withdrawal, and Antabuse is no longer used. Naltrexone may be used to supplement methadone.
DIF: Cognitive Level: Understand (Comprehension)
21. Which is the drug of choice for treating persons with alcohol withdrawal?
a. Antabuse
b. Benzodiazepines
c. Methadone
d. Naltrexone
ANS: B
NURSINGTB.COM
Benzodiazepines are considered effective tools for alcohol withdrawal because they decrease the likelihood of seizures and delirium. The use of Antabuse is rare today because of serious safety issues. Naltrexone is a long-acting narcotic antagonist traditionally used as an adjunct in the treatment of opiate dependence. Methadone is the treatment of choice in withdrawal from heroin or other opiates.
DIF: Cognitive Level: Understand (Comprehension)
22. A client has refused to stop drinking alcohol. Which action should be taken by the nurse?
a. Ask a physician to admit the patient to the acute care hospital.
b. Attempt harm reduction to help the client reduce drinking.
c. Cease giving care because the client is totally noncompliant.
d. Seek to have the patient admitted as a mental health client.
ANS: B
Harm reduction remains controversial although some see it as a paradigm shift with the potential to significantly improve treatment results. Harm reduction is often the only option that will preserve a therapeutic relationship when people continue to use or drink problematically. Attempting the use of harm reduction is preferred over admitting the patient to an acute care hospital, ceasing to provide care, or having the patient admitted as a mental health client.
DIF: Cognitive Level: Apply (Application)
23. “I don’t understand,” the woman said. “It’s my husband who is the alcoholic, not me. Why are you asking me to get involved in his treatment?” Which is the most appropriate response by the nurse?
a. “You are codependent. You will need to learn how to function independently.”
b. “You are an enabler covering up for your husband, and you have to learn how not to do that.”
c. “You are as ill as he is, just in a different way. You also need treatment.”
d. “You have been hurt by his drinking; you will need support as you try to help your husband stop drinking.”
ANS: D
The family has suffered the effects of substance abuse emotionally, socially, economically, physically, and spiritually. The family’s wounds must be acknowledged and treated for the substance abuser to return to an environment supportive of recovery. Although the wife may be a codependent or an enabler, labeling her will not help her learn to change and help her husband change.
DIF: Cognitive Level: Apply (Application)
24. A 14-year-old girl came with her family to the clinic as her father picked up his medication. The girl became anxious and said she had to go home soon to clean the house and start dinner. Which would the nurse most likely suspect from this interaction?
a. As Freud pointed out, girls try to take over the wife role with their dad.
b. The girl did not want to aNdmiRt heIr daGd wBas.aCdruMg addict and was trying to get
away from an uncomfortabUle eSnvirNonmTent. O
c. The girl is taking on the role of hero with responsibility for caretaking functions.
d. The girl was afraid she would be seen with her dad, a known drug addict, in a public place.
ANS: C
In the case of substance abuse, a major purpose of the system is to deny the substance abuse of the affected family member and keep it a “shameful” family secret. Generally, ego boundaries between the family members are weakened or nonexistent, with enmeshment of the members and an intolerance of individual differences. Rules are rigid and communication is unbalanced; the dynamics are either always conflicting or always superficially pleasant.
Children may become involved in a “role reversal” in which they act as caretakers of their parents.
DIF: Cognitive Level: Apply (Application)
25. Which best explains what children of alcoholics do when they become adults with families?
a. They do not touch alcohol because they know the problems it brings.
b. They do not use alcohol but may use other drugs.
c. They manage to use alcohol in social situations but not otherwise.
d. They themselves are at high risk for becoming alcoholics.
ANS: D
Children from dysfunctional families often carry these roles and coping mechanisms into adult life, with many becoming substance abusers or partners of substance abusers. The children of alcoholics also have higher risk for many other behavior and emotional problems.
DIF: Cognitive Level: Understand (Comprehension)
26. Which best describes a professional enabler?
a. A spouse who has been enabling an abuser for several years
b. A physician who provides narcotic analgesics to patients on a regular basis
c. A clergyman who offers to take an abuser to an Alcoholics Anonymous meeting
d. A child who is a caretaker for her substance abusing mother
ANS: B
Health care professionals also can contribute to the initiation and continuation of substance abuse and dependency in various ways, becoming professional enablers. One obvious way is the physician’s role in prescribing psychoactive medications. The medical model advocates the treatment of symptoms by medication. The relief of pain, anxiety, and insomnia is not an exception. The addictive potential of narcotic analgesics and antianxiety agents is often ignored if quick symptom relief is the main goal. Long-term goals for the treatment of medical problems and nonmedication management of pain and anxiety are more thoughtful approaches.
DIF: Cognitive Level: Apply (Application)
27. A young teenager was habitually engaging in binge drinking with friends on weekends. Which would be a long-term concern of this behavior?
a. He might have to drive toNgetRtogIethGer wBit.h CthemMand then drive home after
drinking.
U S N T O
b. Legal drug use almost always precedes use of illegal drugs.
c. Obesity is a major health problem, and alcohol is very high in calories.
d. The teenager’s parents are obviously a dysfunctional family.
ANS: B
All of the answers could be reasons for concern, although young teenagers are too young to drive. Parents are not necessarily dysfunctional on the basis of just the information given. Although obesity is an issue, a more immediate concern would be the fact that use of legal substances (e.g., tobacco, alcohol) almost always precedes use of illegal drugs.
DIF: Cognitive Level: Apply (Application)
28. Which best explains why health professionals and educators are stressing total abstinence of drugs instead of teaching appropriate social use?
a. Federal funds are available to schools if abstinence is stressed.
b. If students perceive a drug as harmful, fewer actually try it.
c. It is easier to avoid a substance altogether than to try to control the dose.
d. This education is consistent with our American culture.
ANS: B
Primary prevention for adolescents is typically focused on education aimed toward complete abstinence. Education plays an important role. A striking feature is the strong adverse relationship between perceived risk and drug use. For all drugs, with no change in drug availability, when students perceive a drug as harmful, fewer students actually use it. Thus, it is important for health professionals and educators to stress total abstinence. Federal funding is not available to schools if abstinence is stressed. This type of education stressing an abstinence only perspective is not consistent with the American culture.
DIF: Cognitive Level: Understand (Comprehension)
29. A registered nurse is discovered stealing a patient’s narcotic medication for personal use. Which is most likely to happen to the nurse?
a. The nurse can be sued by the patient for pain and suffering (because the patient did not get the medication prescribed).
b. The nurse who shows acceptance of a drug problem may be allowed limited practice under supervision while undergoing treatment and monitoring.
c. The nurse will go to jail like any criminal caught stealing.
d. The nurse will lose employment, as well as the license allowing professional practice.
ANS: B
Physicians, nurses, dentists, and pharmacists are vulnerable to substance abuse; alcohol or narcotic use is most common. Their increased access to drugs, belief in pharmaceutical solutions, and work-related stress place them at increased risk for substance abuse. Typically, they gain access to drugs through their work settings by diverting medications for their own use or by abusing drugs obtained by prescription. State regulatory boards discover the abuse by these health care professionals after drug theft or when the effects of their substance abuse
impair their professional functiUoninSg. MNosTt statesOhave rehabilitation programs for health care
professionals that consist of treatment and monitoring. They are allowed to retain their professional licenses during treatment. The threatened loss of their professional license to practice may be a good motivator to break through their denial of the problem and encourage them to seek treatment.
DIF: Cognitive Level: Apply (Application)
30. After his family and employer confronted a man with all the problems his drinking was causing, he agreed to go into treatment. However, the wife asks, “But if we are forcing him to go into treatment, won’t he just resent us and keep on drinking?” Which would be the most appropriate response by the nurse?
a. “He may resent you, but the relationship between the two of you was being ruined by his drinking anyway.”
b. “Isn’t this better until waiting until he has lost his job and you’re forced to seek a divorce?”
c. “Treatment can still be effective, even if you’re forcing him into it.”
d. “You’re right; it’s harder to treat the problem when the person is being forced into treatment, but what choice did you have?”
ANS: C
Although individuals who are forced to enter treatment may not be willing to admit the severity of the abuse, they can still benefit from exposure to the treatment program and eventually begin recovery. Treatment does not need to be voluntary to be effective.
DIF: Cognitive Level: Apply (Application)
31. A family was dependent on the dad for financial support, and now he is in treatment for alcoholism. The wife asks you how long this will take. Which would be the most appropriate response by the nurse?
a. “Don’t worry about length of time. Focus on helping him avoid alcohol.”
b. “It all depends on how badly he wants to hold the family together as opposed to enjoying the relief of drinking again.”
c. “Once an alcoholic, always an alcoholic. He’ll have to avoid liquor the rest of his life.”
d. “Remaining in treatment is crucial; it must last long enough to produce stable behavioral changes.”
ANS: D
Remaining in treatment for an adequate time is crucial for treatment effectiveness. It must last long enough to produce stable behavioral changes.
DIF: Cognitive Level: Understand (Comprehension)
32. Which behavior is a warning that a person is no longer just using a drug’s recreationally but is abusing drugs and becoming addicted?
a. The person decides to try a new drug, claiming to be curious.
b. The person is using the drug more frequently than before.
c. The person joins a friend in using drugs in a social situation.
d. The person is less able to control frequency and amount of indulging.
ANS: D
NURSINGTB.COM
A major step from initiation to continued use to abuse is the stage of transition. Transition is seen when there is a change in total consumption, frequency, and occasions of use. Drug use is now more than just social use, with the person beginning to lose control.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. A client has recently been diagnosed with a substance use disorder. Which criteria would be used to diagnose a client with this disorder? (Select all that apply.)
a. Withdrawal symptoms
b. Tolerance of the substance
c. Social problems related to use of the substance
d. Experimentation with new substances
e. Repeated attempts to control use of the substance without success
f. Neglect of major roles in order to use the substance
ANS: A, B, C, E, F
The American Psychiatric Association (APA), in the DSM-5, no longer uses the terms substance abuse and substance dependence. Rather, it refers to substance use disorders, which are defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual (Hasin et al., 2014). The presence of 2 or more of 11 criteria now indicate substance use disorder: hazardous use; social/interpersonal problems related to use; neglected major roles to use; legal problems; withdrawal (but not for inhalant or hallucinogen disorders); tolerance; used larger amounts/longer; repeated attempts to quit/control use; much time spend using; physical/psychological problems related to use; and activities given up to use (Hasin et al, 2014).
DIF: Cognitive Level: Apply (Application)
2. A nurse plans to implement interventions at the community level to address substance use disorders. Which interventions would the nurse likely implement? (Select all that apply.)
a. Support law enforcement measures to limit access to and distribution of addictive substances (e.g., street drugs)
b. Provide educational programs at schools and penal institutions
c. Facilitate mutual help groups (e.g., Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Al-Anon)
d. Support the development of specialty courts/problem-solving courts (drug courts, veteran courts)
e. Create radio public service communications concerning the risks of substance abuse and the availability of treatment
f. Assist in the formation of national associations such as the National Council on Alcoholism and Drug Dependence
ANS: A, B, E
NURSINGTB.COM
A nurse may intervene at multiple levels (individual and family, community, and state and federal). At the individual and family level, the nurse provides education, treatment, and facilitates mutual help groups such as Alcoholics Anonymous. At the community level, the nurse supports law enforcement measures to limit access to the distribution of addictive substances, implements educational programs at schools and penal institutions, and creates television and radio public service communications concerning the risks of substance abuse and the availability of treatment. At the state and federal level, the nurse assists with formation of national associations such as the National Council on Alcoholism and Drug Dependence and supports the creation of specialty courts/problem-solving courts (drug courts, veteran courts).
DIF: Cognitive Level: Apply (Application)
3. A man was told by his boss that his work had really gone downhill recently and he had to improve or the boss would have to let him go. His wife had moved out of the apartment. Obviously, the drug use was causing problems. Which would cause the man to continue to use? (Select all that apply.)
a. He had paid a lot for this stuff so he had just finished using what he had and then he had quit.
b. He rationalized he was just hitting a rough spot and, as soon as he got over his wife’s betrayal, he would quit using and his job would be fine.
c. He tried to quit, but the withdrawal symptoms were so severe he could not.
d. He verbalized quitting, but his new friends scoffed at him.
e. His boss clearly did not understand what he was dealing with and had not a clue what pressure he was under—so ignoring him was the only option.
f. He knew drug use made him legally handicapped so his boss could not fire him even if he wanted to.
ANS: A, B, C, D
In the transition stage from substance use to substance abuse, there may be clear evidence that there are adverse effects. Rationalizations that deny the seriousness and consequences of the substance use are commonly constructed. Unpleasant physical and emotional withdrawal symptoms are strong motivators to continue use. Being in an environment where others are using will encourage the person to continue using to fit in (peer pressure). The boss clearly understands what is going on, which is why the situation has been addressed. It is unlikely that the drug would make him legally handicapped.
DIF: Cognitive Level: Apply (Application)
4. Which way(s) can physicians enable drug abuse? (Select all that apply.)
a. Prescribing psychoactive medications to a new patient who was claiming anxiety and insomnia
b. Prescribing psychoactive medications to make a patient feel better during a time of situational stress
c. Prescribing nonrefillable small doses of psychoactive medications in response to short-term problems
d. Refusing to prescribe psychoactive medications even if the patient has severe pain so the patient must seek self-medication with illegal substances or alcohol
e. Suggesting psychoactive medications for pain relief after surgical treatment
f. With drugs so available, thUe phSysicNianTcan useOdrugs for a temporary problem;
feeling relief may lead to self-addiction.
ANS: A, B, D, F
Health care professionals also can contribute to the initiation and continuation of substance abuse and dependency in various ways. One obvious way is the physician’s role in prescribing psychoactive medications. The medical model advocates the treatment of symptoms by medication. The relief of pain, anxiety, and insomnia is not an exception. The addictive potential of narcotic analgesics and antianxiety agents is often ignored if quick symptom relief is the main goal. Undermedication or refusal to use “addictive” medicines can lead susceptible clients to self-medicate with illegal drugs or alcohol. A new patient requiring medications may raise suspicion, because drug abusers may go to many different physicians seeking prescriptions. It is not appropriate for psychoactive medications to be suggested for pain relief after surgical treatment.
DIF: Cognitive Level: Understand (Comprehension)
5. Which are basic components of 12-step programs to help treat addictive behaviors such as alcoholism? (Select all that apply.)
a. A willingness to change
b. Attempts to make amends for wrongs done to others
c. Daily attendance at a self-support group meeting
d. Open recognition of weaknesses and request for help from others
e. Public explanation of sins and future plans for resisting temptation
f. Recognition of personal strengths and weaknesses
ANS: A, B, F
Mutual help groups are associations that are voluntarily formed and operate through
face-to-face supportive interaction focusing on a mutual goal. They are usually organized by recovering substance abusers or those recovering from compulsive behavior patterns. The first mutual help group was Alcoholics Anonymous (AA). The early AA members developed 12 steps to guide the recovery process. Basic tenets of 12-step programs include an inventory of past shortcomings and strengths, willingness to change, and making amends. Daily attendance, open recognition of weaknesses and request for help from others, and a public explanation of sins and future plans for resisting temptation are not part of 12-step programs.
DIF: Cognitive Level: Understand (Comprehension)
6. An African American male was addicted to drugs, received treatment, and now needs to resist abusing drugs again. Which barriers exist for this individual? (Select all that apply.)
a. Being arrested when caught rather than receiving treatment
b. Difficulty obtaining employment
c. Easy access to illegal drugs in the community
d. Economic rewards for selling or distributing drugs to others
e. Family demands, including children being physically active and noisy
f. Pressure from drug-using friends to join them in social events
ANS: A, B, C, D, F
Barriers to treating substance abuse and addiction problems in African Americans include poverty, underemployment, and unemployment; prevalence of both drugs and liquor stores within the community; allure and economic rewards of selling drugs; more likely to be
arrested than treated; and unaNbUleRtoS“IchNaGngTeBp.eoCpOleMand places” as advocated by 12-step
programs. Family demands, including children being physically active and noisy, have not
been identified as a common barrier in the African American population.
DIF: Cognitive Level: Apply (Application) [Show Less]