37 - Alcohol, Tobacco, and Other Drug Problems

Question 1

A nurse is providing education to a parent-teacher organization about substance use and abuse among children. Which of the following information would the nurse most likely include in this presentation?

a. ) Inhalants are among the first drugs that young children use.
b. ) Implementing the Drug Abuse Resistance Education (DARE) program is the most effective way to prevent drug use.
c. ) Underage drinking is not a problem in most communities.
d. ) Early experimentation with substances decreases the likelihood of future abuse.

Answer 1

a.) Inhalants are among the first drugs that young children use.

Inhalants are among the first drugs that young children use. The primary abusers of most inhalants are adolescents who are 12-17 years of age. Most recent studies have found that the DARE program is less effective than other interactive prevention programs and may even result in increased drug use. Underage drinking is seen as the most serious drug problem for youth in the United States. The younger a person is when beginning intensive experimentation with drugs, the more likely dependence will develop.

Question 2

A nurse is implementing the harm reduction model. Which of the following will be the focus of nurse when using this approach?

a. ) Education
b. ) Law enforcement
c. ) Scare tactics
d. ) Rehabilitation

Answer 2

a.) Education

The harm reduction model accepts the reality that psychoactive drug use is endemic, and it focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug abuse and get treatment for addicts. The harm reduction model encourages nurses to seek the underlying roots of various health problems and plan action that is realistic, nonjudgmental, holistic, and positive. Law enforcement, scare tactics, and rehabilitation are not part of the harm reduction model

Question 3

The nurse is interviewing a client who reports that he drinks alcohol when snorting cocaine. Which of the following best describes what is happening with this client?

a. ) Drug addiction
b. ) Polysubstance use
c. ) Substance abuse
d. ) Indiscriminate drug use

Answer 3

b.) Polysubstance use

A client who drinks alcohol when snorting cocaine is suffering from polysubstance abuse.

Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed.

Substance abuse is the use of any substance that threatens a person’s health or impairs his or her social or economic functioning.

Indiscriminate drug use refers to careless use of drugs.

Question 4

A nurse is assessing the community for potential settings of drug experiences. Which of the following describes what the nurse would most likely identify?

a. ) A back alley or abandoned building where people are using crack
b. ) An area at the local high school where students are known to smoke cigarettes
c. ) The individuals using the drug, including that individual’s expectations
d. ) The physical, social, and cultural environment within which the use occurs

Answer 4

d.) The physical, social, and cultural environment within which the use occurs

Setting is the influence of the physical, social, and cultural environmental within which the use occurs. All of these environments influence the use of drugs. A back alley, an area at the local high school, and individuals using the drug do not address all of the aspects of setting.

Question 5

The most widely used illicit drug in the United States is:

a. ) alcohol.
b. ) heroin.
c. ) cocaine.
d. ) marijuana.

Answer 5

d.) marijuana.

Marijuana is the most widely used illicit drug in the United States. The oldest and most widely used psychoactive drug in the world is alcohol.

Question 6

How much alcohol can the liver metabolize in an hour?

a. ) 1 oz of whiskey
b. ) 3 oz of wine
c. ) 5 oz of wine
d. ) 12 oz of beer

Answer 6

d.) 12 oz of beer

The amount of alcohol the liver can metabolize per hour is equal to about 3/4 oz of whiskey, 4 oz of wine, or 12 oz of beer.

Question 7

• Dependence* is a term that refers to the:
  a. ) presence and severity of withdrawal symptoms.
  b. ) necessary use of drugs to prevent withdrawal symptoms.
  c. ) level of intoxication associated with addiction.
  d. ) amount of substance needed to satisfy cravings.

Answer 7

b.) necessary use of drugs to prevent withdrawal symptoms.

Dependence refers to the necessary use of drugs to prevent withdrawal symptoms. This occurs because of a state of neuroadaptation (a physiological change in the central nervous system).

Question 8

A nurse has collected a urine specimen from a client for drug testing. Which of the following best describes the purpose of a urinalysis?

a. ) To assess whether a certain drug has been used in the recent past
b. ) To determine the degree of intoxication
c. ) To assess the extent of performance impairment
d. ) To determine how much alcohol was consumed

Answer 8

a.) To assess whether a certain drug has been used in the recent past

The nurse collects a urine specimen with the rationale that urinalysis for drug testing can be used to determine whether a certain drug has been used in the recent past. Urine testing indicates only past use of certain drugs, not intoxication. The extent of performance impairment cannot be determined with urine testing. Alcohol is not always included in a urine drug screen.

Question 9

A nurse partners with multiple agencies in the community to create a support group for those diagnosed with addiction in the community. Which of the following levels of prevention is being implemented?

a. ) Primary
b. ) Secondary
c. ) Tertiary
d. ) Health promotion

Answer 9

c.) Tertiary

When using tertiary prevention, the nurse focuses on treatment and rehabilitation. The support group for those with addiction is helping the addict and the addict’s family, who already “have a problem.”

Primary prevention focuses on health promotion and disease prevention.

Secondary prevention focuses on early detection and screening.

Health promotion is not a level of prevention.

Question 10

A nurse is providing care for a family in which a nonaddict is experiencing a stress-induced preoccupation with an addict’s life, leading to extreme dependence on the addict. Which of the following best describes what is happening?

a. ) Obsession
b. ) Codependency
c. ) Enabling
d. ) Addiction

Answer 10

b.) Codependency

Codependency occurs when a person in a close relationship with an addict develops unhealthy coping mechanisms to continue the relationship.

Obsession is a thought that continually preoccupies ones’ thoughts.

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

Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed.

Question 11

A nurse is caring for a client who is experiencing a drug addiction. Which of the following is the client most at risk for having?

a. ) Infant with a high birth weight
b. ) Easily cured illness or disease
c. ) Accident or committing suicide
d. ) Problem finding employment

Answer 11

c.) Accident or committing suicide

ATOD abuse and addiction is associated with many problems, including neonates with low birth weights and congenital anomalies; accidents, homicides, and suicides; chronic diseases such as cardiovascular disease, cancer, lung disease, hepatitis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS); and mental illness.

Question 12

A nurse is providing comprehensive education about HIV transmission for an injection drug user (IDU). Which of the following would be the most important information to include?

a. ) How and where to acquire needles
b. ) Proper needle usage and possible injection sites
c. ) Spreading of the virus via homosexual activities
d. ) Using bleach between needle uses

Answer 12

d.) Using bleach between needle uses

IDUs represent the most rapidly growing source of new cases of AIDS, and they are the greatest risk for spread of the virus in the heterosexual community. Emphasis is being placed on reduction of the transmission of this disease through contaminated needles. Nurses should provide education on cleaning needles with bleach between uses to decrease the spread of the virus. Education on needle exchange programs is also appropriate; however, this population is not as likely to use these programs even when they are available.

Question 13

A nurse is giving advice using the acronym FRAMES. Which of the following actions would most likely be taken by the nurse?

a. ) Offer a suggestion as to how the behavior should change
b. ) Provide clear guidance to change risky behavior
c. ) Refer the client to a local support group
d. ) Emphasize the need for others to support the client’s change

Answer 13

b.) Provide clear guidance to change risky behavior

Providing clear advice to change risky behavior is one of the elements of the FRAMES method of intervention, “A”—advice. The other FRAMES are feedback, responsibility, menu, empathy, and self-efficacy.

Question 14

A client has not yet made a commitment to take action to change his health behaviors. Which stage of change is the client experiencing?

a. ) Precontemplation
b. ) Contemplation
c. ) Preparation
d. ) Action

Answer 14

b.) Contemplation

During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem. In precontemplation, the person does not intend to change in the foreseeable future. In the preparation phase, the individual is prepared for action and may reduce the problem behavior but has not yet taken effective action. In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.

Question 15

A nurse is caring for adolescents who have experienced substance abuse. Which of the following should the nurse recognize as a major influence in this population?

a. ) Family-related factors
b. ) Positive media messages
c. ) Socioeconomic level
d. ) Peer pressure

Answer 15

a.) Family-related factors

Substance abuse among adolescents is influenced most by family-related factors, such as genetics, family stress, and parenting styles. Research suggests that successful social influence-based prevention programs may be driven by their ability to foster social norms that reduce an adolescent’s social motivation to begin using ATODs. Peer pressure and socioeconomic level may play a role in the abuse of substances, but this has not been the major factor identified. Media messages promoting the use of substances may influence this population, but is not the major factor that has been identified.

Question 16

The leading cause of birth defects in the United States is:

a. ) cigarette smoking.
b. ) fetal alcohol syndrome.
c. ) marijuana use.
d. ) HIV from sharing needles.

Answer 16

b.) fetal alcohol syndrome.

The leading preventable cause of birth defects in the United States is fetal alcohol syndrome, causing mental and behavioral impairment.

Question 17

A nurse is caring for a client who has had long-term marijuana use. Which of the following physical effects should be of priority concern to the nurse?

a. ) Constipation
b. ) Cardiac dysrhythmia
c. ) Abdominal pain
d. ) Respiratory tract damage

Answer 17

d.) Respiratory tract damage

Respiratory tract damage occurs from smoking the drug and is the greatest physical concern among chronic users.

Cardiac dysrhythmias may be a concern of chronic alcohol use.

Constipation and abdominal pain are not of priority concern.

Question 18

What happened in the United States as a result of prohibition?

a. ) Substance abuse declined
b. ) Violent crime and corruption increased
c. ) The need for community health nurses declined
d. ) Facilities to treat substance abuse improved

Answer 18

b.) Violent crime and corruption increased

Prohibition led to increased crime and corruption among law officials related to the illicit market. Because of the problems that were caused, prohibition was eventually recognized as a failure and repealed.

Question 19

he use of any substance that threatens a person’s health or impairs his or her social or economic functioning is:

a. ) drug dependence.
b. ) substance abuse.
c. ) drug addiction.
d. ) illegal.

Answer 19

b.) substance abuse.

Substance abuse is the use of any substance that threatens a person’s health or impairs his or her social or economic functioning.

Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug.

Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed.

Illegal means that it is against the law, not all substances are illegal.

Question 20

Which health problem causes more deaths, illnesses, and disabilities than any other in the United States?

a. ) Tobacco addiction
b. ) Alcohol abuse
c. ) Substance abuse
d. ) Caffeine addiction

Answer 20

c.) Substance abuse

Substance abuse is the number one national health problem, causing more deaths, illnesses, and disabilities than any other health condition. Tobacco addiction, caffeine addiction, and alcohol abuse are part of substance abuse.

Question 21

The nurse is providing community health education about how alcohol affects the body. Which of the following individuals would the nurse describe as being most likely to have the lowest blood alcohol concentration?

a. ) An individual who consumes a drink with a high concentration of alcohol
b. ) An individual who drinks without consuming food
c. ) An individual of the female gender
d. ) An individual with a high body weight

Answer 21

d.) An individual with a high body weight

An individual with a high body weight would likely have the lowest blood alcohol concentration. Increased alcohol concentration, drinking without consuming food, and being a female are all factors that increase blood alcohol concentration.

Question 22

A nurse lobbies with legislators for the passage of legislation to prohibit smoking of tobacco products in public places. Which of the following levels of prevention is being implemented?

a. ) Primary
b. ) Secondary
c. ) Tertiary
d. ) Health promotion

Answer 22

a.) Primary

When using primary prevention, the focus is on health promotion and disease prevention.

When using tertiary prevention, the nurse focuses on treatment and rehabilitation.

Secondary prevention focuses on early detection and screening.

Health promotion is not a level of prevention.

Question 23

The oldest and most widely used psychoactive drug in the world is:

a. ) marijuana.
b. ) heroin.
c. ) alcohol.
d. ) cocaine.

Answer 23

c.) alcohol.

The oldest and most widely used psychoactive drug in the world is alcohol. Marijuana is the most widely used illicit drug in the United States.

Question 24

A nurse is caring for a client who has a history of chronic alcohol abuse. Which of the following medical problems should the nurse anticipate? (Select all that apply.)

a. ) Gastrointestinal disturbances
b. ) Cardiac dysrhythmias
c. ) Depression
d. ) Organic brain syndrome
e. ) Hepatitis B

Answer 24

a.) Gastrointestinal disturbances

b.) Cardiac dysrhythmias

c.) Depression

d.) Organic brain syndrome

Gastrointestinal disturbances, cardiac dysrhythmias, depression, and organic brain syndrome are some effects of chronic alcohol abuse.

Question 25

Why must nurses examine their attitudes about alcohol, tobacco, and other drug (ATOD) abuse and addiction before working with individuals with this health problem?

a. ) Working with clients who have addiction problems often puts the nurse at risk for violence.
b. ) The population of persons with drug and alcohol addiction is found in low-income neighborhoods.
c. ) To be therapeutic, a nurse must develop a trusting nonjudgmental relationship with clients.
d. ) Nurses are the primary persons who treat addiction problems.

Answer 25

c.) To be therapeutic, a nurse must develop a trusting nonjudgmental relationship with clients.

To be therapeutic, the nurse must develop a trusting, nonjudgmental relationship with clients. Therefore, nurses must examine their own attitudes ahead of time.

Working with clients who have addiction problems does not put the nurse at risk for violence. People with drug and alcohol addiction can be found in any neighborhood. Nurses do not treat addiction problems.

Question 26

A nurse is working with a client during a smoking cessation program. The client has developed an action plan for smoking cessation, but has not yet implemented it. Which stage of change is the client experiencing?

a. ) Precontemplation
b. ) Contemplation
c. ) Preparation
d. ) Action

Answer 26

c.) Preparation

During preparation, the individual is prepared for action and may reduce the problem behavior but has not taken effective action yet.

During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem.

In precontemplation, the person does not intend to change in the foreseeable future.

In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.

Question 27

A nurse is assessing a client for addiction. Which of the following primary symptoms of addiction should the nurse recognize?

a. ) Anger
b. ) Apathy
c. ) Denial
d. ) Violence

Answer 27

c.) Denial

In assessing for addiction, the nurse should be aware that a primary symptom of addiction is denial.

Anger, apathy, and violence are not considered the primary symptoms of addiction.

Question 28

Which statement about nicotine and smoking is accurate?

a. ) Cigars contain higher doses of nicotine than cigarettes.
b. ) Tolerance to nicotine takes days to develop.
c. ) Sidestream smoke contains more toxic compounds than mainstream smoke.
d. ) The harsher smoke of pipes and cigars is more hazardous than cigarette smoke.

Answer 28

c.) Sidestream smoke contains more toxic compounds than mainstream smoke.

It is true that sidestream smoke contains greater concentrations of toxic and carcinogenic compounds than mainstream smoke. Pipes are less hazardous than cigarettes because the harsher smoke discourages deep inhalation. The body quickly develops tolerance to nicotine.

Question 29

A school nurse is coordinating the implementation of a drug education program in the school. Which of the following levels of prevention is being implemented?

a. ) Primary level of prevention
b. ) Secondary level of prevention
c. ) Tertiary level of prevention
d. ) Primary health care prevention

Answer 29

a.) Primary level of prevention

Primary prevention includes education about drugs and guidelines for their use, preventing the problem before it occurs.

Secondary prevention aims for early detection and screening.

Tertiary prevention addresses treatment and rehabilitation.

Primary health care prevention is not a level of prevention.

Question 30

A nurse recommends to a school board that other methods besides the “just say no” approach be considered when providing drug use prevention education to the elementary students. Which of the following best describes the rationale for this recommendation?

a. ) Children do not like to hear the word “no,” and the approach is too negative.
b. ) Project DARE is more effective and has decreased drug use.
c. ) Children are naturally curious and may experiment with drugs.
d. ) “Just say no” to drugs does not include smoking and alcohol abuse.

Answer 30

c.) Children are naturally curious and may experiment with drugs.

The “just say no“ approach does not help young people because children are naturally curious and drug experimentation is often a part of normal development, children from dysfunctional homes often use drugs to get attention and escape intolerable environments, and it does not address the powerful component of peer pressure.

Most recent studies have found that the DARE program is less effective than other interactive prevention programs and may even result in increased drug use.

Question 31

A nurse refers a client to alcoholics anonymous (AA). Who will play the most important role in the treatment of alcoholism at this support group?

a. ) Self
b. ) Spouses
c. ) Children
d. ) Peers

Answer 31

d.) Peers

AA began a strong movement of peer support to treat a chronic illness. The fellowship, support, and encouragement among AA members provide a vital social network for the person recovering from an addiction.

Question 32

Which factor has contributed to the problem of substance abuse?

a. ) Increased knowledge about the use of drugs
b. ) Social acceptability of certain drugs
c. ) Recognition of substance abuse as a health problem
d. ) Control of the content and strength of illegal drugs

Answer 32

b.) Social acceptability of certain drugs

Social acceptance of certain drugs, such as caffeine, alcohol, and tobacco, contributes to the substance abuse problem. Not all substances that are abused are illegal.

Question 33

A nurse is assessing the drug use patterns of a client. Which of the following questions would be most appropriate for the nurse to ask?

a. ) Where was the drug acquired?
b. ) Who gave the drug to you?
c. ) Why do you use the drug?
d. ) How often do you use the drug?

Answer 33

d.) How often do you use the drug?

During an assessment, all relevant drug-use history is collected and aids in the assessment of drug-use patterns. The nurse should note any changes in drug-use patterns over time. Thus, the most appropriate question is the nurse asking how often a client uses drugs.