adams4e tif ch11

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 11Question 1Type: MCMA

The nurse is managing care for a group of substance abusers. The patients have completed group education about the disease of addiction. The nurse determines that learning has occurred when the patients make which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "A heroin addict can die from heroin withdrawal."

2. "Substance abuse depends on complex variables."

3. "Most addicts became addicted from pain medication in a hospital."

4. "Addiction includes a compulsion to use a mood-altering substance."

5. "There is most likely a genetic component to addiction."

Correct Answer: 2,4,5

Rationale 1: Addiction is an overwhelming compulsion that drives someone to repetitive drug-taking behavior, despite serious health and social consequences. Substance abuse depends on multiple, complex, interacting variables. Children of alcoholic parents are four times more likely to become alcoholics than children of nonalcoholic parents. Prescription drugs rarely cause addiction when used according to accepted medical protocols. While extremely unpleasant, withdrawal from opioids is not life threatening.



Rationale 4: Addiction is an overwhelming compulsion that drives someone to repetitive drug-taking behavior, despite serious health and social consequences. Substance abuse depends on multiple, complex, interacting

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

variables. Children of alcoholic parents are four times more likely to become alcoholics than children of nonalcoholic parents. Prescription drugs rarely cause addiction when used according to accepted medical protocols. While extremely unpleasant, withdrawal from opioids is not life threatening.


Global Rationale:

Cognitive Level: ApplyingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 11-1

Question 2Type: MCSA

The adolescent patient is in a drug rehabilitation program. The mother of this patient says to the nurse, "The doctor said my son has a physical addiction to alcohol. What does this mean?" What is the best response by the nurse?

1. "His brain remembers the euphoria he had with alcohol, and he has a craving to return to it."

2. "He will have an intense craving for alcohol; this is best managed in group therapy."

3. "His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped."

4. "He will have feelings of depression when stopping alcohol; we need to monitor him for suicide."

Correct Answer: 3

Rationale 1: Over time, the body's cells become accustomed to the presence of the unnatural substance. Specific, physical withdrawal symptoms will occur; the patient needs to be medically withdrawn from the substance. Psychological dependence, or craving, does not involve physical withdrawal symptoms. Alcohol does produce euphoria, but a craving for the substance is not a medical issue. Depression may accompany physical withdrawal, but physical signs are what require medical management.





Global Rationale:

Cognitive Level: ApplyingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 11-2


The patient has an extensive history of alcoholism. He is having coronary bypass surgery. While administering anesthesia, the certified nurse anesthetist notes that the patient requires higher-than-usual amounts of the drug. The nurse correctly evaluates this response as what phenomenon?

1. The nurse anesthetist most likely did not calculate the correct amount of anesthesia for this patient.

2. The patient has developed a paradoxical reaction to the anesthesia, and will require a different drug.

3. The patient has developed a resistance to the anesthesia, so it will not work very well.

4. The patient had developed cross-tolerance to the anesthesia, and will require higher amounts.

Correct Answer: 4

Rationale 1: With chronic alcohol use, the liver adapts and metabolizes alcohol at a faster rate. More of the substance is required to achieve the same effect. This is a phenomenon known as cross-tolerance. This patient has a tolerance to alcohol, so he will require additional anesthesia for surgery since both drugs are CNS depressants. There is no evidence to support that the nurse anesthetist incorrectly calculated the anesthesia dose. Resistance refers to the immune system and infections, and should not be used interchangeably with tolerance. Paradoxical refers to the opposite response; in this case, the patient would have become very excitable; there is no evidence of this.

Rationale 2: With chronic alcohol use, the liver adapts and metabolizes alcohol at a faster rate. More of the substance is required to achieve the same effect. This is a phenomenon known as cross-tolerance. This patient has Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

a tolerance to alcohol, so he will require additional anesthesia for surgery since both drugs are CNS depressants. There is no evidence to support that the nurse anesthetist incorrectly calculated the anesthesia dose. Resistance refers to the immune system and infections, and should not be used interchangeably with tolerance. Paradoxical refers to the opposite response; in this case, the patient would have become very excitable; there is no evidence of this.



Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 11-4


The patient comes to the emergency department and tells the nurse, "I have been off my drugs for 3 days." The nurse assesses the patient for withdrawal symptoms associated with the category of drug used. Withdrawal from which drug, if taken by the patient, should cause the nurse the most concern?

1. Heroin

2. Alprazolam (Xanax)

3. Cocaine

4. Marijuana

Correct Answer: 2


Rationale 1: Alprazolam (Xanax) is a benzodiazepine. This drug, which is a central nervous system (CNS) depressant, will likely lead to the most life-threatening withdrawal symptoms in a patient who has stopped taking it. Withdrawal from heroin is very unpleasant, but it is not life threatening. Withdrawal from cocaine is uncomfortable, but it is not life threatening. There is virtually no withdrawal from marijuana.




Global Rationale:

Cognitive Level: ApplyingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-3


The mother of an adolescent patient says to the nurse, "I think my son is staying up too late studying, and I see him using Visine eye drops all the time for his red eyes. Should I have his vision checked?" What is the best response by the nurse?

1. "He might be depressed; insomnia is common with depression."

2. "Sounds like he is smoking marijuana, and I would talk to him."

3. "Sounds like he is using cocaine; I have seen this before."

4. "Yes, that is a great idea, he may need some glasses."

Correct Answer: 2

Rationale 1: One hallmark symptom of marijuana use is red or bloodshot eyes, caused by dilation of blood vessels. Visine constricts the blood vessels of the eyes, reducing the redness. It is important for the parent to Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

discuss this with the adolescent. Having the adolescent's eyes checked may indicate that the mother is in denial, and that the nurse needs to be more alert to the signs and symptoms of drug abuse. Depression in this patient is possible, but depressed patients do not always have red eyes, and do not commonly use Visine eye drops. Red or bloodshot eyes are not commonly seen with cocaine abuse, but are always seen with marijuana use.

Rationale 2: One hallmark symptom of marijuana use is red or bloodshot eyes, caused by dilation of blood vessels. Visine constricts the blood vessels of the eyes, reducing the redness. It is important for the parent to discuss this with the adolescent. Having the adolescent's eyes checked may indicate that the mother is in denial, and that the nurse needs to be more alert to the signs and symptoms of drug abuse. Depression in this patient is possible, but depressed patients do not always have red eyes, and do not commonly use Visine eye drops. Red or bloodshot eyes are not commonly seen with cocaine abuse, but are always seen with marijuana use.



Global Rationale:



The patient has been abusing alcohol for several years and tells the nurse, "I used to drink a pint of whiskey every day. Now I get sick and pass out after just two drinks." What does the nurse correctly recognize about this patient?

1. The patient's symptoms are related to hyperglycemia; he may have pancreatic damage.

2. The patient may have liver damage, resulting in an inability to metabolize large amounts of alcohol.

3. The patient is in denial and is most likely minimizing the amount of alcohol he consumes.


4. The patient has brain damage from the alcohol and cannot remember how much he consumes.

Correct Answer: 2

Rationale 1: Alcoholism is a common cause of cirrhosis, a debilitating, and often fatal, failure of the liver to perform its vital functions, such as metabolism of alcohol. While patients with alcoholism are frequently in denial, and tend to minimize the amount of alcohol they consume, this patient is describing the results of liver damage. While patients with alcoholism frequently have pancreatic damage, this patient is describing the results of liver damage. While patients with alcoholism frequently have brain damage, this patient is describing the results of liver damage.




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-5

Question 7Type: MCMA

The patient is withdrawing from opioids. Which symptom best describe(s) the results of the nurse's assessment?




1. Abdominal cramping and pain

2. Hypotension

3. Pinpoint pupils

4. Dilated pupils

5. Diaphoresis


Rationale 1: Signs of opioid withdrawal include diaphoresis, restlessness, dilated pupils, hypertension, and abdominal cramps and pain. The pupils will be dilated during opioid withdrawal, but will appear as pinpoints when the patient is using opioids. The blood pressure will be elevated during opioid withdrawal, but will be decreased when the patient is using opioids.

Rationale 2: Signs of opioid withdrawal include diaphoresis, restlessness, dilated pupils, hypertension, and abdominal cramps and pain. The pupils will be dilated during opioid withdrawal, but will appear as pinpointswhen the patient is using opioids. The blood pressure will be elevated during opioid withdrawal, but will be decreased when the patient is using opioids.




Global Rationale:

Cognitive Level: ApplyingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-3



What is a priority outcome for the patient who has chronic alcoholism with liver damage?

1. The patient will switch to a safer drug, like a benzodiazepine.

2. The patient will become involved in Alcoholics Anonymous (AA).

3. The patient will keep all appointments with the doctor treating his liver damage.

4. The patient will learn to drink more responsibly.

Correct Answer: 2

Rationale 1: Long-term management for alcohol abuse includes behavioral counseling and self-help groups like Alcoholics Anonymous (AA). The priority outcome, and a principle of Alcoholics Anonymous (AA), is complete abstinence from mood-altering substances so the patient should not use benzodiazepines. Drinking more responsibly is not appropriate; the patient must abstain from all alcohol. Keeping all medical appointments is a good outcome, but does not address the problem of the patient's continued use of alcohol.




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 11-6



The patient is admitted to the in-patient substance abuse unit. She tells the nurse she has been buying "yellow jackets" (pentobarbital, [Nembutal]) on the street, but hasn't had any for a few days. What is the best plan by the nurse at this time?

1. Prepare to manage the depression and suicidal thoughts the patient will have.

2. Prepare to do frequent room searches, as the patient's friends will most likely bring drugs in for her.

3. Prepare to manage a withdrawal that could be life threatening.

4. Prepare to manage a withdrawal that will likely be minimal.

Correct Answer: 3

Rationale 1: Barbiturates are central nervous depressant (CNS) drugs. Withdrawal symptoms resemble those of alcohol withdrawal, and may be life threatening. Withdrawal from barbiturates will more likely be life threatening, not minimal. Physical needs have priority over psychological needs, such as depression, in this case. Doing room searches is a good idea, but preparing for withdrawal is a higher priority.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 11-5

Question 10


Type: MCSA

The patient had been abusing cocaine for several years. Recently, the patient snorted cocaine that was much purer than was thought, resulting in an overdose. The patient died in the emergency department. What does the nurse recognize as the most likely cause of death?

1. Cardiac arrest

2. Rhabdomyolysis

3. Impurities in the cocaine

4. Bowel ischemia

Correct Answer: 1

Rationale 1: Overdose of cocaine can result in dysrhythmias, convulsions, stroke, or death due to cardiac and respiratory arrest. Impurities in the cocaine would not have resulted in the death of the patient. Bowel ischemia would not occur with a cocaine overdose. Rhabdomyolysis would not occur with a cocaine overdose.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 11-5


The patient has smoked a pack of cigarettes per day for 20 years. The patient also takes oral contraceptives. In implementing a teaching plan, what is the most important information for the nurse to include?


1. “You are at a higher risk for a heart attack than nonsmokers.”

2. “The nicotine will decrease the effectiveness of your birth control pills.”

3. “You are at a higher risk for developing diabetes than smokers who do not use birth control pills.”

4. “You are at a higher risk for emphysema than nonsmokers.”

Correct Answer: 1

Rationale 1: Cardiovascular effects can be particularly serious in patients taking oral contraceptives if they also smoke. The risk of a fatal heart attack is five times greater in smokers who also use oral contraceptives than in nonsmokers. There is no evidence to support that nicotine decreases the effectiveness of oral contraceptives. Smokers are at higher risk for emphysema, but this has nothing do with the patient's use of oral contraceptives. There is no evidence to support a correlation between diabetes, smoking, and oral contraceptives.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 11-5



The patient has been prescribed disulfiram (Antabuse) to discourage a return to drinking alcohol. The patient tells the nurse that after stopping disulfiram (Antabuse) for a week, he returned to drinking alcohol. What will the nurse most likely assess in the patient?

1. Headache, nausea, and vomiting

2. Confusion and fine tremors

3. An absence of symptoms, as the drug was discontinued

4. Severe hyperglycemia and dry skin

Correct Answer: 1

Rationale 1: If alcohol is consumed while taking disulfiram (Antabuse), the patient becomes violently ill within 5 to 10 minutes. Symptoms include headache, shortness of breath, nausea, and vomiting. Alcohol sensitivity continues for up to 2 weeks after disulfiram (Antabuse) has been discontinued. Severe hypoglycemia and dry skin are not side effects of the combined use of alcohol and disulfiram (Antabuse). Confusion and fine tremors are not side effects of the combined use of alcohol and disulfiram (Antabuse).




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-6

Question 13Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Type: MCSA

The patient tells the nurse that her 12-year-old child asks to use her nail polish remover several times a day. When her friends come to visit, this seems to occur more frequently. What is the best response by the nurse?

1. "Your daughter may be 'huffing'; that is really scary."

2. "Your daughter may be 'huffing' or inhaling the remover."

3. "Your daughter may be 'huffing' or drinking small amounts of the remover."

4. "Your daughter may be 'huffing' or rubbing the remover on her skin."

Correct Answer: 2

Rationale 1: Inhaling volatile chemicals, known as "huffing" is most prevalent in the 10-to-12-year-old group. Virtually any organic compound can be huffed, including nail polish remover, spray paint, household glue, and gasoline. Huffing involves inhaling volatile chemicals, not rubbing them on the skin. Huffing involves inhaling volatile chemicals, not drinking them. Telling the mother that "huffing" is scary does not give her much information, and is an inappropriate response.




Global Rationale:




The patient is a 10-year-old child admitted to the emergency department after "huffing" gasoline. The physician suspects mild brain damage. What signs will the nurse teach the parents to observe for after they take the child home?

1. Slurred speech, memory loss, and personality changes

2. Depression, cold extremities, and dyspnea

3. Nausea, vomiting, and dizziness

4. Irregular pulse, fainting, and anger

Correct Answer: 1

Rationale 1: Children can die after a single episode of "huffing" a volatile chemical, or they may suffer brain damage. Brain damage may be manifested as slurred or slow speech, memory loss, or personality changes. Irregular pulse, fainting, and anger are not signs of brain damage. Depression, cold extremities, and dyspnea are not signs of brain damage. Nausea, vomiting, and dizziness are not signs of brain damage.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 11-6

Question 15


Type: MCSA

Which of the following profiles would have the greatest risk for developing a drug addiction?

1. A 30-year-old female who is pregnant and lives in an apartment in a small town (lower middle class)

2. A 45-year-old female with diabetes who lives in a house in the country (middle class)

3. A 21-year-old male with insomnia who lives in a college dormitory (wealthy)

4. A 70-year-old retired male with congestive heart failure who lives in his house in a large city (fixed income)

Correct Answer: 3

Rationale 1: The 21-year-old male has the most risk factors. He lives in a college dormitory, where peer pressure and drug availability are more likely. He also suffers from insomnia, which would likely encourage scheduled drug use. Finally, he is wealthy, enabling him to purchase drugs. The 70-year-old male has congestive heart failure, which generally does not require highly addictive drugs. Additionally, he is on a fixed income, which would make it more difficult to support a drug addiction. The 30-year-old female is also in a lower financial class, making it more difficult to support a drug addiction. Additionally, she is pregnant, and social norms generally are not supportive of drug use during pregnancy. The 45-year-old female might have the financial means to support a drug addiction but suffers from diabetes, which does not generally require addictive drug therapy.

Rationale 2: The 21-year-old male has the most risk factors. He lives in a college dormitory, where peer pressure and drug availability are more likely. He also suffers from insomnia, which would likely encourage scheduled drug use. Finally, he is wealthy, enabling him to purchase drugs. The 70-year-old male has congestive heart failure, which generally does not require highly addictive drugs. Additionally, he is on a fixed income, which would make it more difficult to support a drug addiction. The 30-year-old female is also in a lower financial class, making it more difficult to support a drug addiction. Additionally, she is pregnant, and social norms generally are not supportive of drug use during pregnancy. The 45-year-old female might have the financial means to support a drug addiction but suffers from diabetes, which does not generally require addictive drug therapy

Rationale 3: The 21-year-old male has the most risk factors. He lives in a college dormitory, where peer pressure and drug availability are more likely. He also suffers from insomnia, which would likely encourage scheduled drug use. Finally, he is wealthy, enabling him to purchase drugs. The 70-year-old male has congestive heart failure, which generally does not require highly addictive drugs. Additionally, he is on a fixed income, which would make it more difficult to support a drug addiction. The 30-year-old female is also in a lower financial class, making it more difficult to support a drug addiction. Additionally, she is pregnant, and social norms generally are not supportive of drug use during pregnancy. The 45-year-old female might have the financial means to support a drug addiction but suffers from diabetes, which does not generally require addictive drug therapy.

Rationale 4: The 21-year-old male has the most risk factors. He lives in a college dormitory, where peer pressure and drug availability are more likely. He also suffers from insomnia, which would likely encourage scheduled drug use. Finally, he is wealthy, enabling him to purchase drugs. The 70-year-old male has congestive heart failure, which generally does not require highly addictive drugs. Additionally, he is on a fixed income, which would make it more difficult to support a drug addiction. The 30-year-old female is also in a lower financial class, making it more difficult to support a drug addiction. Additionally, she is pregnant, and social norms generally are


not supportive of drug use during pregnancy. The 45-year-old female might have the financial means to support a drug addiction but suffers from diabetes, which does not generally require addictive drug therapy.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Health Promotion and MaintenanceClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-1


When an individual wants to stop using a drug but can’t, she would be suffering from

1. psychological dependence.

2. substance dependence.

3. physical dependence.

4. withdrawal syndrome.

Correct Answer: 2

Rationale 1: The question does not indicate the presence or lack of symptoms. Therefore, the more general term substance dependence is the best choice.




Global Rationale:

Cognitive Level: RememberingClient Need: Health Promotion and MaintenanceClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-2

Question 17Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Type: MCSA

The nurse would expect to see which of the following withdrawal symptoms from an alcoholic patient?

1. Lethargy, constipation, light sensitivity, and weight loss

2. Anxiety, seizures, hearing loss, and alopecia

3. Tremors, anxiety, confusion, and delirium

4. Abdominal pain, chills, pupil dilation, and lethargy

Correct Answer: 3

Rationale 1: Common withdrawal symptoms associated with alcohol include tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, seizures, and delirium.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-3


A hospice patient has been receiving oral pain medication for several weeks. The patient started with 4 mg of the drug, and each week has had to increase the amount by 2–3 mg to obtain adequate pain relief. The nurse recognizes that the patient

1. has developed immunity to the drug.

2. has developed a tolerance to the drug.

3. has developed a physiologic addiction to the drug.


4. has developed a psychological addiction to the drug.

Correct Answer: 3

Rationale 1: Drug tolerance occurs when the body adapts to a substance after repeated administration. Although addictions are possible, the situation presented best describes drug tolerance, not addiction. Drug immunity is a term that is often confused with drug tolerance. Drug immunity is more appropriately used when discussing the immune system.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-4


Which of the following drugs is least likely to produce physical dependence or tolerance?

1. Marijuana

2. Morphine

3. Nicotine

4. Ethyl alcohol

Correct Answer: 1


Rationale 1: Although psychological dependence is very high with marijuana, it has minor-to-no withdrawal symptoms.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-5


During a health history, the nurse should use therapeutic communication when asking about substance abuse. Which of the following is essential to establish a trusting nurse–patient relationship?

1. Informing the patient that substance abuse is a sin

2. Avoiding communicating disapproval of indicated substance abuse

3. Ensuring that the patient's mother and father are at the bedside

4. Avoiding shocked facial expressions

Correct Answer: 4

Rationale 1: The nurse should be nonjudgmental, but should firmly communicate disapproval of any indicated substance abuse. Informing the patient that substance abuse is a sin is being judgmental. Patients might be less likely to inform the nurse of a hidden substance abuse problem in the presence of family members.


Rationale 3: The nurse should be nonjudgmental, but should firmly communicate disapproval of any indicated substance abuse. Informing the patient that substance abuse is a sin is being judgmental. Patients might be less likely to inform the nurse of a hidden substance abuse problem in the presence of family members. Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


Global Rationale:

Cognitive Level: UnderstandingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 11-6


A patient suffering from tachycardia and palpitations would most likely be experiencing the signs of drug toxicity from which of the following?

1. Nicotine

2. Alcohol

3. Benzodiazepines

4. Marijuana

Correct Answer: 1

Rationale 1: Signs of nicotine toxicity include heart palpitations, tachydysrhythmias, confusion, depression, and seizures.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment


Learning Outcome: 11-5


A patient is admitted with complications of long-term abuse of anabolic steroids. Which of the following patient histories should not surprise the nurse?



1. A 23-year-old personal trainer

2. A 17-year-old senior high school baseball player

3. A 35-year-old weightlifter

4. A 32-year-old professional football player

5. A 21-year-old downhill skier preparing for the Olympics


Rationale 1: Some abusers use anabolic steroids to enhance their appearance. It should not be surprising to find steroid abuse in this patient.

Rationale 2: High school students are not tested for anabolic steroid use, so it would not be surprising to find steroid abuse in this patient.

Rationale 3: If this weightlifter is not competing in a professional organization, it would not be surprising to find that this patient is abusing anabolic steroids.

Rationale 4: Since most sports organizations, including professional football, test for steroid use, it would be surprising to find that this patient is abusing anabolic steroids.

Rationale 5: Since most sports organizations, including the Olympics, test for steroid use, it would be surprising to find that this patient is abusing anabolic steroids.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 11-1



A nurse is preparing to admit a patient suspected of overdose. The nurse knows to suspect which drugs as being the most commonly abused?



1. Methylphenidate (Ritalin)

2. Nicotine

3. Marijuana

4. Amobarbital (Amytal)

5. Secobarbital (Seconal)


Rationale 1: Legal prescriptions such as methylphenidate (Ritalin) have become frequent drugs of abuse.

Rationale 2: Nicotine is one of the most commonly abused drugs.

Rationale 3: Marijuana is the most frequently abused illegal drug.

Rationale 4: The medical use of barbiturates has declined, decreasing illicit abuse.

Rationale 5: The medical use of barbiturates has declined, decreasing illicit abuse.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 11-1


The nurse is reinforcing factors that contribute to addiction to a group of patients recovering from addiction and their family members. Which statement made by a patient or family member would indicate the need for additional teaching?




1. "I'm not likely to have any more problems with addiction since neither of my parents had a problem with addiction."

2. "I can still see my friends as long as I stay away from alcohol."

3. "I don't want to become addicted like my husband did. I'm never going to take any kind of drug unless I absolutely have to."

4. "I realize now that I was just looking for ways to help me feel good about myself."

5. "After a while, it just seemed even though I was not in pain, I would still want to take the pain pills."


Rationale 1: Addiction depends on multiple and complex variables. Genetics plays a part but many other factors also contribute to addiction.

Rationale 2: Counselors encourage users to stop associating with social contacts who shared the substance abuse to lessen the possibility for relapse.

Rationale 3: The therapeutic use of drugs rarely causes addiction when used according to accepted medical protocols.

Rationale 4: The drug experience may bring feelings of pleasure or well-being. The patient may find achieving this feeling to be worth repeating, leading to addiction.

Rationale 5: This patient recognizes that taking pain medication even when in not pain leaves one vulnerable for addiction. The therapeutic use of drugs rarely causes addiction when used according to accepted medical protocols.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-4


A patient has been abusing an antianxiety medication. Which assessment by the nurse would confirm this is psychological dependence instead of physical dependence? Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



1. The patient's history reveals the long-term use of high doses of an antianxiety medication.

2. The patient describes the "need" to use the antianxiety medication despite not feeling anxious.

3. The patient describes feeling nauseous with abdominal cramping.

4. The patient tells you her family has "disowned" her because of her need for the antianxiety medication.

5. The patient complains she has not slept in days, feels anxious, and tired.


Rationale 1: Psychological dependence usually requires the use of relatively high doses of antianxiety medication over a prolonged period of time.

Rationale 2: Psychological dependence is the "need" or desire to continue taking a drug when there is a lack of physical symptoms. In this case, the patient does not feel anxious but still has the desire to take the antianxiety medication.

Rationale 3: Physical dependence produces physical signs of discomfort when the agent is discontinued. This is not true of psychological dependence.

Rationale 4: To continue the use of the antianxiety drug at the risk of jeopardizing relationships is indicative of psychological dependence.

Rationale 5: Physical dependence produces physical signs of discomfort when the agent is discontinued. This is not true of psychological dependence.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 11-5


The nurse is preparing care for a patient diagnosed with substance abuse of a Schedule I drug. Which drugs are Schedule I drugs?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


1. Heroin

2. Marijuana

3. LSD

4. Cocaine

5. Diazepam (Valium)


Rationale 1: Heroin is a Schedule I drug.

Rationale 2: Marijuana is a Schedule I drug.

Rationale 3: LSD is a Schedule I drug.

Rationale 4: Cocaine is a Schedule II drug.

Rationale 5: Diazepam (Valium) is a benzodiazepine. Benzodiazepines are Schedule IV drugs.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 11-2


adams4e tif ch11

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