Which term describes the body's adaptation to long-term drug exposure, so that stopping the drug produces a withdrawal reaction?
Physical dependence
✓
Psychological dependence
Tolerance
Intoxication
Correct Answer
Physical dependence
Physical dependence is a homeostatic adaptation to prolonged drug exposure, and removing the drug triggers withdrawal (abstinence syndrome); it can occur with prescribed drugs such as corticosteroids. Psychological dependence refers to cravings and the cognitive and behavioral side of substance use. Tolerance is a reduced response to the same dose over time. Intoxication is the set of acute effects that follow recent use.
Category: Substance Use Concepts
Question 2
Combining alcohol with which drug class carries the greatest added risk of fatal respiratory depression?
Statins
Opioids
✓
Thiazide diuretics
Proton pump inhibitors
Correct Answer
Opioids
Alcohol and opioids are both CNS depressants, and together they greatly increase the risk of respiratory depression, coma and death. Statins do not depress the CNS, though heavy drinking adds to liver strain. Thiazide diuretics can add to orthostatic hypotension with alcohol but do not suppress breathing. Proton pump inhibitors reduce stomach acid and have no CNS depressant effect.
Category: Substance Use Concepts
Question 3
Before giving the first dose of naltrexone to a patient with opioid use disorder, which question is the nurse's priority?
"Do you have a history of asthma?"
"Have you ever had a reaction to penicillin?"
"When did you last use an opioid?"
✓
"Do you take any antacids?"
Correct Answer
"When did you last use an opioid?"
Naltrexone blocks opioid receptors, so giving it while opioids are still present can precipitate sudden withdrawal; the patient must be opioid-free for several days first. Asking about asthma matters for nicotine nasal spray, not naltrexone. A penicillin allergy has no bearing on naltrexone. Antacids are not a key concern before naltrexone.
Category: Opioid Use Disorder Drugs
Question 4
Naltrexone helps prevent a return to opioid use through which action?
Partially stimulating mu receptors to ease cravings
Fully stimulating mu receptors to prevent withdrawal
Inhibiting acetaldehyde breakdown to cause illness
Blocking mu receptors so opioids produce little euphoria
✓
Correct Answer
Blocking mu receptors so opioids produce little euphoria
Naltrexone is a pure mu opioid receptor antagonist, so if the patient uses an opioid, the euphoric effect is blocked. Partially stimulating mu receptors to ease cravings describes buprenorphine. Fully stimulating mu receptors to prevent withdrawal describes methadone. Inhibiting acetaldehyde breakdown to cause illness describes disulfiram.
Category: Opioid Use Disorder Drugs
Question 5
Why is the first dose of buprenorphine held until the patient shows signs of opioid withdrawal?
Its high receptor affinity can displace full agonists and precipitate withdrawal
✓
It is a full agonist that would cause an overdose if started earlier
It cannot cross the blood-brain barrier while other opioids are present
It must be activated by liver enzymes induced during withdrawal
Correct Answer
Its high receptor affinity can displace full agonists and precipitate withdrawal
Buprenorphine is a partial mu agonist that binds more tightly than most full agonists, so it knocks them off the receptor while producing a weaker effect, which can trigger abrupt withdrawal if started too soon. It is a partial agonist, not a full agonist that would cause an overdose. It crosses the blood-brain barrier regardless of other opioids. It is not activated by enzymes induced during withdrawal.
Category: Opioid Use Disorder Drugs
Question 6
Which ECG change should the nurse monitor for in a patient receiving methadone?
Peaked T waves
QT interval prolongation
✓
PR interval shortening
ST segment elevation
Correct Answer
QT interval prolongation
Methadone can prolong the QT interval, which raises the risk of torsades de pointes, so the risk is greater with other QT-prolonging drugs or congenital long QT syndrome. Peaked T waves are a classic sign of hyperkalemia. PR interval shortening is not a known methadone effect. ST segment elevation points to myocardial injury, not a methadone effect.
Category: Opioid Use Disorder Drugs
Question 7
A patient admitted to the hospital says they take methadone daily from an opioid treatment program. How should the nurse confirm the current dose?
Ask the retail pharmacy for the last fill
Use the dose from an old discharge summary
Contact the dispensing clinic
✓
Estimate it from a urine drug screen
Correct Answer
Contact the dispensing clinic
Methadone for opioid use disorder is dispensed by the treatment program, so the clinic holds the accurate current dose. A retail pharmacy does not dispense methadone for opioid use disorder and would have no record. An old discharge summary may be out of date, and an error with a full agonist is dangerous. A urine drug screen shows presence of a drug, not the dose.
Category: Opioid Use Disorder Drugs
Question 8
A nurse gives naloxone to a patient with respiratory depression from a long-acting opioid, and the patient wakes up. Why must close monitoring continue?
Naloxone increases absorption of the remaining opioid
Naloxone commonly causes heart block an hour later
Naloxone wears off before many opioids, so sedation can return
✓
Correct Answer
Naloxone wears off before many opioids, so sedation can return
Naloxone acts within minutes but lasts a shorter time than many opioids, so respiratory depression can recur and repeat doses may be needed. Naloxone itself does not depress breathing. It does not increase absorption of the remaining opioid. Heart block an hour later is not a recognized effect of naloxone.
Category: Opioid Overdose Reversal
Question 9
Which statement about vaping products is accurate?
They are less regulated and can contain heavy metals
✓
They deliver nicotine with no health risk
They are always sold in child-resistant packaging
They are an FDA-approved form of nicotine replacement
Correct Answer
They are less regulated and can contain heavy metals
Vaping products are less regulated than approved nicotine replacement, may contain heavy metals and can even explode, so they are not a safe alternative. The claim that they deliver nicotine with no health risk is false. Child-resistant packaging does not make them safe around children, and swallowed liquid can poison a child. They are not an FDA-approved form of nicotine replacement; gum, patches, lozenges, inhalers and nasal sprays are.
Category: Nicotine Cessation Drugs
Question 10
A patient with clear signs of opioid intoxication has a negative standard urine opioid screen. Which interpretation is accurate?
The patient cannot have taken any opioid
Synthetic opioids such as fentanyl may not be detected
✓
The symptoms must be caused by alcohol alone
Naloxone will not work without a positive screen
Correct Answer
Synthetic opioids such as fentanyl may not be detected
Standard urine screens reliably detect drugs such as heroin, morphine and codeine but can miss fentanyl and oxycodone, so a negative result does not rule out opioid use. Concluding the patient cannot have taken any opioid ignores this limit. Assuming alcohol alone is the cause skips the clinical picture of pinpoint pupils and slow breathing. Naloxone reverses opioid effects whatever the screen shows.
Category: Opioid Overdose Reversal
Question 11
Benzodiazepines such as chlordiazepoxide prevent complications of alcohol withdrawal through which action?
Blocking dopamine D2 receptors
Inhibiting acetaldehyde dehydrogenase
Enhancing GABA activity at GABA-A receptors
✓
Blocking mu opioid receptors
Correct Answer
Enhancing GABA activity at GABA-A receptors
Like alcohol, benzodiazepines enhance GABA at the GABA-A receptor, so they stand in for alcohol and calm the overexcited nervous system during withdrawal. Blocking dopamine D2 receptors is how haloperidol works. Inhibiting acetaldehyde dehydrogenase is how disulfiram works. Blocking mu opioid receptors is how naltrexone works.
Category: Alcohol Withdrawal Drugs
Question 12
A patient with heavy daily drinking was admitted for surgery. Which findings on the first hospital day suggest early alcohol withdrawal?
Pinpoint pupils and slow breathing
Bradycardia and drowsiness
Lethargy and low body temperature
Tremor, anxiety, and sweating
✓
Correct Answer
Tremor, anxiety, and sweating
Withdrawal generally produces the opposite of intoxication, so a depressant like alcohol leaves the nervous system overexcited, causing tremor, anxiety, sweating and restlessness, starting within hours of the last drink. Pinpoint pupils and slow breathing suggest opioid intoxication. Bradycardia and drowsiness reflect CNS depression, not withdrawal. Lethargy and low body temperature are not signs of an overexcited nervous system.
Category: Alcohol Withdrawal Drugs
Question 13
A hospitalized patient in alcohol withdrawal has a seizure. Which IV drug does the nurse anticipate?
Lorazepam
✓
Flumazenil
Haloperidol
Naloxone
Correct Answer
Lorazepam
Lorazepam, an IV benzodiazepine, is a standard choice to stop seizures caused by alcohol withdrawal because it enhances GABA activity like alcohol does. Flumazenil reverses benzodiazepines and could worsen withdrawal seizures. Haloperidol lowers the seizure threshold. Naloxone reverses opioids and has no role in alcohol withdrawal seizures.
Category: Alcohol Withdrawal Drugs
Question 14
What is the key risk of using haloperidol to calm a patient in alcohol withdrawal?
It causes a disulfiram-like reaction
It lowers the seizure threshold
✓
It reverses benzodiazepine effects
It raises the blood alcohol level
Correct Answer
It lowers the seizure threshold
Haloperidol, a first-generation antipsychotic that blocks D2 receptors, makes seizures more likely, which is dangerous during alcohol withdrawal, so it is not routine and patients receiving it are watched for seizures. It does not cause a disulfiram-like reaction. It does not reverse benzodiazepine effects; flumazenil does. It does not raise the blood alcohol level.
Category: Alcohol Withdrawal Drugs
Question 15
Which laboratory tests should the nurse monitor in a patient taking disulfiram?
Thyroid function tests
Serum amylase and lipase
Liver function tests
✓
Hemoglobin A1C
Correct Answer
Liver function tests
Disulfiram can cause hepatitis and liver toxicity, so liver function tests are checked and the patient reports jaundice, dark urine or right upper abdominal pain. Thyroid function tests are not affected by disulfiram. Serum amylase and lipase screen for pancreatitis, which is not a hallmark disulfiram toxicity. Hemoglobin A1C tracks long-term glucose control and does not detect disulfiram toxicity.
Category: Alcohol Deterrent Therapy
Question 16
Which product should a patient taking disulfiram be taught to avoid?
Saline nasal spray
Calcium carbonate tablets
Fluoride toothpaste
Alcohol-based mouthwash
✓
Correct Answer
Alcohol-based mouthwash
Hidden sources of alcohol such as some mouthwashes and cough syrups can trigger a disulfiram reaction, so patients read labels and avoid them. Saline nasal spray contains salt water and no alcohol. Calcium carbonate tablets do not interact with disulfiram. Fluoride toothpaste is not an alcohol source of concern.
Category: Alcohol Deterrent Therapy
Question 17
A family member asks whether disulfiram can be crushed into a relative's food without telling them. How should the nurse respond?
No, it must never be given without the person's full knowledge
✓
Yes, if the dose is mixed into a full meal
Yes, as long as the person has not been drinking that day
No, because crushing the tablet destroys the drug
Correct Answer
No, it must never be given without the person's full knowledge
Disulfiram's boxed warning says it must never be given to a patient who is intoxicated or without the patient's full knowledge, and relatives should be told this, because drinking on disulfiram causes a severe reaction. Mixing it into a full meal does not make covert dosing acceptable. Not having been drinking that day does not remove the need for consent. Crushing the tablet is not the reason it cannot be given this way.
Category: Alcohol Deterrent Therapy
Question 18
A patient taking varenicline tells the nurse about new agitation and a persistently depressed mood. What should the nurse do?
Advise taking the dose at bedtime instead
Report the mood changes to the prescriber promptly
✓
Reassure the patient that this means the drug is working
Suggest adding nicotine gum to ease the symptoms
Correct Answer
Report the mood changes to the prescriber promptly
Varenicline can worsen depression and suicidal thinking in some patients, so new changes in mood or behavior are reported right away so therapy can be reassessed. Advising taking the dose at bedtime does not address a mood change. Reassuring the patient that this means the drug is working is false and delays care. Suggesting adding nicotine gum does not treat a drug-related mood change.
Category: Nicotine Cessation Drugs
Question 19
Which form of nicotine replacement therapy should be avoided in a patient with asthma?
Transdermal patch
Gum
Nasal spray
✓
Lozenge
Correct Answer
Nasal spray
Nicotine nasal spray irritates the nose and airways and can trigger an asthma exacerbation, so nicotine sprays are avoided in patients with asthma. The transdermal patch delivers nicotine through the skin without airway irritation. Gum and lozenges are absorbed through the lining of the mouth and do not carry the same airway risk.
Category: Nicotine Cessation Drugs
Question 20
A patient starting varenicline asks whether drinking alcohol is a problem. Which response by the nurse is accurate?
Varenicline blocks the effects of alcohol, so drinking will not affect you
Any alcohol will cause flushing and vomiting, as it does with disulfiram
Alcohol is safe in any amount because the two drugs do not interact
Alcohol may affect you more strongly, so cut back until you know how you react
✓
Correct Answer
Alcohol may affect you more strongly, so cut back until you know how you react
Varenicline labeling reports that some patients feel stronger intoxicating effects of alcohol, sometimes with unusual or aggressive behavior and memory loss, so patients reduce drinking until they know how varenicline affects their tolerance. Varenicline does not block the effects of alcohol. It does not cause the flushing and vomiting of a disulfiram reaction, which comes from acetaldehyde buildup. Saying alcohol is safe in any amount ignores this labeled interaction.
Category: Nicotine Cessation Drugs