NCLEX Psychiatric Nursing: Substance-Related Disorders (15 Items)

This nursing exam tackles important issues about substance-related disorders including the types, causes, and the management of substance abuse. Equip yourselves with enough knowledge by answering this 15-item exam and do best in your NCLEX!

Addiction isn’t about substance – you aren’t addicted to the substance, you are addicted to the alteration of mood that the substance brings.
–Susan Cheever


Concepts and topics included in this exam are:

  • Overview of substance-related disorders
  • Types of abused substances
  • Causes of substance abuse
  • Management of substance abuse
  • Care for the client with substance-related disorder


Here are the guidelines for the exam:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.


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1. Nurse Rob has observed a co-worker arriving to work drunk at least three times in the past month. Which action by Nurse Rob would best ensure client safety and obtain necessary assistance for the co-worker?


A. Ignore the co worker’s behavior, and frequently assess the clients assigned to the co-worker.
B. Make general statements about safety issues at the next staff meeting.
C. Report the coworker’s behavior to the appropriate supervisor.
D. Warn the co-worker that this practice is unsafe.

2. Elsa is being treated in a chemical dependency unit. She tells the nurse that she only uses drugs when under stress and therefore does not have a substance problem. Which defense mechanism is the client using?

A. Compensation
B. Denial
C. Suppression
D. Undoing

3. Nurse Tara is teaching a community group about substance abuse. She explains that a genetic component has been implicated in which of the following commonly abused substances?

A. Alcohol
B. Barbiturates
C. Heroin
D. Marijuana

4. Nurse Julie recommends that the family of a client with substance-related disorder attend a support group, such as Al-Anon and Alateen. The purpose of these groups  is to help family members understand the problem and to:


A. Change the problem behaviors of the abuser.
B. Learn how to assist the abuser in getting help.
C. Maintain focus on changing their own behaviors.
D. Prevent substance problems in vulnerable family members.

5. Ryan who is a chronic alcohol abuser is being assessed by Nurse Gina. Which problems are related to thiamin deficiency?

A. Cardiovascular symptoms, such as decreased hemoglobin and hematocrit levels
B. CNS symptoms, such as ataxia and peripheral neuropathy
C. Gastrointestinal symptoms, such as nausea and vomiting
D. Respiratory symptoms, such as cough and sore throat

6. Nurse Wilma is teaching a client about disulfiram (Antabuse), which the client is taking to deter his use of alcohol. She explains that using alcohol when taking this medication can result in:

A. Abdominal cramps and diarrhea.
B. Drowsiness and decreased respiration.
C. Flushing, vomiting, and dizziness.
D. Increased pulse and blood pressure.

7. The nurse administers bromocriptine (Parlodel) to Bryan who is undergoing detoxification for amphetamine abuse. The rationale for this medication is to: 


A. Aid in GABA inhibition.
B. Prevent norepinephrine excess.
C. Restore depleted dopamine levels.
D. Treat psychotic symptoms.

8. Which medication is commonly used in treatment programs for heroin abusers to produce a non-euphoric state and to replace heroin use?

A. Diazepam
B. Carbamazepine
C. Clonidine
D. Methadone

9. Nurse Christine is teaching an adolescent health class about the dangers of inhalant abuse; the nurse warns about the possibility of:

A. Contracting an infectious disease, such as hepatitis or AIDS
B. Recurrent flashback events
C. Psychological dependence after initial use
D. Sudden death from cardiac or respiratory depression

10. The newly hired nurse at Nurseslabs Medical Center is assessing a client who abuses barbiturates and benzodiazepine. The nurse would observe for evidence of which withdrawal symptoms?


A. Anxiety, tremors, and tachycardia
B. Respiratory depression, stupor, and bradycardia
C. Muscle aches, cramps, and lacrimation
D. Paranoia, depression, and agitation

11. The community nurse practicing primary prevention of alcohol abuse would target which groups for educational efforts?

A. Adolescents in their late teens and young adults in their early twenties
B. Elderly men who live in retirement communities
C. Women working in careers outside the home
D. Women working in the home

12. Johnette is reviewing her lessons in Pharmacology. She is aware that the general classification of drugs belonging to the opioid category is analgesic and:

A. Depressant.
B. Hallucinogenic.
C. Stimulant.
D. Tranquilizing.

13. When a client abuses a CNS depressant, withdrawal symptoms will be caused by which of the following?


A. Acetylcholine excess
B. Dopamine depletion
C. Serotonin inhibition
D. Norepinephrine rebound

14. Kendall, the sister of a client with a substance-related disorder, tells the nurse she calls out sick for her sister Kylie occasionally when the latter has too much to drink and cannot work. This behavior can be described as:

A. Caretaking.
B. Codependent.
C. Helpful.
D. Supportive.

15. During an initial assessment of a client admitted to a substance abuse unit for detoxification and treatment, the nurse asks questions to determine patterns of use of substances. Which of the following questions are most appropriate at this time? Select all that apply.

A. How long have you used substances?
B. How often do you use substances?
C. How do you get substances into your body?
D. Do you feel bad or guilty about your use of substances?
E. How much of each substance do you use?
F. Have you ever felt you should cut down substance use?
G. What substances do you use?

Answers and Rationale

1. Answer: C. Report the coworker’s behavior to the appropriate supervisor.

The nurse is obligated by ethical considerations of client safety, as well as by nurse practice acts in many states, to report substance abuse in health care workers. Most healthcare facilities have an employee assistance program to help workers with substance abuse problems.

  • Option A: Ignoring the co worker’s behavior would be a form of enabling behavior (codependency) on the staff nurse’s part.
  • Option B: Making general statements about safety in a staff meeting avoids dealing with the problem.
  • Option D: Warning the co-worker is inadequate; it does not ensure client safety or helps him receive necessary aid.

2. Answer: B. Denial

Individuals who have substance problems often use denial.

  • Options A, C, and D: Compensation, suppression, and undoing are incorrect and do not fit the situation described.

3. Answer: A. Alcohol

Several chromosomes (1, 3, and 7) have been implicated in increased vulnerability to alcohol abuse. Statistics have shown that risk for alcohol abuse in first-degree relatives of alcohol abusers is as high as 40% to 60%. Most of the genetic research has been done related to alcohol.

  • Options B, C, and D: Definitive data regarding genetic transmission is not available at this time for barbiturates, heroin, and marijuana.

4. Answer: C. Maintain focus on changing their own behaviors.

Family support groups, such as Al-Anon and Alateen, emphasize the importance of changing one’s own behavior rather than trying to change the behavior of the individual with a substance abuse problem.

  • Options A and B: Trying to change the abuser’s behavior or learning ways to find help for the abuser would be viewed as codependent behaviors, and thus would not be advocated by family support groups.
  • Option D: Learning about substance abuse may help a vulnerable family member to avoid this problem; however, that is not the purpose of these groups.

5. Answer: B. CNS symptoms, such as ataxia and peripheral neuropathy

Wernicke’s encephalopathy is a CNS disorder caused by acute thiamin deficiency in people who abuse alcohol. Other symptoms, besides ataxia and peripheral neuropathy, are acute confusion or delirium.

  • Options A and C: Cardiovascular and gastrointestinal symptoms are associated with alcohol abuse; they are not caused by thiamin deficiency.
  • Option D: Respiratory problems are not usually directly related to alcohol.

6. Answer: C. Flushing, vomiting, and dizziness.

Disulfiram (Antabuse) prevents complete alcohol metabolism in the body. Therefore when alcohol is consumed, the client has a hypersensitivity reaction. Flushing, vomiting, and dizziness are associated with the incomplete breakdown of alcohol metabolites.

  • Options A, B, and D: Other choices are not associated with the use of disulfiram along with alcohol.

7. Answer: C. Restore depleted dopamine levels.

Amphetamine abuse depletes the neurotransmitter dopamine. When withdrawing from amphetamines, dopamine depletion causes depression, insomnia, and intense craving for the drug. Bromocriptine (Parlodel) is a dopamine agonist that will help restore this neurotransmitter. GABA inhibition, prevention of norepinephrine excess, and treatment of psychotic symptoms are incorrect rationales for the use of this medication.

  • Options A, B, and D: GABA inhibition, prevention of norepinephrine excess, and treatment of psychotic symptoms are incorrect rationales for the use of this medication.

8. Answer: D. Methadone

Methadone maintenance programs are used to provide a heroin-depleted individual with a medically controlled dose of methadone to produce a noneuphoric state that will prevent withdrawal symptoms. This method of treatment is advocated to help heroin abusers avoid criminal activities associated with obtaining heroin; it also prevents diseases associated with I.V. use of heroin.

  • Options A and B: Diazepam and carbamazepine may be used for withdrawal from alcohol, barbiturates, and benzodiazepines.
  • Option C: Clonidine can be used in acute withdrawal from heroin to avoid norepinephrine rebound when opiates are stopped.

9. Answer: D. sudden death from cardiac or respiratory depression

Inhalants are CNS depressants; if taken in an excess amount, they can cause cardiac and respiratory depressions. It is impossible to control the inhalant dosage; therefore, death can occur.

  • Options A, B, and C: Contracting an infectious disease, recurrent flashback events, and psychological dependence after initial use are not associated with inhalant abuse.

10. Answer: A. Anxiety, tremors, and tachycardia

Barbiturates and benzodiazepine are CNS depressants; therefore, withdrawal symptoms are related to CNS stimulation caused by the rebounding of neurotransmitters (norepinephrine). Symptoms include increased anxiety, tremors, and vital sign changes (such as tachycardia and hypertension).

  • Option B: Respiratory depression, stupor, and bradycardia are typically associated with an overdose—not withdrawal—of barbiturates or benzodiazepine.
  • Option C: Muscle aches, cramps, and lacrimation are most commonly associated with withdrawal from opiates.
  • Option D: Paranoia, depression, and agitation are usually associated with withdrawal from CNS stimulants, such as amphetamines or cocaine.

11. Answer: A. Adolescents in their late teens and young adults in their early twenties

High-risk groups for alcohol abuse include individuals between ages 18 and 25 and the unemployed.

  • Option B: There is no evidence that elderly men in retirement communities have increased rates of alcohol abuse.
  • Options C and D: Men have 2 to 3 times increased risk than women of abusing alcohol.

12. Answer: A. Depressant.

Opiates are both analgesics and CNS depressants because they decrease the effect of neurotransmitters that are excitatory or stimulating.

  • Options B and C: Hallucinogenic and stimulant are categories that do not apply to opiates.
  • Option D: Although an opiate can provide a tranquilizing effect; the general category would be that of a depressant.

13. Answer: D. Norepinephrine rebound

CNS depressants, when abused, cause depletion of stimulating neurotransmitters. When the CNS depressant is stopped, the result is a rebound of excitatory or stimulating neurotransmitters, such as norepinephrine.

  • Options A, B, and C: Acetylcholine, dopamine, and serotonin are not significant factors in the symptoms of withdrawal from a CNS depressant.

14. Answer: B. Codependent.

Enabling behaviors that inadvertently promote continued use of a substance by the person abusing substances is known as codependency.

  • Option A: The sister’s behavior is not an example of caretaking or support. She is taking responsibility for the client’s behavior and allowing her to avoid the consequences of his abuse problem.
  • Options C and D: The behavior is unhelpful and unsupportive.

15. Answer: A, B, C, E, G

These questions will elicit information about the client’s pattern of use of substances. Options D and F are questions related to CAGE, a tool for screening suspected substance abusers.

Study Guides

Comprehensive Mental Health and Psychiatric Nursing Questions

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Mental Health and Psychiatric Disorders

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