Which of the following is NOT a behavioral sign of substance use disorder in nurses?

• A. Forgetfulness
• B. Drowsiness
• C. Mood changes
• D. Consistently reliable attendance

Answer: (D)

Recognizing substance use disorder in nurses centers on changes in work behavior that reflect impairment affecting patient safety and care. Forgetfulness may show lapses in memory or attention that interfere with following procedures. Drowsiness signals residual effects or withdrawal, reducing alertness and reaction time on the unit. Mood changes—such as irritability, sudden shifts in affect, or withdrawal from colleagues—reflect emotional instability that can disrupt teamwork and judgment. Consistently reliable attendance, on the other hand, does not fit this pattern; it indicates continued reliability and presence, which does not align with the behavioral signs typically associated with substance use disorder.