Deck 12: Addictive Behaviors

Question 1

A 19-year-old patient comes to the emergency department with severe chest pain and agitation. Which action should the nurse take first?

A) Give the PRN naloxone (Narcan) IV.
B) Ask about any use of stimulant drugs.
C) Assess orientation to person, place, and time.
D) Check blood pressure, pulse, and respirations.

Answer 1

Assess orientation to person, place, and time.

Question 2

A patient who takes methadone (Dolophine) daily to prevent a relapse of heroin addiction is admitted for knee surgery. To promote effective pain control postoperatively, the nurse will plan to

A) use a mixed opioid agonist-antagonist drug for pain relief.
B) administer opioid analgesics on a regularly scheduled basis.
C) avoid use of opioids and use alternatives such as NSAIDs instead.
D) give prescribed doses of opioid pain medication as needed for pain.

Answer 2

administer opioid analgesics on a regularly scheduled basis.

Question 3

A 20-year-old patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath. Which of these actions ordered by the health care provider will the nurse implement first?

A) Obtain a 12-lead ECG.
B) Start O₂ at 4 L/minute.
C) Draw blood for drug screening.
D) Infuse normal saline at 100 ml/hr.

Answer 3

Start O₂ at 4 L/minute.

Question 4

All the following medications are ordered for a patient admitted with a blood alcohol concentration of 0.18 mg%. Which one will the nurse give first?

A) thiamine (vitamin B₁) 100 mg daily
B) lorazepam (Ativan) 1 mg as needed
C) folic acid (Vitamin B₉) 0.4 mg daily
D) dextrose 5% in 0.45 saline over 8 hours

Question 5

A patient with a history of heavy alcohol use is seen at the clinic with acute gastritis. Which statement by the patient indicates that the patient is in the contemplation stage of change?

A) "I am older and wiser now, and I know I can change my drinking behavior."
B) "Alcohol has never bothered my stomach. I think it's likely that I have the flu."
C) "I think my drinking is affecting my stomach, but maybe some drugs will help."
D) "People say that I drink too much, but I really feel pretty good most of the time."

Question 6

A new 21-year-old patient who is scheduled for an annual physical examination arrives in the clinic smelling of cigarette smoke and carrying a pack of cigarettes. Which action will the nurse plan to take?

A) Urge the patient to quit smoking as soon as possible.
B) Avoid confronting the patient about smoking at this time.
C) Wait for the patient to start the discussion about quitting smoking.
D) Explain that the "cold turkey" method is most effective in stopping smoking.

Question 7

A patient who is admitted to the hospital for treatment of an abscess on the left thigh admits to using fentanyl (Sublimaze) illegally. The nurse will monitor the patient for manifestations of withdrawal such as

A) nausea and diarrhea.
B) tremors and seizures.
C) lethargy and disorientation.
D) delusions and hallucinations.

Question 8

A 69-year-old who has been taking alprazolam (Xanax) calls the clinic asking for a refill of the prescription 1 month before the Xanax should need to be refilled. The best response by the nurse to the patient is

A) "The prescription cannot be refilled for another month. What happened to all of your pills?"
B) "Do you have any muscle cramps and tremors if you don't take the medication frequently?"
C) "I will ask the doctor to prescribe a few more pills, but you will not be able to get any more for another month."
D) "I am concerned that you may be overusing the Xanax. Let's make an appointment for you to see the doctor today."

Question 9

When assessing a patient who has a history of alcohol abuse, the nurse will plan to assess for

A) low blood pressure.
B) decreased heart rate.
C) elevated temperature.
D) abdominal tenderness.

Question 10

A disoriented and agitated patient comes to the emergency department after using methamphetamine. Vital signs are blood pressure 162/98, heart rate 142 and irregular, and respirations 32. The most important intervention by the nurse is to

A) reorient the patient at frequent intervals.
B) monitor the patient's ECG and vital signs.
C) keep the patient in a quiet and darkened room.
D) obtain a health history including prior drug use.

Question 11

During physical assessment of a patient who has sinus headaches, the nurse finds nasal sores and necrosis of the nasal septum. The nurse should ask the patient specifically about the use of

A) heroin.
B) cocaine.
C) tobacco.
D) marijuana.

Question 12

A patient with alcohol dependence is admitted to the hospital with chest pain. Twenty-four hours after admission, the patient becomes very tremulous and anxious. An appropriate intervention by the nurse is to

A) insert an IV line and infuse fluids.
B) promote oral intake to 3000 ml/day.
C) provide a quiet, well-lit environment.
D) administer opioids to provide sedation.

Question 13

A patient who smokes a pack of cigarettes daily develops tachycardia and irritability on the second day after abdominal surgery. Which action is best for the nurse to take at this time?

A) Escort the patient outside where smoking is allowed.
B) Request a prescription for a nicotine replacement agent.
C) Move the patient to a private room and allow smoking.
D) Tell the patient that this is a good time to quit smoking.

Question 14

A patient admitted with chest pain who is a pack-a-day smoker tells the nurse, "I am just not ready to quit smoking yet." The best response by the nurse is

A) "This would be a really good time to quit."
B) "Your smoking is the cause of your chest pain."
C) "Do you think that smoking has caused any health problems?"
D) "Are you familiar with the various nicotine replacement options?"

Question 15

A patient who is alcohol-intoxicated must undergo emergency surgery for abdominal trauma. The nurse anticipates that during the perioperative period, the patient

A) will require an increased dose of the general anesthetic medication.
B) will need frequent monitoring for bleeding and respiratory complications.
C) is likely to develop withdrawal symptoms within a few hours after surgery.
D) should be stimulated every hour to prevent prolonged postoperative sedation.

Question 16

Which information obtained by the nurse about a patient who has been using varenicline (Chantix) is most important to report to the health care provider?

A) The patient continues to smoke a few cigarettes every day.
B) The patient complains of headaches that occur almost daily.
C) The patient complains of new-onset sadness and depression.
D) The patient says, "I have decided that I am not ready to quit."

Question 17

A patient in the outpatient clinic who is using a nicotine patch (Nicoderm CQ) tells the nurse about waking frequently during the night. Which action is best for the nurse to take?

A) Question the patient about use of the patch at night.
B) Suggest that the patient go to bed earlier in the evening.
C) Ask the health care provider about prescribing a sedative drug for nighttime use.
D) Remind the patient that the benefits of the patch outweigh the short-term insomnia.

Question 18

A patient who smokes a pack of cigarettes daily is admitted to the hospital for surgery. When planning postoperative care, the nurse should include measures to

A) improve sleep.
B) enhance appetite.
C) decrease diarrhea.
D) prevent sore throat.

Question 19

An agitated individual is brought to the emergency department by friends who state that the patient took a hallucinogenic drug at a party and then tried to jump from a second-story window. The priority nursing diagnosis for the patient is

A) risk for injury related to altered perception.
B) ineffective health maintenance related to drug use.
C) powerlessness related to loss of behavioral control.
D) ineffective denial related to lack of control of life situation.

Question 20

A patient admitted to the hospital after an automobile accident has a blood alcohol concentration ( BAC ) of 220 mg/dl ( 0.22 mg% ). The patient is alert and does not appear highly intoxicated. An appropriate nursing action is to

A) maintain the patient on NPO status.
B) avoid the use of intravenous ( IV ) fluids.
C) administer acetaminophen for headache.
D) monitor frequently for anxiety, hyperreflexia, and sweating.

Question 21

A patient who has a history of ongoing opioid abuse is hospitalized for surgery. After a visit by a friend, the nurse finds that the patient is unresponsive with pinpoint pupils. Which of these prescribed medications will the nurse administer immediately?

A) naloxone (Narcan)
B) diazepam (Valium)
C) clonidine (Catapres)
D) methadone (Dolphine)