Question 1

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

Accepted Answer

Nicotine replacement agents should be prescribed for patients who smoke and are hospitalized to avoid withdrawal symptoms. Allowing the patient to smoke or use other tobacco products encourages ongoing tobacco use. Telling the patient to calm down will not relieve withdrawal symptoms.

Question 2

A patient presents to the emergency department with a blood alcohol concentration (BAC)of 0.18%. After reviewing the medication orders,which drug should the nurse administer first?

Accepted Answer

Thiamine is given to all patients with alcohol intoxication to prevent Wernicke's encephalopathy. Because Wernicke's encephalopathy can be precipitated by the administration of glucose solutions,thiamine should be given before or concurrently with a dextrose solution. Lorazepam would not be appropriate while the patient still has an elevated BAC. Folic acid may also be administered but is not as important as thiamine.

Question 3

A young adult patient 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?

Accepted Answer

Current national guidelines indicate that health care professionals should urge patients who smoke to quit smoking at every encounter. The other actions will not help decrease the patient's health risks related to smoking.

Question 4

During physical assessment of a patient who has frequent nosebleeds,the nurse finds nasal sores and necrosis of the nasal septum. The nurse should ask the patient specifically about the use of which drug?

Accepted Answer

Inhaled cocaine causes ischemia of the nasal septum,leading to nasal sores and necrosis. These symptoms are not associated with the use of heroin,tobacco,or marijuana.

Question 5

The nurse cares for an agitated patient who was admitted to the emergency department after taking a hallucinogenic drug and attempting to jump from a third-story window. Which nursing diagnosis should the nurse assign as the highest priority?

Accepted Answer

Although all the diagnoses may be appropriate for the patient,the highest priority is to address the patient's immediate risk for injury.

Question 6

Which assessment finding would alert the nurse to ask the patient about alcohol use?

Accepted Answer

Abdominal pain associated with gastrointestinal tract and liver dysfunction is common in patients with chronic alcohol use. The other problems are not associated with alcohol use.

Question 7

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

Accepted Answer

Adverse effects of varenicline include depression and attempted suicide. The patient's symptoms require immediate assessment and discontinuation of the drug. The other information will also be reported,but it does not indicate any life-threatening problems associated with the medication.

Question 8

A patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath. What should the nurse do first?

Accepted Answer

The priority here is to ensure that oxygenation is adequate. The other orders also should be accomplished as soon as possible but are not the first priority.

Question 9

A patient admitted to the hospital after an automobile accident is alert and does not appear to be highly intoxicated. The blood alcohol concentration (BAC)is 110 mg/dL (0.11 mg%). Which action by the nurse is appropriate?

Accepted Answer

The patient's assessment data indicate probable physiologic dependence on alcohol,and the patient is likely to develop acute withdrawal such as anxiety,hyperreflexia,and sweating,which could be life threatening. Acetaminophen is not recommended because it is metabolized by the liver. Alcohol has a dehydrating effect so fluids should not be restricted and there is no indication that the patient should be NPO.

Question 10

The nurse plans postoperative care for a patient who smokes two packs of cigarettes daily. Which goal should the nurse include in the plan of care for this patient?

Accepted Answer

Insomnia is a characteristic of nicotine withdrawal. Diarrhea,sore throat,and anorexia are not symptoms associated with nicotine withdrawal.

Question 11

A patient with alcohol dependence is admitted to the hospital with back pain following a fall. Twenty-four hours after admission,the patient becomes tremulous and anxious. Which action by the nurse is appropriate?

Accepted Answer

The patient's symptoms suggest acute alcohol withdrawal,and a quiet and well-lit environment will help decrease agitation,delusions,and hallucinations. There is no indication that the patient is dehydrated. Benzodiazepines,rather than opioids,are used to prevent withdrawal. IV lines are avoided whenever possible.

Question 12

An alcohol-intoxicated patient with a penetrating wound to the abdomen is undergoing emergency surgery. What will the nurse expect the patient to need during the perioperative period?

Accepted Answer

Patients who are intoxicated at the time of surgery are at increased risk for problems with bleeding and respiratory complications such as aspiration. In an intoxicated patient,a lower dose of anesthesia is used because of the synergistic effect of the alcohol. Withdrawal is likely to occur later in the postoperative course because the medications used for anesthesia,sedation,and pain will delay withdrawal symptoms. The patient should be monitored frequently for oversedation but does not need to be stimulated.

Question 13

A newly admitted patient complains of waking frequently during the night. The nurse observes the patient wearing a nicotine patch on the right upper arm. Which action should the nurse take first?

Accepted Answer

Insomnia can occur when nicotine patches are used all night. This can be resolved by removing the patch in the evening. The other actions may be helpful in improving the patient's sleep,but the initial action should be to ask about nighttime use of the patch and suggest removal of the patch at bedtime.

Question 14

A patient with a history of heavy alcohol use is diagnosed with acute gastritis. Which statement by the patient indicates a willingness to stop alcohol use?

Accepted Answer

The statement "I am older and wiser now,and I can change my drinking behavior" indicates the patient expresses willingness to stop alcohol use and an initial commitment to changing alcohol intake behaviors. In the remaining statements,the patient recognizes that alcohol use is the reason for the gastritis but is not yet willing to make a change.

Question 15

A patient admitted with shortness of breath and chest pain who is a pack-a-day smoker tells the nurse,"I am just not ready to quit smoking yet." Which response by the nurse is appropriate for the patient's stage of change?

Accepted Answer

The patient is in the precontemplation stage of change,and the nurse's role is to assist the patient to become motivated to quit. The current Clinical Practice Guidelines indicate that the nurse should ask the patient to identify any negative consequences from smoking. The responses "This would be a really good time to quit" and "Your smoking is the cause of your chest pain" express judgmental feelings by the nurse and are not likely to motivate the patient. Providing information about the various nicotine replacement options would be appropriate for a patient who has expressed a desire to quit smoking.

Question 16

A 73-yr-old patient is admitted for pancreatitis. Which tool would be the most appropriate for the nurse to use during the admission assessment?

Accepted Answer

Because alcohol use is a common factor associated with the development of pancreatitis,the first assessment step is to screen for alcohol use using a validated screening questionnaire. The SMAST-G is a short-form alcoholism screening instrument tailored specifically to the needs of the older adult. If the patient scores positively on the SMAST-G,then the CIWA-Ar would be a useful tool for determining treatment. The DAST-10 provides more general information regarding substance use. The Mini-Mental State Examination is used to screen for cognitive impairment.

Question 17

An older adult patient who has been taking alprazolam (Xanax)calls the clinic asking for a refill of the prescription 1 month before the alprazolam should need to be refilled. Which response by the nurse is best?

Accepted Answer

The patient should be assessed for problems that are causing overuse of alprazolam,such as anxiety or memory loss. The other responses by the nurse will not allow for the needed assessment and possible referral for support services or treatment of drug dependence.

Question 18

A 25-yr-old patient comes to the emergency department with severe chest pain and agitation. Which action should the nurse take first?

Accepted Answer

The patient has symptoms consistent with the use of cocaine or amphetamines and is at risk for fatal tachydysrhythmias or complications of hypertension such as stroke or myocardial infarction. The nurse also will ask about drug use and assess orientation,but these are not the priority actions. Naloxone may be given if the patient develops symptoms of central nervous system depression,but this patient's current symptoms indicate stimulant use.

Question 19

A disoriented and agitated patient comes to the emergency department and admits using methamphetamine. Vital signs are blood pressure 164/94 mm Hg,heart rate 136 beats/min and irregular,and respirations 32 breaths/min. Which action by the nurse is most important?

Accepted Answer

The priority is to ensure physiologic stability given that methamphetamine use can lead to complications such as myocardial infarction. The other actions are also appropriate but are not of as high a priority.

Question 20

A patient who is admitted to the hospital for wound debridement admits to using fentanyl (Sublimaze)illegally. What withdrawal signs does the nurse expect?

Accepted Answer

Symptoms of opioid withdrawal include gastrointestinal symptoms such as nausea,vomiting,and diarrhea. The other symptoms are seen during withdrawal from other substances such as alcohol,sedative-hypnotics,or stimulants.

Quiz 10: Substance Use Disorders