Deck 11: Substance Use

Question 1

Aclient who smokes a pack of cigarettes daily develops tachycardia and irritability on the second day after abdominal surgery. Which of the following actions should the nurse implement first?

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

Answer 1

Request a prescription for a nicotine replacement agent.

Question 2

An agitated individual is brought to the emergency department by friends who state that the client took a hallucinogenic drug at a party and then tried to jump from a second-story window. Which of the following nursing diagnoses is priority?

A)Risk for injury related to altered sensation.
B)Ineffective health maintenance related to ineffective coping strategies.
C)Powerlessness related to insufficient knowledge to manage a situation.
D)Ineffective denial related to insufficient sense of control.

Answer 2

Risk for injury related to altered sensation.

Question 3

The nurse is caring for a client who takes methadone daily to prevent a relapse of heroin addiction and has been admitted for knee surgery. Which of the following actions should the nurse include in the plan of care to promote effective pain control postoperatively?

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.
D)Give prescribed doses of opioid pain medication as needed for pain.

Answer 3

Administer opioid analgesics on a regularly scheduled basis.

Question 4

The nurse is caring for a client admitted to hospital with chest pain who is a pack-a-day smoker and tells the nurse, "I am just not ready to quit smoking yet." Which of the following responses is the most appropriate?

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 5

The nurse is caring for a client who smokes a pack of cigarettes daily and has been admitted to the hospital for surgery. In anticipation of nicotine withdrawal, which of the following goals should the nurse include when planning postoperative care?

A)Improve sleep.
B)Enhance appetite.
C)Decrease diarrhea.
D)Prevent sore throat.

Question 6

An older adult has been taking alprazolam and calls the clinic asking for a refill of the prescription 1 month before it should need to be refilled. Which of the following responses is most appropriate?

A)"The prescription cannot be refilled for another month. What happened to all of your pills?"
B)"Do you have any muscle cramps or 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 alprazolam. Let's make an appointment for you to see the doctor today."

Question 7

The nurse is preparing to conduct an annual physical examination with a young adult client who 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 client to quit smoking as soon as possible.
B)Avoid confronting the client about smoking at this time.
C)Wait for the client to start the discussion about quitting smoking.
D)Explain that the "cold turkey" method is most effective in stopping smoking.

Question 8

The nurse is caring for a client admitted to the hospital after an automobile accident who has a blood alcohol concentration (BAC) of 48 mmol/L (0.22 mg%). The client is alert and does not appear highly intoxicated. Which of the following nursing actionsshould the nurse implement?

A)Maintain the client on NPO status.
B)Avoid the use of intravenous (IV) fluids.
C)Administer acetaminophen for headache.
D)Monitor frequently for anxiety, hyper-reflexia, and sweating.

Question 9

Suicide is an overdose effect of which of the following substances?

A)Alcohol
B)Inhalants
C)Opioids
D)Hallucinogens

Question 10

Aclient who is alcohol-intoxicated must undergo emergency surgery for abdominal trauma. Which of the following should the nurse anticipate when caring for the client in the perioperative period?

A)An increased dose of the general anaesthetic medication.
B)Frequent monitoring for bleeding and respiratory complications.
C)Development of withdrawal symptoms within a few hours after surgery.
D)Stimulation every hour to prevent prolonged postoperative sedation.

Question 11

The nurse is caring for a client with alcohol dependence who has been admitted to the hospital with chest pain. Twenty-four hours after admission, the client becomes very tremulous and anxious. Which of the following actions should the nurse implement?

A)Insert an IV line and infuse fluids.
B)Promote oral intake to 3 000 mL/day.
C)Provide a quiet, well-lit environment.
D)Administer opioids to provide sedation.

Question 12

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

A)"I am older and wiser now, and I know I can change my drinking behaviour."
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 13

The nurse is caring for a client who is admitted to the hospital for treatment of an abscess on the left thigh and the client tells the nurse that they use fentanyl illegally. Which of the following symptoms should the nurse anticipate assessing?

A)Nausea and diarrhea
B)Tremors and seizures
C)Lethargy and disorientation
D)Delusions and hallucinations

Question 14

A young adult client arrives at the emergency department with severe chest pain and agitation. Which of the following actions should the nurse take first?

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

Question 15

The nurse is caring for an adult client who is experiencing acute intoxication. The nurse is aware that acute intoxication responses usually resolve within which of the following time frames?

A)4 hours
B)12 hours
C)24 hours
D)48 hours

Question 16

During physical assessment of a client who has sinus headaches, the nurse finds nasal sores and necrosis of the nasal septum. Client use of which of the following substances should the nurse include in the assessment?

A)Heroin
B)Cocaine
C)Tobacco
D)Marijuana

Question 17

The nurse is assessing a client who has a history of alcohol use. Which of the following assessment data should the nurse expect?

A)Low blood pressure
B)Decreased heart rate
C)Elevated temperature
D)Abdominal tenderness

Question 18

The nurse is caring for a young adult client who has inhaled cocaine and has been admitted to the emergency department with palpitations and shortness of breath. Which of the following actions ordered by the health care provider will the nurse implementfirst?

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/hour.

Question 19

A client who is disoriented and agitated comes to the emergency department after using methamphetamine. Vital signs are blood pressure 162/98, heart rate 142 and irregular, and respirations 32. Which of the following actions is priority for the nurse toimplement?

A)Reorient the client at frequent intervals.
B)Monitor the client's ECG and vital signs.
C)Keep the client in a quiet and darkened room.
D)Obtain a health history including prior drug use.

Question 20

All the following medications are ordered for a client admitted with a blood alcohol concentration of 0.18 mg%. Which of the following should the nurse administer first?

A)Thiamine 100 mg daily
B)Lorazepam 1 mg as needed
C)Folic acid 0.4 mg daily
D)Dextrose 5% in 0.45 saline over 8 hours

Question 21

The nurse is caring for a client who has a history of ongoing opioid use and has been hospitalized for surgery. After a visit by a friend, the nurse assesses that the client is unresponsive with pinpoint pupils. Which of these prescribed medications will thenurse administer immediately?

A)Naloxone
B)Diazepam
C)Clonidine
D)Methadone

Question 22

The nurse is caring for a young adult who has a cocaine addiction. Which of the following routes of cocaine administration results in the fastest absorption and the highest "rush"?

A)Smoking
B)Buccal
C)Oral
D)Intranasal