Anatomy and physiology test bank, Exams of Anatomy

Download Anatomy and physiology test bank and more Exams Anatomy in PDF only on Docsity! Chapter 10: Substance Use Disorders Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. Which assessment finding would alert the nurse to ask the patient about alcohol use? a. Low blood pressure c. Elevated temperature b. Decreased heart rate d. Abdominal tenderness ANS: D 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. DIF: Cognitive Level: Apply (application) REF: 151 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 2. 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? a. Improve sleep c. Decrease diarrhea b. Enhance appetite d. Prevent sore throat ANS: A Insomnia is a characteristic of nicotine withdrawal. Diarrhea, sore throat, and anorexia are not symptoms associated with nicotine withdrawal. DIF: Cognitive Level: Apply (application) REF: 150 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 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? 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 a discussion about quitting smoking. d. Explain that the “cold turkey” method is most effective in stopping smoking. ANS: A 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. DIF: Cognitive Level: Apply (application) REF: 146 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 4. 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? a. Restrict oral and IV fluids. b. Maintain the patient on NPO status. c. Administer acetaminophen for headache. d. Monitor for hyperreflexia and diaphoresis. ANS: D 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. DIF: Cognitive Level: Apply (application) REF: 155 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 5. 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? a. An increased dose of the general anesthetic medication b. Interventions to prevent withdrawal symptoms within 2 hours c. Frequent monitoring for bleeding and respiratory complications d. Stimulation every hour to prevent prolonged postoperative sedation ANS: C 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. DIF: Cognitive Level: Apply (application) REF: 149 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 6. 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? a. Encourage increased oral intake. b. Cocaine d. Marijuana ANS: B 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. DIF: Cognitive Level: Apply (application) REF: 146 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 12. 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? a. “This would be a really good time to quit.” b. “Your smoking is the cause of your chest pain.” c. “Are you familiar with nicotine replacement products?” d. “What health problems do you think smoking has caused?” ANS: C 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. DIF: Cognitive Level: Apply (application) REF: 146 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. 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? a. Reorient the patient at frequent intervals. b. Monitor the patient’s electrocardiogram (ECG). c. Keep the patient in a quiet and darkened room. d. Obtain a health history including prior drug use. ANS: B 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. DIF: Cognitive Level: Apply (application) REF: 146 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 14. 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? a. Mini-Mental State Examination b. Drug Abuse Screening Test (DAST-10) c. Screening Test-Geriatric Version (SMAST-G) d. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) ANS: C 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. DIF: Cognitive Level: Apply (application) REF: 156 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 15. 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? a. “The prescription cannot be refilled for another month. What happened to all of your pills?” b. “Do you have muscle cramps and tremors if you don’t take the medication frequently?” c. “I will ask the health care provider to prescribe more pills, but you will not be able to have them until next month.” d. “I am concerned that you may be overusing those. Let’s make an appointment for you with the health care provider.” ANS: D 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. DIF: Cognitive Level: Apply (application) REF: 152 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 16. A patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath. What should the nurse do first? a. Infuse normal saline. b. Check oxygen saturation. c. Draw blood for drug screening. d. Obtain a 12-lead echocardiogram (ECG). ANS: B 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. DIF: Cognitive Level: Analyze (analysis) REF: 151 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 17. 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? a. Risk for injury related to altered perception b. Ineffective coping related to situational issues c. Ineffective health maintenance related to drug use d. Powerlessness related to loss of behavioral control ANS: A Although all the diagnoses may be appropriate for the patient, the highest priority is to address the patient’s immediate risk for injury. DIF: Cognitive Level: Analyze (analysis) REF: 152 OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity 18. A 25-yr-old patient comes to the emergency department with severe chest pain and agitation. Which action should the nurse take first? a. Ask about use of stimulant drugs. b. Start an IV for sedative administration. c. Assess orientation to person, place, and time. d. Check blood pressure, pulse, and respirations. ANS: D 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. ANS: D Because the patient with cocaine use has symptoms suggestive of a possible fatal dysrhythmia, this patient should be assessed immediately. The other patients should also be seen as soon as possible, but their clinical manifestations do not suggest that life-threatening complications may be occurring. DIF: Cognitive Level: Analyze (analysis) REF: 151 OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 24. Which nursing activity can the nurse delegate to unlicensed assistive personnel (UAP) who are working in a family practice clinic? a. Make referrals to community substance use treatment centers. b. Teach patients about the use of prescribed nicotine replacement products. c. Obtain patient histories regarding alcohol, tobacco, and other substance use. d. Administer and score the Alcohol Use Disorders Identification Test (AUDIT). ANS: D No clinical judgment is needed to administer the AUDIT, which is a written questionnaire that is given to patients for self-administration and scored based on patient answers. Making appropriate referrals, patient teaching, and obtaining a patient history all require critical thinking and RN education and scope of practice. DIF: Cognitive Level: Apply (application) REF: 154 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment OTHER 1. A patient is admitted to the emergency department for treatment of a possible opioid overdose. Rank the nursing activities in the correct order from first activity to last activity. (Put a comma and a space between each answer choice [A, B, C, D, E]). a. Initiate IV access. b. Take a health history. c. Administer naloxone d. Obtain a toxicology screen e. Provide respiratory support with a bag-valve mask. ANS: E, A, C, D, B Maintenance of the airway is the first priority for patients with possible depressant overdose. Opioid antagonists are given before toxicology testing is done because reversal of the opioid will prevent respiratory arrest. However, this will require IV access. The toxicology report will help guide further treatment for possible multiple substance ingestions. The health history will guide care after the initial emergency treatment phase. DIF: Cognitive Level: Analyze (analysis) REF: 152 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment