ch. 11 substance abuse
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?
a. "I am older and wiser now, and I think I can change my drinking behavior."
The nurse plans postoperative care for a patient who smokes a pack of cigarettes daily. Which goal should the nurse include in the plan of care for this patient?
a. Improve sleep
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 prescribed medication will the nurse administer immediately?
a. Naloxone (Narcan)
A patient who is admitted to the hospital for wound debridement admits to using fentanyl (Sublimaze) illegally. What finding does the nurse expect?
a. Nausea and diarrhea
A newly admitted patient complains of waking frequently during the night. The nurse observes the patient wearing a nicotine patch (Nicoderm CQ) on the right upper arm. Which action is best for the nurse to take?
a. Question the patient about use of the patch at night.
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
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?
a. Thiamine (vitamin B1) 100 mg daily
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.
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?
b. Cocaine
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?
b. Frequent monitoring for bleeding and respiratory complications
A disoriented and agitated patient comes to the emergency department and admits using methamphetamine. Vital signs are blood pressure 162/98, heart rate 142 and irregular, and respirations 32. Which action by the nurse ismost important?
b. Monitor the patient's electrocardiogram (ECG) and vital signs.
After the nurse receives report, which patient should the nurse assess first?
b. Patient admitted with cocaine use who has an irregular heart rate of 142 beats/minute
A patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath. What should the nurse do first?
b. Start oxygen at 4 L/minute.
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?
c. "I am concerned that you may be overusing the Xanax. Let's make an appointment for you to see the doctor."
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 best?
c. "What health problems do you think smoking has caused?"
After receiving change-of-shift report on four patients who are undergoing substance abuse treatment, which patient will the nurse assess first?
c. A patient who has tremors secondary to benzodiazepine withdrawal and whose last benzodiazepine use was 4 days ago
Which nursing activity can the nurse delegate to unlicensed assistive personnel (UAP) who are working in a family practice clinic?
c. Administer and score the Alcohol Use Disorders Identification Test (AUDIT).
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 most appropriate?
c. Provide a quiet, well-lit environment.
A 75-year-old patient is admitted for pancreatitis. Which tool would be the most appropriate for the nurse to use during the admission assessment?
c. Screening Test-Geriatric Version (SMAST-G)
Which information is most important for the nurse to report to the health care provider about a patient who has been using varenicline (Chantix)?
c. The patient complains of new-onset sadness and depression.
Which assessment finding would alert the nurse to ask the patient about alcohol use?
d. Abdominal tenderness
A young adult patient comes to the emergency department with severe chest pain and agitation. Which action should the nurse take first?
d. Check blood pressure, pulse, and respirations.
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 most appropriate?
d. Monitor frequently for anxiety, hyperreflexia, and sweating.
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?
d. Request a prescription for a nicotine replacement agent.
