Patho/Pharm 2 Week 3 Combined

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A patient who is in pain is concerned about becoming addicted to pain medication and asks the nurse, "Can I become addicted to this medication?" What is the nurse's best response? Select all that apply. A. "You may develop a tolerance for the medication and need more of it in order for it to be therapeutic." B. "You will likely experience euphoria from the medication." C. "You will likely become dependent on this medication and require other medications to control your pain." D. "Before stopping the medication, you may need to taper it so you do not suffer from withdrawal." E. "You will not become physically addicted, but you may develop a physiological addiction."

A. "You may develop a tolerance for the medication and need more of it in order for it to be therapeutic." D. "Before stopping the medication, you may need to taper it so you do not suffer from withdrawal."

What are some primary prevention activities a nurse can perform related to substance abuse? Select all that apply. A. Education to prevent substance abuse B. Focusing on relapse prevention C. Identification of risk factors for abuse D. Medical detoxification E. Referral to a self-help group for stress relief and meditation

A. Education to prevent substance abuse C. Identification of risk factors for abuse E. Referral to a self-help group for stress relief and meditation

The nurse is assessing a patient using the CAGE questionnaire. The nurse suspects possible alcoholism when the patient makes which of the following statements? Select all that apply. A. The patient states, "My wife keeps nagging me about my drinking." B. The patient states, "I am going to try to cut down on drinking. I have been partying too much." C. The patient states, "I go to meetings once or twice a week but continue to drink." D. The patient states, "I usually have a Bloody Mary or Mimosa with breakfast." E. The patient says to the nurse, "I am ashamed of how much I have been drinking lately." F. The patient states, "I can quit whenever I want to."

A. The patient states, "My wife keeps nagging me about my drinking." B. The patient states, "I am going to try to cut down on drinking. I have been partying too much." D. The patient states, "I usually have a Bloody Mary or Mimosa with breakfast." E. The patient says to the nurse, "I am ashamed of how much I have been drinking lately."

Which pt behaviours should the nurse suspect as related to alcohol withdrawal? 1. Hyperalert state, jerky movements, easily startled 2. Tachycardia, diaphoresis, elevated BP 3. Peripheral vascular collapse, electrolyte imbalance 4. Paranoid delusions, fever, fluctuating levels of conciousness

ANS: 1 1. Patients who are exhibiting hyperalertness and jerky movements and who startle easily are most likely in a state of alcohol withdrawal, a condition that peaks in 24 to 48 hours after cessation or reduction of alcohol intake and then rapidly and dramatically disappears unless the withdrawal process progresses to alcohol withdrawal delirium. 2. Tachycardia, diaphoresis, and elevated blood pressure are associated with alcohol delirium and are considered a medical emergency and can result in death if not treated. 3. Peripheral vascular collapse and electrolyte imbalance are associated with alcohol delirium and are considered a medical emergency and can result in death if not treated. 4. Paranoid delusions, fever, and fluctuating levels of consciousness are associated with alcohol delirium and are considered a medical emergency and can result in death if not treated.

Which condition would the nurse be most concerned about when caring for a patient who abuses alcohol? 1. Cirrhosis of the liver 2. Suicidal potential 3. Wernicke's encephalopathy 4. Korsakoff syndrome

ANS: 2 1. Although the patient may develop or present with cirrhosis, the nurse must first plan care for prevention of self-harm. 2. Safety is always the priority when caring for patients. Ensuring safety includes completing a suicide risk assessment. 3. Wernicke's encephalopathy may develop, but the nurse must first plan care for prevention of self-harm. 4. Korsakoff syndrome is not the priority of care.

Which patient response to the question "Have you ever drunk more alcohol or used more drugs than you meant to?" should immediately cause the nurse to assess further? 1. "No, I have never used drugs or alcohol." 2. "I have drunk alcohol before but have ever never let myself get drunk." 3. "I figured you'd ask me about that." 4. "Yes, I did that once and will never do it again."

ANS: 3 1. No further assessment is immediately required. 2. Further assessment would be appropriate through the context of the general assessment; however, alcohol and drug use would not be the immediate priority. 3. Automatic responses such as "I figured you'd ask me about that" serve as red flags that further assessment must be done right away to provide clarification. 4. No further assessment is immediately required.

During a nutritional assessment, the nurse calculates that a female patient's BMI is 27. The nurse would advise the patient to follow which of these recommendations? a. This measurement indicates that the patient is overweight and should follow a plan of diet and exercise to lose weight. b. This measurement indicates that the patient is underweight and will need to take measures to gain weight. c. This measurement indicates that the patient is morbidly obese and may be a candidate for bariatric surgery. d. This measurement indicates that the patient is of normal weight and should continue with current lifestyle.

ANS: A A BMI of 25 to 29.9 is in the overweight range. A BMI of <18.5 is in the underweight range. A BMI of 30 to 34.9 is obesity class I, a BMI of 35 to 39.9 is obesity class II, and a BMI of >40 is obesity class III (morbid obesity). A BMI of 19 to 24 is in the normal range.

Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose? a. Simple and safe b. Active and bright c. Stimulating and colourful d. Confrontational and challenging

ANS: A Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a "bad trip."

At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as which of the following? a. Codependence b. Assertiveness c. Role reversal d. Homeostasis

ANS: A Codependence refers to participating in behaviours that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. The other options are not supported by information given in the scenario. See relationship to audience response question.

During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol." b. "It will be important for you to structure life to avoid as much stress as you can and provide social protection." c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behaviour carefully." d. "It is good that you are supportive of your spouse's sobriety and want to help maintain it."

ANS: A During recovery, patients identify and use alternative coping mechanisms to reduce reliance on substances. Physical adaptations must occur. Emotional responses were previously dulled by alcohol but are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who need anticipatory guidance and accurate information.

Critical Thinking: During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema, and suspects a nutritional deficiency. What additional data would the nurse expect to find to confirm the suspicion? a. Hair loss and hair that is easily removed from the scalp b. Inflammation of the tongue and fissured tongue c. Inflammation of peripheral nerves and numbness and tingling in extremities d. Fissures and inflammation of the mouth

ANS: A Hair loss (alopecia) and hair that is easily removed from the scalp (easy pluckability), like dry, flaking skin, is caused by essential fatty acid deficiency. Inflammation of the tongue (glossitis) and fissured tongue are manifestations of a niacin deficiency. Inflammation of peripheral nerves (neuropathy) and numbness and tingling in extremities (paresthesia) are manifestations of a thiamin deficiency. Fissures of the mouth (cheilosis) and inflammation of the mouth (stomatitis) are manifestations of a pyridoxine deficiency.

Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.

ANS: A Overdose of stimulants, such as amphetamines, can produce respiratory and circulatory dysfunction as well as hyperthermia. Concentration is impaired. This patient will be hypervigilant; it is not necessary to awaken the patient.

During history-taking, a patient tells the nurse that he is addicted to alprazolam (Xanax) and that he takes six 1 mg tablets a day. He quit cold turkey yesterday and now presents with extreme agitation, increased heart rate, and panic. The nurse suspects which disorder? a. Stress reaction b. DTs c. Overdose d. Relapse

ANS: A Stress reaction is a withdrawal symptom that can occur when detoxing too quickly. DTs are usually associated with alcohol withdrawal. Overdose of alprazolam would present with extreme drowsiness, confusion, muscle weakness, and loss of balance or coordination. The effects of alprazolam are dizziness, drowsiness, dry mouth, and lightheadedness.

Select the most therapeutic manner for a nurse to work with a patient who is beginning treatment for alcohol addiction. a. Empathetic, supportive b. Skeptical, guarded c. Cool, distant d. Confrontational

ANS: A Support and empathy assist the patient to feel safe enough to start looking at problems. Counselling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defences.

Select the priority outcome for a depressed patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will do which of the following? a. State, "I know I need long-term treatment." b. Use denial and rationalization in healthy ways. c. Identify constructive outlets for expression of anger. d. Develop a trusting relationship with one staff member.

ANS: A The correct option refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not give enough information to determine whether anger has been identified as a problem. A trusting relationship, while desirable, should have occurred earlier in treatment.

The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Systolic blood pressure higher than 200 mm Hg e. Temperature over 100° F (37.7° C) f. Pulse rate 110 beats/minute

ANS: A, C, D Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal

The nurse can assist a patient to prevent substance abuse relapse by doing which of the following? Select all that apply. a. Rehearsing techniques to handle anticipated stressful situations b. Advising the patient to accept residential treatment if relapse occurs c. Assisting the patient to identify life skills needed for effective coping d. Advising isolating self from significant others until sobriety is established e. Informing the patient of physical changes to expect as the body adapts to functioning without substances

ANS: A, C, E Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals. Anticipatory problem solving and role-playing are good ways of rehearsing effective strategies for handling stressful situations and helping the patient evaluate the usefulness of new strategies. The nurse can provide valuable information about physiological changes expected and ways to cope with these changes. Residential treatment is not usually necessary after relapse. Patients need the support of friends and family to establish and maintain sobriety.

The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking-cessation programs is true? a.Rapid chewing of the nicotine gum releases an immediate dose of nicotine. b.Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch. c.Compliance with treatment is higher with use of the gum rather than the transdermal patch. d.The nicotine gum can be used only up to six times per day

ANS: AQuick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum, because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke

Critical Thinking: The nurse is doing a nutritional assessment on a patient with hypertension. What foods would be recommended for this patient? a. regular diet b. low sodium diet c. pureed diet d. low sugar diet

ANS: B A low sodium diet will prevent water retention which could increase blood pressure. Patients with hypertension would not be on a regular diet due to sodium content. A pureed diet is indicated for stroke patients who may have impaired swallowing. A low sugar diet is indicated for patients with diabetes.

Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia (loss of full control of bodily movements) and slurred speech. The blood alcohol level is 0.50 mg%. Considering the relationship between the behaviour and blood alcohol level, which conclusion is most probable? a. The patient rarely drinks alcohol. b. The patient has a high tolerance to alcohol. c. The patient has been treated with disulfiram (Antabuse). d. The patient has ingested both alcohol and sedative drugs recently.

ANS: B A nontolerant drinker would be in coma with a blood alcohol level of 0.50 mg%. The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behaviour and strongly indicates that the patient's body is tolerant. If disulfiram and alcohol are ingested together, an entirely different clinical picture would result. The blood alcohol level gives no information about ingestion of other drugs.

A patient asks for information about Alcoholics Anonymous. Select the nurse's best response. a. "Alcoholics Anonymous is a form of group therapy led by a psychiatrist." b. "Alcoholics Anonymous is a self-help group for which the goal is sobriety." c. "Alcoholics Anonymous is a group that learns about drinking from a group leader." d. "Alcoholics Anonymous is a network that advocates strong punishment for drunk drivers."

ANS: B Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/min 0400: 126/80 mm Hg and 76 beats/min 0600: 128/82 mm Hg and 72 beats/min 0800: 132/88 mm Hg and 80 beats/min 1000: 148/94 mm Hg and 96 beats/min What is the nurse's priority action? a. Force fluids. b. Consult the health care provider. c. Obtain a clean-catch urine sample. d. Place the patient in a vest-type restraint.

ANS: B Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for medical intervention. No indication is present that the patient may have a urinary tract infection or that the patient is presently in need of restraint. Hydration will not resolve the problem.

A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a. Check the patient every 15 minutes b. One-on-one supervision c. Keep the room dimly lit d. Force fluids

ANS: B Immediate medical attention, ongoing assessment and supervised treatment is necessary to promote physical safety until sedation reduces the patient's feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels fall.

A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? a. Cardiovascular b. Respiratory c. Neurologic d. Hepatic

ANS: B Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority. See relationship to audience response question.

In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory centre secondary to narcotic intoxication. Select the priority outcome. a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min. c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d. Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

ANS: B The correct short-term outcome is the only one that relates to the patient's physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The patient's respirations are slow and shallow, but there is no evidence of congestion.

A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while working through a 12-step plan." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be assigned a sponsor who will plan your treatment program."

ANS: B Using the 12 steps, often referred to as "working the steps," helps a person refrain from addictive behaviours while fostering individual change and growth. Peer support, accomplished by obtaining a sponsor prior to discharge, can increase the patient's likelihood of attendance at 12-step meetings. The other options are incorrect.

The nurse is presenting a substance-abuse lecture for teenage girls and is asked about "roofies." The nurse recognizes that this is the slang term for which substance? a. cocaine b. flunitrazepam c. secobarbital d. methamphetamine

ANS: B Flunitrazepam is a benzodiazepine that has recently gained popularity as a recreational drug and is commonly called roofies (the "date-rape" drug). The other drugs are not known as roofies.

A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment? a. diazepam (Valium) b. methadone c. disulfiram (Antabuse) d. bupropion (Zyban

ANS: B Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation

Strategies that a nurse could use in a motivational interview to increase the chances of change include which of the following? (Select all that apply.) a. Educating the patient on the physical damage the substance is causing b. Encouraging the patient to think of ways to change environmental triggers to abuse substances c. Asking the patient how they think substance abuse affects their family life d. Explaining to the patient that substance abuse affects everyone in the family and give examples e. Asking the patient what methods they think would work and encouraging participating in self-help groups

ANS: B, C, E Empowering the patient by helping them see what effect the abuse has on their life is a key component of motivation. Educating the patient is too much like lecturing and may cause resistance. Explaining how the family responds to the problem may elicit guilt and resistance.

A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.) a.This drug is available as a chewing gum that can be taken to reduce cravings. b.Use caution when driving because drowsiness may be a problem. c.There have been very few adverse effects reported for this drug. d.Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur. e.Avoid caffeine while on this drug

ANS: B, D Patients taking varenicline have reported drowsiness, which has prompted the FDA to recommend caution when driving and engaging in other potentially hazardous activities until the patient can determine how the drug affects his or her mental status. In addition, the FDA has warned about psychiatric symptoms including agitation, depression, and suicidality. Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache, and insomnia. There are no cautions about taking caffeine while on this drug

A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome? (Select all that apply.) a. Euphoria b. Severe vomiting c. Diarrhea d. Pulsating headache e. Difficulty breathing f. Sweating

ANS: B, D, E, F Acetaldehyde syndrome results when alcohol is taken while on disulfiram (Antabuse) therapy. Adverse effects include CNS effects (pulsating headache, sweating, marked uneasiness, weakness, vertigo, others); GI effects (nausea, copious vomiting, thirst); and difficulty breathing. Cardiovascular effects also occur; see Table 17-2. Euphoria and diarrhea are not adverse effects associated with acetaldehyde syndrome

Critical Thinking: During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema. Which nutritional deficiency might be present? a. Vitamin C b. Vitamin B c. Essential fatty acid d. Protein

ANS: C Dry and scaly skin is a manifestation of essential fatty acid deficiency. Vitamin C deficiency causes bleeding gums, arthralgia, and petechiae. Vitamin B deficiency is too large a category to consider. Specific categories of vitamin B deficiency have been identified, such as pyridoxine and thiamine. Protein deficiency causes decreased pigmentation and lackluster hair.

A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, and diaphoretic and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. a. The patient is attempting to obtain attention by manipulating staff. b. The patient may have sustained a head injury before admission. c. The patient has symptoms of alcohol-withdrawal delirium. d. The patient is having an acute psychosis.

ANS: C Symptoms of agitation, elevated pulse, and perceptual distortions indicate alcohol withdrawal delirium. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.

The nurse is caring for a patient who is experiencing alcohol withdrawal. What is the main priority for this patient? a. Describe how the alcohol is causing the withdrawal effects. b. Leave the patient by him/herself so as not to cause agitation. c. Promote a safe, calm, and comfortable environment. d. Refer the patient to an alcohol-abuse counselor.

ANS: C The main priority is the patient's safety due to risk of harm from seizures, DTs, and anxiety. The nurse could provide referrals or discuss the relationship of alcohol to physical problems after the withdrawal period is over. Do not leave the patient alone, as many patients will need reassurance that they will survive the ordeal of withdrawal.

A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action? a. Perform a thorough assessment of the patient. b. Verify that security services are immediately available. c. Self-assess personal attitude, values, and beliefs about this health problem. d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

ANS: C The nurse should show compassion, care, and helpfulness for all patients, including those with addictive diseases. It is important to have a clear understanding of one's own perspective. Negative feelings may occur for the nurse; supervision is an important resource. The activities identified in the distracters occur after self-assessment.

The nurse is assessing a patient using the CAGE Questionnaire. The patient answers yes to all of the questions. The nurse suspects alcoholism and feels the patient is in denial when the patient states which of the following? a. "I go to meetings once a day and still drink." b. "My family and friends have been avoiding me lately." c. "I don't have a problem with alcohol. I can quit anytime I want to." d. "I know it will be hard to quit, but I am willing to try."

ANS: C The patient may need help admitting that there is a problem. The CAGE is designed to objectively assist in assessing problems related to alcohol use. A patient who states they are going to meetings is admitting they have a problem even if they still drink. Admitting that quitting is difficult is acceptance that there is a problem. Reality is setting in for a patient who can see that family and friends are avoiding them.

The nurse assesses the outcomes of a motivational interview on a patient with a dual diagnosis of alcoholism with DTs and determines that the communication was nontherapeutic. What should the nurse's next priority be? a. Encourage the patient to think of ways to change environmental triggers to abuse substances. b. Ask the patient what methods they think would work and encourage participating in self-help groups. c. Notify provider to obtain order for oxazepam (Serax) and vitamin B infusion. d. Notify provider to obtain order for CT scan and psychologic consult.

ANS: C The patient will need to be treated for the psychosis prior to conducting the motivational interview, because the patient can become violent and nonreceptive to the interventions. Oxazepam and vitamin B are the two therapies that work for DTs.

A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance? a. Opioids b. Alcohol c. Stimulants d. Depressants

ANS: C The adverse effects listed may occur with use of stimulants and are commonly an extension of their therapeutic effects. Opioids, alcohol, and depressants do not have these effects

During an interview, the nurse is discussing dietary habits with a patient. Which tool would be the best choice to use as a quick screening tool to assess dietary intake? a. Food diary b. Calorie count c. Comprehensive diet history d. 24-hour recall

ANS: D A 24-hour recall is useful as a quick screening tool to assess dietary intake. A food diary provides detailed information, but it is not convenient and requires a follow-up visit. A calorie count requires several days to collect data and requires a trained dietician to analyze the results. A comprehensive diet history may provide more accurate reflection of nutrient intake, but it is time consuming to acquire and requires a trained/skilled dietary interviewer.

A 45-year-old man is brought to the emergency department presenting with a respiratory rate of 6 breaths/min, and cardiac dysrhythmias. The most appropriate question the nurse should ask the patient's friend is a. "Does he take amphetamines or uppers?" b. "Has he ever used LSD?" c. "Have you two been out of the country in the last 2 days?" d. "Is he using any opioids such as heroin?"

ANS: D The clinical manifestations of an opioid overdose include seizures, shock, respiratory depression, dysrhythmias, and altered level of consciousness. An opioid overdose is a medical emergency. Amphetamine overdose is ruled out because it causes hypertension and central nervous system disturbances such as paranoia, panic, and delusions. LSD overdose would also manifest with hypertension and tachypnea along with hallucinations and possible loss of contact with reality. Travel outside the country is unrelated.

A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Sooner or later, alcohol will kill you. Then what will happen to your children?" b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, why were you hospitalized again?" d. "Tell me what happened the last time you drank."

ANS: D The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defences against anxiety that the patient still needs. They reflect the nurse's frustration with the patient.

The nurse is assisting a 79-year-old patient with information about diet and weight loss. The patient has a body mass index (BMI) of 31. How should the nurse instruct this patient? a. "Your weight is within normal limits. Continue maintaining with current lifestyle choices." b. "You are a little overweight. Cut down on calories and increase your activity, and you should be fine." c. "You are morbidly obese, and we would like to schedule you an appointment to speak with a bariatric specialist about surgery." d. "You are considered obese and will need to consult with your doctor about a plan that includes exercises, not diet, to decrease weight."

ANS: D This patient is at an increased risk for sarcopenia and should be instructed to increase activity that includes strength training to prevent muscle loss. Diet is not indicated. A BMI of 31 is considered obese; however, this patient does not qualify for surgical intervention until BMI reaches over 35.

A patient took a large quantity of phenylcyclohexyl piperidine. Priority nursing and medical measures include which of the following? Select all that apply. a. Administration of naloxone (Narcan) b. Vitamin B12 and folate supplements c. Restoring nutritional integrity d. Management of heart rate e. Environmental safety

ANS: D, E Care of patients who have taken phenylcyclohexyl piperidine (PCP) is similar to the care of those who have used other stimulants. Tachycardia and chest pain are common when a patient has used PCP. These problems are life-threatening and take priority. Patients who have used these substances commonly have bizarre behaviour or paranoia (or both); therefore, safety is a priority concern. Nutrition is not a priority in an overdose situation. Vitamin replacements and naloxone apply to other drugs of abuse.

A nurse is interviewing a patient and assessing the patient's readiness to change. Which statements by the patient in the motivational interview reflect this willingness? Select all that apply. A. The patient states, "I don't think my body will recover from the drinking." B. The patient states, "I will watch the game at my friend's house instead of at the bar." C. The patient states, "I now realize that the drinking has affected by family life." D. The patient states, "I am glad that I did not drag others into my drinking." E. The patient states, "I have been attending one meeting a day."

B. The patient states, "I will watch the game at my friend's house instead of at the bar." C. The patient states, "I now realize that the drinking has affected by family life." E. The patient states, "I have been attending one meeting a day."

A patient with a history of cardiac problems talks with the nurse about bowel elimination. The nurse stresses to the patient not to strain during bowel movements. Straining can put pressure on the vagas nerve and cause bradycardia. The nurse is explaining which physiologic action? Valsalva maneuver Tachypnea Eupnea First-degree heart block

Valsalva maneuver

The nurse is talking with a patient who was just diagnosed with a urinary tract infection. The patient asks the nurse how to prevent such infections in the future. The nurse should make which appropriate recommendations for the patient? (Select all that apply.) Void when the urge is felt. Exercise daily. Drink 6 to 8 glasses of noncaffeinated fluids daily. Increase fiber in the diet. Eat fruit twice daily.

Void when the urge is felt. Drink 6 to 8 glasses of noncaffeinated fluids daily.

Match the following drugs used for treatment of cocaine toxicity with their specific uses (answers may be used more than once). ___a. Haloperidol (Haldol) ___b. IV lidocaine ___c. IV diazepam (Valium) ___d. Propranolol (Inderal) ___e. Bretylium (Bretylol) ___f. IV lorazepam (Ativan) ___g. Procainamide (Pronestyl) 1. Tachycardia 2. Hallucinations 3. Dysrhythmias 4. Seizures

a. 2; b. 3; c. 4; d. 1; e. 3; f. 4; g. 3

As health care professionals, nurses have a responsibility to help reduce the use of tobacco. List the recommended "five As" as brief clinical interventions. a. b. c. d. e.

a. Ask; b. Advise; c. Assess; d. Assist; e. Arrange

Priority Decision: During admission to the emergency department, a patient with chronic alcoholism is intoxicated and very disoriented and confused. Which drug will the nurse administer first? a. IV thiamine b. IV benzodiazepines c. IV haloperidol (Haldol) d. IV naloxone (Narcan) in normal saline

a. Because Wernicke's encephalopathy resulting from a thiamine deficiency is a possibility with chronic alcoholism, IV thiamine is often administered to intoxicated patients to prevent the development of Korsakoff's psychosis. Thiamine should be given before any glucose solutions are administered because glucose can precipitate Wernicke's encephalopathy. Benzodiazepines may be used for sedation and to minimize withdrawal symptoms but would not be given before thiamine, and haloperidol could be used if hallucinations occur.

A patient who is a heavy caffeine user has been NPO all day in preparation for a late afternoon surgery. The nurse monitors the patient for effects of caffeine withdrawal that may include a. headache. b. nervousness. c. mild tremors. d. shortness of breath

a. Headache is a common symptom of caffeine withdrawal and often occurs in heavy caffeine users who are NPO for diagnostic tests and surgery.

Which substance, when abused, can cause euphoria, drowsiness, decreased respiratory rate, and slurred speech? a. Opioids b. Alcohol c. Cannabis d. Depressants

a. Opioids produce these physiologic responses. Although alcohol intake can cause euphoria, drowsiness, and slurred speech, the abuser of alcohol develops tolerance and does not usually have these manifestations. Effects of chronic alcohol abuse include impairment of all body systems (see Table 11-7). Cannabis produces euphoria, sedation, and hallucinations. Depressants may cause slurred speech and drowsiness but not euphoria or decreased respirations unless there is an overdose.

Which manifestation(s) is (are) experienced by a patient when withdrawing from sedative-hypnotic addiction (select all that apply)? a. Seizures b. Violence c. Suicidal thoughts d. Tremors and chills e. Sweating, nausea, and cramps

a. Seizures may be experienced with phenobarbital or a long-acting benzodiazepine. Tremors, chills, sweating, nausea, and cramps are seen with opioid withdrawal. Hallucinogens are least likely to have withdrawal symptoms. Suicidal thoughts and violence are more likely to occur in patients withdrawing from stimulants.

Priority Decision: A patient with a history of alcohol abuse is admitted to the hospital following an automobile accident. What is most important for the nurse to assess to plan care for the patient? a. When the patient last had alcohol intake b. How much alcohol has recently been used c. What type of alcohol has recently been ingested d. The patient's current blood alcohol concentration

a. The knowledge of when the patient last had alcohol intake will help the nurse to anticipate the onset of withdrawal symptoms. In patients with alcohol tolerance, the amount of alcohol and the blood alcohol concentration do not reflect impairment as consistently as in the nondrinker. The type of alcohol ingested is not important because in the body it is all alcohol.

The third day after an alcohol-dependent patient was admitted to the hospital for pancreatitis, the nurse determines that the patient is experiencing alcohol withdrawal. What are the signs of withdrawal on which the nurse bases this judgment (select all that apply)? a. Apathy b. Seizures c. Gross tremors d. Severe depression e. Cardiovascular collapse f. Visual and auditory hallucinations

b, c, f. Seizures, gross tremors, visual and auditory hallucinations, and alcohol withdrawal delirium are the four major withdrawal syndrome manifestations. Apathy and depression occur in withdrawal from stimulants. Cardiovascular collapse is seen in sedative-hypnotic withdrawal.

To stop the behavior that leads to the most preventable cause of death in the United States, the nurse should support programs that a. prohibit alcohol use in public places. b. prevent tobacco use in children and adolescents. c. motivate individuals to enter addiction treatment. d. recognize addictions as illnesses rather than crimes.

b. Smoking is the single most preventable cause of death and most smokers start smoking by age 16. If smoking in preadolescents and adolescents could be prevented, it is unlikely that these individuals would start smoking at a later age. Health problems associated with smoking and future use of other addictive substances would be significantly reduced

What term is used to describe a decreased effect of a substance following repeated exposure? a. Relapse b. Tolerance c. Abstinence d. Withdrawal

b. Tolerance is described. Relapse is when the person returns to substance use after a period of abstinence. Abstinence is avoidance of substance use. Withdrawal is the response that occurs after abrupt cessation of a substance.

Priority Decision: A patient in alcohol withdrawal has a nursing diagnosis of ineffective protection related to sensorimotor deficits, seizure activity, and confusion. Which nursing intervention is most important for the patient? a. Provide a darkened, quiet environment free from external stimuli. b. Force fluids to assist in diluting the alcohol concentration in the blood. c. Monitor vital signs frequently to detect an extreme autonomic nervous system response. d. Use restraints as necessary to prevent the patient from reacting violently to hallucinations

c. An extreme autonomic nervous system response may be life threatening and requires immediate intervention. A quiet room is recommended but it should be well lighted to prevent misinterpretation of the environment and visual hallucinations. Cessation of alcohol intake causes low blood alcohol levels leading to withdrawal symptoms and fluids should be administered carefully to prevent dysrhythmias. Patients should not be restrained if at all possible because injury and exhaustion can occur as patients struggle against restraint.

What is an important postoperative intervention indicated for the alcoholic patient who is alcohol intoxicated and is undergoing emergency surgery? a. Monitor weight because of malnutrition. b. Give an emergency dose of IV magnesium. c. Decrease pain medication to prevent cross-tolerance to opiates. d. Closely monitor for signs of withdrawal and respiratory and cardiac problems.

d. Alcohol-induced central nervous system (CNS) depression can lead to respiratory and circulatory failure in an alcoholic patient. Vital signs are monitored closely because of the increased risk of infection from malnutrition. Emergency magnesium would not be expected, although an emergency dose of thiamine may have been given before surgery. Pain medication requirements may be increased if the patient is cross-tolerant to opiates.

On admission to the hospital for a knee replacement, a patient who has smoked for 20 years expresses an interest in quitting. What is the best response by the nurse? a. "Good for you! You should talk to your doctor about that." b. "Why did you ever start in the first place? It's so hard to quit." c. "Since you won't be able to smoke while you are in the hospital, just don't start again when you are discharged. d. "Great! I'll help you make a plan and work with your doctor to get you what you need to start while you are here."

d. Nurses have a professional responsibility to help individuals stop smoking. The advice and motivation of health care professionals can be very helpful to the individual. Nurses should encourage and provide information to patients and work with physicians to identify ways to assist patients with quitting.

When assessing an older patient for substance abuse, the nurse specifically asks the patient about the use of alcohol and which other types of medications? a. Opioids b. Sedative-hypnotics c. Central nervous system stimulants d. Prescription and over-the-counter (OTC) medications

d. Older adult patients have the highest use of OTC and prescription drugs, and simultaneous use of these drugs with alcohol is a major problem. Illegal drug use is minimal in older patients except in long-term addicts.

What is the definition of substance abuse? a. A compulsive need to experience pleasure b. Behavior associated with maintaining an addiction c. Absence of a substance will cause withdrawal symptoms d. Overuse and dependence on a substance that negatively affects functioning

d. Substance abuse negatively affects psychologic, physiologic, and/or social functioning of an individual. The compulsive need for pleasure is psychologic dependence. Behavior to maintain addiction is addictive behavior. Absence of a substance causing withdrawal symptoms is physical dependence.

The nurse is working with a patient at the clinic who does not want to quit smoking even though he is having trouble breathing at times and has a frequent cough. Which clinical practice guideline strategies should the nurse use with this patient? a. Cost, cough, cleanliness, Chantix b. Ask, advise, assess, assist, arrange c. Deduce, describe, decide, deadline d. Relevance, risks, rewards, roadblocks, repetition

d. The "five Rs" are used for individuals who are unwilling to quit tobacco use. The "five As" are used for individuals who want to quit tobacco use. Although cost, cough, cleanliness, and the use of Chantix as well as deduce, describe, decide, and deadline may be ways to assist this patient, these are not recommendations or clinical practice guidelines.

A nurse in a home setting is assessing a 79-year-old male patient's risk for malnutrition. The nurse suspects malnutrition when reviewing which laboratory results? (Select all that apply) A) Body mass index (BMI) of 17 B) Waist-to-hip ratio of 1.0 C) Weight loss of 6% since last month's visit D) Prealbumin level of 16 mg/dL E) Hematocrit level of 50% F) Hemoglobin level of 8.2 g/dL

A) BMI of 17 C) Weight loss of 6% since last month's visit F) hemoglobin level of 8.2 g/dL A BMI of 18.5 to 24.9 is normal, and this patient's BMI is below normal; a major weight loss is defined as more than a 2% weight change over 1 week; and the expected hemoglobin level for a man is 14 to 18 g/dL. The patient's values may also indicate dehydration. The expected level for prealbumin is 15 to 36 mg/dL. A hematocrit level of 50% is within normal limits.

The nurse is teaching a patient the importance of protein for healing. Which foods should the nurse include in the teaching plan? A) Fish B) Cereal C) Bread D) Oatmeal

A) Fish Fish contains all of the essential amino acids. Cereal is a starch. Bread is a starch. Oatmeal is a grain and is considered a starch.

A nurse in a home setting is assessing a 79-year-old male patient's risk for malnutrition. The nurse suspects malnutrition when reviewing which laboratory results? (Select all that apply.) A. Body mass index (BMI) of 17 Correct B. Waist-to-hip ratio of 1.0 C. Weight loss of 6% since last month's visit D. Prealbumin level of 16 mg/dL E. Hematocrit level of 50% F. Hemoglobin level of 8.2 g/dL

A, C, F

A patient is being treated for an illicit drug addiction. The nurse understands that the treatment may include which of the following? Select all that apply. A. A motivational interview B. Observing for stress reaction C. Converting narcotic use from an illicit to a legally controlled drug D. Observing for delirium tremens E. Encouraging involvement in Narcotics Anonymous

A. A motivational interview B. Observing for stress reaction E. Encouraging involvement in Narcotics Anonymous

A. Seizures

The nurse is caring for a patient diagnosed with peptic ulcer disease (PUD). The patient was prescribed the proton pump inhibitor Prevacid (lansoprazole). Which of the following supplements may be prescribed to prevent deficiency? A. Vitamin B12 B. Vitamin C C. Vitamin D D. Omega-3 fatty acids

A. Vitamin B12

A patient brought to the emergency department after phenylcyclohexyl piperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. Which of the following nursing interventions would be most therapeutic? 1. Taking him to the gym on the psychiatric unit 2. Obtaining an order for seclusion and close observation 3. Assigning a psychiatric technician to "talk him down" 4. Administering naltrexone as needed per hospital protocol

ANS: 2 Aggressive, violent behaviour is often seen with PCP ingestion. The patient will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off. Talking down is never advised because of the patient's unpredictable violent potential. Naltrexone is an opiate antagonist.

11. A patient admitted to an alcoholism rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defense mechanism? a. Denial b. Projection c. Introjection d. Rationalization

ANS: A Minimizing one's drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for one's faults or problems. Rationalization involves making excuses. Introjectioninvolves incorporating a quality of another person or group into one's own personality.

During a physical examination, the nurse notes that the patient's skin is dry and flaking. What additional data would the nurse expect to find to confirm the suspicion of a nutritional deficiency? a. Hair loss and hair that is easily removed from the scalp b. Inflammation of the tongue and fissured tongue c. Inflammation of peripheral nerves and numbness and tingling in extremities d. Fissures and inflammation of the mouth

A patient admitted to an alcoholism rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defence mechanism? a. Denial b. Projection c. Introjection d. Rationalization

ANS: A Minimizing one's drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for one's faults or problems. Rationalization involves making excuses. Introjection involves incorporating a quality of another person or group into one's own personality.

When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred? a. Tolerance has developed. b. Antagonistic effects are evident. c. Metabolism of the alcohol is now delayed. d. The pharmacokinetics of the alcohol has changed.

ANS: A Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither delayed metabolism nor antagonistic effects account for this change.

The nurse recognizes a potential health threat to an alcoholic patient who is using the drug disulfiram (Antabuse) when the nurse reads in the health record that the patient is also which of the following? (Select all that apply.) a. On blood thinners b. Taking diphenhydramine (Benadryl) tablets c. Ingesting alcohol d. On penicillin e. Using mouthwash

ANS: A, C, E Disulfiram increases the effect of anticoagulants such as warfarin (Coumadin). Ingesting alcohol may cause headache, nausea, vomiting, tachycardia, chest pain, or dizziness. Mouthwash can have alcohol as one of the main ingredients and should be checked prior to using.

An African American is at an increased risk for which of the following? (Select all that apply.) a. Vitamin D deficiency b. Type 1 diabetes c. Celiac disease d. Type 2 diabetes e. Hypertension f. Metabolic syndrome

ANS: A, D, E, F Type 1 diabetes and celiac disease are more common in Northern European heritage.

10. Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable? The patient: a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has ingested both alcohol and sedative drugs recently.

ANS: B A non-tolerant drinker would be in coma with a blood alcohol level of 500 mg%. The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patient's body is tolerant. If disulfiram and alcohol are ingested together, an entirely different clinical picture would result. The blood alcohol level gives no information about ingestion of other drugs.

1. A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be assigned a sponsor who will plan your treatment program."

ANS: B Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

2. A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/min 0400: 126/80 mm Hg and 76 beats/min 0600: 128/82 mm Hg and 72 beats/min 0800: 132/88 mm Hg and 80 beats/min 1000: 148/94 mm Hg and 96 beats/min What is the nurse's priority action? a. Force fluids. b. Consult the health care provider. c. Obtain a clean-catch urine sample. d. Place the patient in a vest-type restraint.

ANS: B Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for medical intervention. No indication is present that the patient may have a urinary tract infection or is presently in need of restraint. Hydration will not resolve the problem.

7. A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a. Check the patient every 15 minutes b. One-on-one supervision c. Keep the room dimly lit d. Force fluids

ANS: B One-on-one supervision is necessary to promote physical safety until sedation reduces the patient's feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels fall.

3. A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? a. Cardiovascular b. Respiratory c. Neurologic d. Hepatic

6. A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n): a. narcotic analgesic, such as hydromorphone (Dilaudid). b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium). c. antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril). d. monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil).

ANS: B Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

19. In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic intoxication. Select the priority outcome. a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min. c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d. Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

27. An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect: a. a schizophrenic episode. b. hallucinogen ingestion. c. opium intoxication. d. cocaine overdose.

ANS: B The patient who is high on a hallucinogen often experiences synesthesia (visions in sound), depersonalization, and concerns about going "crazy." Synesthesia is not common in schizophrenia. CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviors. Phencyclidine (PCP) use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.

24. Symptoms of withdrawal from opioids for which the nurse should assess include: a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.

ANS: B The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis. See relationship to audience response question. (Educators may alter this question to multiple answers if desired.)

A patient who was admitted 24 hours ago has become increasingly irritable and now says there are bugs on his bed. The nurse suspects a. alcohol-induced psychosis. b. delirium tremens (DTs). c. neurologic injury related to a fall. d. posttraumatic stress reaction.

ANS: B During the 6 to 96 hours after last alcohol use, patients may experience DTs, as evidenced by disorientation, nightmares, abdominal pain, nausea, and diaphoresis, as well as elevated temperature, pulse rate, and blood pressure measurement and visual and auditory hallucinations.

A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe which of the following? a. A narcotic analgesic, such as hydromorphone (Dilaudid) b. A benzodiazepine, such as lorazepam (Ativan) or chlordiazepoxide (Librium) c. An antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril) d. A monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil)

ANS: B Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. Which of the following should the nurse suspect? a. A schizophrenic episode b. Hallucinogen ingestion c. Opium intoxication d. Cocaine overdose

ANS: B The patient who is high on a hallucinogen often experiences synesthesia (visions in sound), depersonalization, and concerns about "going crazy." Synesthesia is not common in schizophrenia. CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviours. Phencyclidine (PCP) use commonly causes bizarre or violent behaviour, nystagmus, elevated vital signs, and repetitive jerking movements.

Which of the following symptoms of withdrawal from opioids should the nurse assess? a. Dilated pupils, tachycardia, elevated blood pressure, and elation b. Nausea, vomiting, diaphoresis, anxiety, and hyperreflexia c. Mood lability, incoordination, fever, and drowsiness d. Excessive eating, constipation, and headache

A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel "normal" again. Which statement by the nurse is correct? a. "It's possible that these cravings will never stop." b. "These cravings may persist for several months." c. "The cravings tell us that you are still using nicotine." d. "The cravings show that you are about to experience nicotine withdrawal."

ANS: B Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false.

Which of the following would be part of the treatment plan for a person experiencing alcohol overdose? Select all that apply. a. Monitor vital signs every 5 minutes b. Monitor for respiratory depression c. Maintain hydration with IV fluids d. Administer antipsychotic medication e. Administer oxygen

ANS: B, C, E Correct aspects of the treatment plan for this patient would be to monitor for respiratory depression, maintain hydration with IV fluids, and administer oxygen. Vital signs are to be monitored; however every 5 minutes is too often—every 15 minutes is sufficient. There is no indication that the patient requires an antipsychotic medication.

1. A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy. Patient teaching should include the need to: (select all that apply) a. avoid aged cheeses. b. avoid alcohol-based skin products. c. read labels of all liquid medications. d. wear sunscreen and avoid bright sunlight. e. maintain an adequate dietary intake of sodium. f. avoid breathing fumes of paints, stains, and stripping compounds.

ANS: B, C, F The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions. The other options do not relate to hidden sources of alcohol.

A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy? a. He should not smoke cigarettes while on this drug b.He needs to know about the common over-the-counter substances that contain alcohol. c.This drug will cause the same effects as the alcohol did, without the euphoric effects. d.Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts

ANS: BThe use of disulfiram (Antabuse) with alcohol-containing over-the-counter products will elicitsevere adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person. Cigarette smoking does not cause problems when taking disulfiram. Disulfiram does not have the same effects as alcohol

During a physical examination, the nurse notes that the patient's skin is dry and flaking, with patches of eczema. Which nutritional deficiency might be present? a. Vitamin C b. Vitamin B c. Essential fatty acid d. Protein

What is the most significant predictor of treatment success, considering the ambivalence of most patients? a) Ongoing support from at least two family members. b) Employment of the patient. c) An empathic, hopeful, and consistently motivational approach. d) A regular schedule of appointments with a primary care provider.

ANS: C The most significant predictor of treatment success, considering the ambivalence of most of these patients, is an empathic, hopeful, and consistently motivational approach. This is the rationale behind motivational interviewing approaches.

26. Which assessment findings are likely for an individual who recently injected heroin? a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speech

ANS: D Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use. (Educators may alter this question to multiple answers if desired.)

22. A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate? a. 1-week detoxification program b. Long-term outpatient therapy c. 12-step self-help program d. Residential program

ANS: D Residential programs and therapeutic communities help patients change lifestyles, abstain from drugs, eliminate criminal behaviors, develop employment skills, be self-reliant, and practice honesty. Residential programs are more effective for patients with antisocial tendencies than outpatient programs.

8. A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Sooner or later, alcohol will kill you. Then what will happen to your children?" b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, why were you hospitalized again?" d. "Tell me what happened the last time you drank."

ANS: D The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurse's frustration with the patient.

21. Which goal for treatment of alcoholism should the nurse address first? a. Learn about addiction and recovery. b. Develop alternate coping strategies. c. Develop a peer support system. d. Achieve physiologic stability.

ANS: D The individual must have completed withdrawal and achieved physiologic stability before he or she is able to address any of the other treatment goals.

5. A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Disturbed sensory perception b. Ineffective coping c. Ineffective denial d. Risk for injury

ANS: D The patient's clouded sensorium, sensory perceptual distortions, and poor judgment predispose a risk for injury. Safety is the nurse's priority. The other diagnoses may apply but are not the priorities of care.

A young woman has been admitted to hospital for use of room deodorizers as inhalants. Which is a sign of intoxication from inhaling volatile nitrites such as room deodorizers? a. Flushing b. Hallucinations c. Slurred speech d. Enhancement of sexual pleasure

ANS: D A sign of intoxication from inhaling volatile nitrites such as room deodorizers is enhancement of sexual pleasure. Flushing, hallucinations, and slurred speech are signs of intoxication from inhaling organic solvents.

Benzodiazepines are useful for treating alcohol withdrawal because they do which of the following? a. Block cortisol secretion b. Increase dopamine release c. Decrease serotonin availability d. Exert a calming effect

ANS: D Benzodiazepines act by binding to α-aminobutyric acid-benzodiazepine receptor sites, producing a calming effect.

Which assessment findings are likely for an individual who recently injected heroin? a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speech

ANS: D Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviours consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use.

What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol? a) The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place. b) Neither should be reported until the nurse has collected factual evidence. c) No report should be made until suspicions are confirmed by a second staff member. d) Supervisory staff should be informed as soon as possible in both cases.

ANS: D If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation (specific dates, times, events, consequences) by co-workers is crucial. The nurse manager's major concerns are with job performance and patient safety. Reporting an impaired colleague is not easy, even though it is our responsibility. To not "see" what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug.

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Naloxone (Targin) b. Methadone (Metadol) c. Disulfiram (Antabuse) d. Naltrexone (ReVia)

ANS: D Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.

Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search and destroy tactics to keep the home alcohol-free." c. "It's important that you visit your family member on a regular basis." d. "Make your loved one responsible for the consequences of behaviour."

ANS: D Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviours, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviours or are of no help.

Which goal for treatment of alcoholism should the nurse address first? a. Learn about addiction and recovery. b. Develop alternate coping strategies. c. Develop a peer support system. d. Achieve physiologic stability.

ANS: D The individual must have completed withdrawal and achieved physiologic stability before he or she is able to address any of the other treatment goals.

A patient is thin, tense, and jittery and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely? a. PCP b. Heroin c. Barbiturates d. Amphetamines

ANS: D The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behaviour. Barbiturates and heroin would result in symptoms of CNS depression.

A person of Northern heritage is at an increased risk for which of the following? (Select all that apply) A) Vitamin C deficiency B) Type I diabetes C) Celiac disease D) Type 2 diabetes E) Hypertension F) Metabolic syndrome

B) Type 1 diabetes C) Celiac disease Type 1 diabetes and Celiac disease are more common in Northern heritage. African Americans and Hispanics are at increased risk for Type 2 diabetes, hypertension, and metabolic syndrome. Vitamin C deficiency is not a common deficiency related to heritage or ethnicity.

An person of Northern heritage is at an increased risk for which of the following: (Select all that apply.) A. Vitamin c deficiency B. Type 1 diabetes C. Celiac disease D. Type 2 diabetes E. Hypertension F. Metabolic syndrome

B, C

Which factors can alter both bowel and urinary elimination patterns in adult patients? (Select all that apply.) Sedentary lifestyle Neurologic impairment Antidepressant medications Cognitive disorders Impaired mobility

Cognitive disorders Impaired mobility Neurologic impairment

According to the food plan, what represents one serving from the bread, cereal, and grain products group? A) 1 cup cooked rice B) 6 soda crackers C) 1 hamburger bun D) 1 slice of bread

D) 1 slice of bread One slice of bread represents one serving from this group. One-half cup cooked rice represents one serving from this group. Three to four crackers represent one serving from this group. One hamburger bun represents two servings from this group.

A patient has impaired urinary elimination: retention. Which system is at risk for alteration in addition to the renal system? Skeletal Gynecologic Gastrointestinal Immune

Immune

What effect does inadequate fluid intake have on a patient's urinary system? Increases the risk for urinary infections. Decreases incidence of urinary incontinence. Increases the ability to recognize bladder cues. Decreases the presence of bladder crystals.

Increases the risk for urinary infections.

If a patient has a colostomy in the area known as the "ascending colon," what would the nurse expect of the stool in the colostomy device? Stool would be formed. Stool would be dark. Stool would be loose. Stool would have flecks of blood.

Stool would be loose.

17) When assessing an older patient for substance abuse, the nurse specifically asks the patient about the use of alcohol in which other types of medications? a) Opioids. b) Sedative hypnotics. c) central nervous system stimulants. d) prescription and over the counter medications.

d) prescription and over the counter medications.

What is a primary prevention tool used for colon cancer screening? a. Abdominal x-rays b. Blood, urea, and nitrogen (BUN) testing c. Serum electrolytes d. Occult blood testing

d. Occult blood testing

The nurse is teaching adult male healthy eating guidelines. How many servings of dairy should the nurse recommend for this patient? A) 2 - 3 B) 3 - 5 C) 5-6 D) 0 - 2

A) 2 - 3 Between 2 and 3 servings is the recommended daily intake of dairy. 3 to 5 servings would be recommended for children and pregnant and lactating women. 5 to 6 servings of dairy is not a standard recommendation for any age category. 0 to 2 servings is not a standard recommendation for any age category.

Which of the following is the most helpful message to transmit about relapse to the patient recovering from alcohol abuse? 1. Relapses are an indicator of treatment failure. 2. Relapses are caused by physiological changes. 3. Relapses result from lack of good situational support. 4. Relapses can be learning situations to prolong sobriety.

ANS: 3 Relapses and lapses can point out problems to be resolved and can result in renewed efforts for change.

25. A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes: a. cross-tolerance. b. substance abuse c. substance addiction. d. substance intoxication.

ANS: C Nicotine meets the criteria for a "substance," the criterion for addiction is present, and withdrawal symptoms are noted with abstinence or reduction of dose. The scenario does not meet criteria for substance abuse, intoxication, or cross-tolerance.

12. Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Bromocriptine (Parlodel) b. Methadone (Dolophine) c. Disulfiram (Antabuse) d. Naltrexone (ReVia)

A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient? a. Naltrexone prevents the cravings for opioid drugs. b. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal. c. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone. d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid's desired effects are lost

ANS: D Naltrexone works to eliminate the euphoria that occurs with opioid drug use; therefore, the reinforcing effect of the drug is lost.

In which age group is skipping meals most commonly seen? A) School-age children B) Adolescents C) Adults D) Older adults

B) Adolescents Eating patterns may reveal poor eating habits associated with multiple school or athletic activities. The eating patterns of school-age children usually are influenced by their parents. Although many busy adults may skip meals, as a group most adults eat consistently. Although some older adults may skip meals, as a group most eat consistently.

The nurse is assessing a group of patients to determine their risk of vitamin D deficiency. Which of the following patients has the highest risk for vitamin D deficiency? A. Caucasian female who is 39 weeks gestation. B. An African-American female who is breastfeeding. C. An Asian female diagnosed with hypoglycemia. D. A Hispanic female who has a BMI of 24.1.

B. An African-American female who is breastfeeding.

The nurse suspects that the patient is suffering from malnutrition. Which laboratory test indicates a patient's protein calorie status? A) Hemoglobin and hematocrit B) Serum glucose levels C) Lipid profile D) Serum albumin

D) Serum albumin Serum albumin measures serum protein. Hemoglobin and hematocrit screen for anemia resulting from dietary deficiency. Serum glucose levels are a reflection of carbohydrate metabolism. Lipid profile is an indication of fat (lipid) metabolism.

15) During the admission to the emergency Department a patient with chronic alcoholism is intoxicated and very disoriented and confused. Which drug will the nurse administer first? a) IV thiamine. b) IV benzodiazepines. c) IV haloperidol. d) IV naloxone in NS.

a) IV thiamine.

The process of digestion is important for every living organism for the purpose of nourishment. Where does most digestion take place in the body? a. Large intestine b. Stomach c. Small intestine d. Pancreas

c. Small intestine

3. A patient took a large quantity of bath salts. Priority nursing and medical measures include: (select all that apply) a. administration of naloxone (Narcan). b. vitamin B12 and folate supplements. c. restoring nutritional integrity. d. management of heart rate. e. environmental safety.

ANS: D, E Care of patients who have taken bath salts is similar to those who have used other stimulants. Tachycardia and chest pain are common when a patient has used bath salts. These problems are life-threatening and take priority. Patients who have used these substances commonly have bizarre behavior and/or paranoia; therefore, safety is a priority concern. Nutrition is not a priority in an overdose situation. Vitamin replacements and naloxone apply to other drugs of abuse.

The nurse is caring for a 50-year-old man who has a body mass index (BMI) of 31 kg/m2, a normal C-reactive protein level, and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patient's intake of foods that is high in: A. Iron B. Protein C. Calories D. Carbohydrate

B. Protein

what term is used to describe a decreased effect of a substance following repeated exposure? a) Relapse b) tolerance c) abstinence d) withdrawal

b) tolerance

When the nurse is encouraging a woman who smokes one and a half packs of cigarettes per day to quit with the use of nicotine replacement therapy, the woman asks how the nicotine in a Patch or gum differs from the nicotine she get some cigarettes. what should the nurse explain about nicotine replacement? a) It includes this substance that eventually creates an aversion to nicotine. b) it provides a non carcinogenic nicotine, unlike the nicotine in cigarettes. c) it prevents the weight gain that is a concerned women who stop smoking. d) it eliminates the thousands of toxic chemicals that are inhaled with smoking.

d) it eliminates the thousands of toxic chemicals that are inhaled with smoking

The school nurse is assessing the nutritional status of a healthy adolescent. Which assessment will the nurse include in this assessment? (Select all that apply) A) Anthropometrics B) Biochemical tests results C) Clinical evaluation of diet D) Dietary assessment E) Body mass index (BMI)

A) Anthropometrics B) Biochemical tests results C) Clinical evaluation of diet E) Body mass index (BMI) Options A, B, C, and E are included in routine assessment of nutritional assessment for adolescent patients. Unless clinically indicated, biochemical tests are not routinely performed with this age group.

Appropriate approaches used by the long-term care nurse to provide education for a 73 year old who has just been diagnosed with diabetes include which of the following? (Select all the apply) A) Schedule a visit by another resident who is diabetic. B) Demonstrate food choices using food photographs. C) Avoid discussion of the patient's favorite foods. D) Remind the patient that a lot of damage has already occurred. E) Encourage the patient's family to participate in teaching sessions. F) Ask the patient about past experiences with lifestyle changes.

A) Schedule a visit by another resident who is diabetic. B) Demonstrate food choices using food photographs. E) Encourage the patient's family to participate in teaching sessions. F) Ask the patient about past experiences with lifestyle changes. Strategies to promote learning in older adults include peer teaching, visual aids, family participation, and relating new learning to past experiences. Discussion of the patient's favorite foods is needed to determine how old favorites can be adapted to the new diet. Reminders about the damage already done will indicate that the changes are not worth the effort.

The nurse is caring for a patient diagnosed with peptic ulcer disease (PUD). The patient was prescribed the proton pump inhibitor Prevacid (lansoprazole). Which of the following supplements may be prescribed to prevent deficiency? A) Vitamin B12 B) Vitamin C C) Vitamin D D) Omega-3 fatty acids

A) Vitamin B12 Vitamin B12 deficiency can occur as a result of the reduced gastric acidity associated with use of proton pump inhibitors, and supplementation is often warranted. Vitamin C deficiency is not a known deficiency associated with medications. Vitamin D deficiency may occur in patients who take cholesterol medication, and this link is currently being investigated. Omega-3 fatty acids may be used as monotherapy or in conjunction with cholesterol medication for patients with hyperlipidemia.

Appropriate approaches used by the long-term care nurse to provide education for a 73-year-old who has just been diagnosed with diabetes include which of the following? (Select all that apply.) A. Schedule a visit by another resident who is diabetic. B. Demonstrate food choices using food photographs. C. Avoid discussion of the patient's favorite foods. D. Remind the patient that a lot of damage has already occurred. E. Encourage the patient's family to participate in teaching sessions. F. Ask the patient about past experiences with lifestyle changes.

A, B, E, F

Nursing assessment of an alcohol-dependent patient 6 to 12 hours after the last drink would most likely reveal the presence of which of the following? 1. Tremors 2. Seizures 3. Blackouts 4. Hallucinations

ANS: 1 Tremors are an early sign of alcohol withdrawal. The presence of seizures is at high risk at 24-48 hours.

The nurse is caring for a patient with an addictive disorder who is currently drug-free. The pt is experiencing repeated occurrences of viid, frightening images and thought. Which term would the nurse use to document this finding? 1. Tolerance 2. Flashbacks 3. Withdrawal 4. Synergistic effect

ANS: 2 1. Tolerance occurs when a patient's physiological reaction to a drug decreases with repeated administration of the same dose. 2. Flashbacks occur in a drug-free state and involve visual distortions, time expansion, loss of ego boundaries, and intense emotions. Often, flashbacks are mild and perhaps pleasant, but at other times, individuals experience repeated recurrences of frightening images or thoughts. 3. Withdrawal causes physiological changes as blood and tissue concentrations of a drug decrease in individuals who have maintained heavy and prolonged use of a substance. 4. The term synergistic effect is used when drugs are taken together and the effect of either or both drugs is intensified.

Cocaine exerts which of the following effects on a patient? 1. Stimulation after 15 to 20 minutes 2. Stimulation and anesthetic effects 3. Immediate imbalance of emotions 4. Paranoia

ANS: 2 Cocaine exerts two main effects on the body: anesthetic and stimulant.

Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? 1. Opiates 2. Marijuana 3. Barbiturates 4. Hallucinogens

ANS: 3 Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death.

A patient has been using cocaine intranasally for 4 years. When the patient is brought to the hospital in an unconscious state, nursing measures should include which of the following? 1. Induction of vomiting 2. Administration of ammonium chloride 3. Monitoring of opiate withdrawal symptoms 4. Observation for hyperpyrexia and seizures

ANS: 4 Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose.

16. Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose? a. Simple and safe b. Active and bright c. Stimulating and colorful d. Confrontational and challenging

18. At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as: a. codependence. b. assertiveness c. role reversal d. homeostasis.

ANS: A Codependence refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. The other options are not supported by information given in the scenario. See relationship to audience response question.

13. During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol." b. "It will be important for you to structure life to avoid as much stress as you can and provide social protection." c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully." d. "It is good that you are supportive of your spouse's sobriety and want to help maintain it."

23. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.

15. Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction. a. Empathetic, supportive b. Skeptical, guarded c. Cool, distant d. Confrontational

ANS: A Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defenses.

28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information? a. Substance Abuse and Mental Health Services Administration (SAMHSA) b. Institute of Medicine - National Research Council (IOM) c. National Council of State Boards of Nursing (NCSBN) d. American Society of Addictions Medicine

ANS: A The Substance Abuse and Mental Health Services Administration (SAMHSA) is the official resource for comprehensive information regarding addictions. The other resources have relevant information, but they are not as comprehensive.

30. Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will: a. state, "I know I need long-term treatment." b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.

ANS: A The key refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not give enough information to determine whether anger has been identified as a problem. A trusting relationship, while desirable, should have occurred earlier in treatment.

17. When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred? a. Tolerance has developed. b. Antagonistic effects are evident. c. Metabolism of the alcohol is now delayed. d. Pharmacokinetics of the alcohol have changed.

ANS: A Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects account for this change.

Which of the following symptoms would signal opioid withdrawal? a) Rhinorrhea, chills, fever, and muscle aches b) Illusions, disorientation, tachycardia, and tremors c) Fatigue, lethargy, sleepiness, and convulsions d) Synesthesia, depersonalization, and hallucinations

ANS: A Symptoms of opioid withdrawal resemble the "flu"; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever.

What behaviours would the nurse expect to assess in a nontolerant drinker with a blood alcohol level of 0.20 mg%? Select all that apply. a. Ataxia b. Staggering c. Confusion d. Stupor e. Emotional liability

ANS: A, B, E The nurse would see staggering, ataxia, and emotional lability in a nontolerant drinker with a blood alcohol level (BAL) of 0.20 mg%. Confusion and stupor are seen with BALs of 0.30 mg% and higher.

2. The nurse can assist a patient to prevent substance abuse relapse by: (select all that apply) a. rehearsing techniques to handle anticipated stressful situations. b. advising the patient to accept residential treatment if relapse occurs. c. assisting the patient to identify life skills needed for effective coping. d. advising isolating self from significant others until sobriety is established. e. informing the patient of physical changes to expect as the body adapts to functioning without substances.

9. A patient asks for information about Alcoholics Anonymous. Select the nurse's best response. "Alcoholics Anonymous is a: a. form of group therapy led by a psychiatrist." b. self-help group for which the goal is sobriety." c. group that learns about drinking from a group leader." d. network that advocates strong punishment for drunk drivers."

ANS: B Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

. The home care nurse is assessing an older patient diagnosed with mild cognitive impairment (MCI) in the home setting. Which information is of concern? a. The patient's son uses a marked pillbox to set up the patient's medications weekly. b. The patient has lost 10 pounds (4.5 kg) during the last month. c. The patient is cared for by a daughter during the day and stays with a son at night. d. The patient tells the nurse that a close friend recently died.

ANS: B A 10-pound weight loss in 1 month could indicate cancer or may be an indication of further progression of memory loss. Depression is also another common cause of weight loss. The use of a marked pillbox and planning by the family for 24-hour care are appropriate for this patient. It is not unusual that an older patient would have friends who have died.

The home care nurse is assessing an older patient diagnosed with mild cognitive impairment (MCI) in the home setting. Which information is of concern? a. The patient's son uses a marked pillbox to set up the patient's medications weekly. b. The patient has lost 10 pounds (4.5 kg) during the last month. c. The patient is cared for by a daughter during the day and stays with a son at night. d. The patient tells the nurse that a close friend recently died.

The nurse is completing a nutritional assessment on a patient with hypertension. What foods would be recommended for this patient? a. Regular diet b. Low sodium diet c. Pureed diet d. Low sugar diet

14. The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should: a. provide long-term care for the patient in a residential facility. b. withdraw the patient from cannabis, then treat the schizophrenia. c. consider each diagnosis primary and provide simultaneous treatment. d. first treat the schizophrenia, then establish goals for substance abuse treatment.

ANS: C Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.

4. A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient: a. is attempting to obtain attention by manipulating staff. b. may have sustained a head injury before admission. c. has symptoms of alcohol-withdrawal delirium. d. is having an acute psychosis.

31. A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action? a. Perform a thorough assessment of the patient. b. Verify that security services are immediately available. c. Self-assess personal attitude, values, and beliefs about this health problem. d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition? a. Renal failure b. Cerebrovascular accident c. Korsakoff's psychosis d. Alzheimer's disease

ANS: C A variety of serious neurologic and mental disorders, such as Korsakoff's psychosis and Wernicke's encephalopathy, as well as cirrhosis of the liver, may occur with chronic use of alcohol. Renal failure, cerebrovascular accident, and Alzheimer's disease are not associated directly with chronic use of alcohol.

4. A new patient beginning an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening." Select the nurse's most therapeutic responses. Select all that apply. a. "I see," and use interested silence. b. "I think you are drinking more than you report." c. "Social drinkers have one or two drinks, once or twice a week." d. "You describe drinking steadily throughout the day and evening." e. "Your comments show denial of the seriousness of your problem."

ANS: C, D The correct answers give information, summarize, and validate what the patient reported but are not strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program.

20. Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search and destroy tactics to keep the home alcohol free." c. "It's important that you visit your family member on a regular basis." d. "Make your loved one responsible for the consequences of behavior."

ANS: D Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviors or are of no help.

29. A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely? a. PCP b. Heroin c. Barbiturates d. Amphetamines

ANS: D The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behavior. Barbiturates and heroin would result in symptoms of CNS depression.

A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Disturbed sensory perception b. Ineffective coping c. Ineffective denial d. Risk for injury

ANS: D The patient's clouded sensorium, sensory perceptual distortions, and poor judgement predispose a risk for injury. Safety is the nurse's priority. The other diagnoses may apply but are not the priorities of care.

The nurse is assessing a group of patients to determine their risk of vitamin D deficiency. Which of the following patients has the highest risk for vitamin D deficiency? A) A Caucasian female who is 39 weeks gestation. B) An African-American female who is breastfeeding. C) An Asian female diagnosed with hypoglycemia. D) A Hispanic female who has a BMI of 24.1

B) An African-American female who is breastfeeding. Vitamin D deficiency is more frequently found among persons of African heritage and has increased in prevalence, especially among the infants of breastfeeding African-American mothers. Caucasian females do not share these risk factors. There is no known risk of hypoglycemia and vitamin D deficiency; however, diabetes increases the risk for vitamin D deficiency. There is no known risk of vitamin D deficiency in normal-weight females of Hispanic heritage; however, obesity is a risk factor.

The nurse is assessing an elderly patient's risk of nutritional deficiency. An important risk factor for nutritional deficiency in the elderly is: A) Increased blood pressure B) Decreased activities of daily living. C) An allergy to shellfish D) Exercise pattern

B) Decreased activities of daily living It is important to determine if the patient is capable of obtaining and preparing adequate food. Elevations in blood pressure may be affected by nutritional intake but are not a risk for deficiency. Many individuals have food allergies, but this in itself should not increase the risk of nutritional deficiency. Exercise pattern may provide insight to the nurse's activity level but not necessarily to the nutritional level.

The nurse is assessing a patient's nutritional status and suspects the patient needs more macronutrients. Which of the following are considered macronutrients? A) Minerals B) Vitamins C) Fats D) Water

C) Fats Macronutrients include carbohydrates, proteins, and fats. Minerals are considered micronutrients. Vitamins are considered micronutrients. Water is an essential dietary component, but it is not a macronutrient.

The nurse is working with a patient to develop a nutritional plan for a patient newly diagnosed with diabetes. The nurse assesses what the patient's food preferences are because: A) Food preferences can indicate a chronic disease that the nurse may be unaware of. B) Life expectancy can be predicted based on food preferences. C) Food preferences and dislikes have a strong influence on what a person eats. D) A list of food preferences will help identify individuals who will not comply with special diets.

C) Food preferences and dislikes have a strong influence on what a person eats. Option C becomes important with dietary teaching. Chronic illness is not identified by a person's food preference. Longevity may be influenced by the foods consumed, but food preferences cannot be used to predict someone's life span. Dietary compliance cannot be determined based on food preference alone, but it helps to identify those who may struggle with special diets.

The nurse is caring for a 25-year-old woman who is requesting information to lose weight. What information will the nurse include in a weight-loss plan? A. Weigh yourself at the same time every morning and evening. B. Stick to a 600- to 800-calorie diet for the most rapid weight loss. C. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. D. Weighing all foods on a scale is necessary to choose appropriate portion sizes.

C. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain.

The nurse is assessing a patient's dietary intake to help the patient lose weight. What is the easiest way to assess the patient's normal dietary intake? A) Comparing established eating habits with Dietary Reference Intakes B) Asking the nurse to fill out a food plan C) Comparing the recommended dietary allowances to the USDA MyPlate D) Asking the patient to do a 24-hour dietary recall

D) Asking the patient to do a 24-hour dietary recall Having the patient do a 24-hour food recall will assist the nurse in collaborating with the patient to include foods that the patient enjoys. Option A will likely lead to adherence to the plan for two reasons: (1) The patient is involved in the plan. (2) The patient will not be deprived of favorite foods. Comparing what is recommended requires the patient to know what is recommended. Patients who need to lose weight may not have mastered this skill. Filling out a food plan may not include the patient's favorite foods. The utilization of the USDA MyPlate is a good intervention for implementation of the teaching plan.

The nurse is caring for a confused patient who is wearing a vest restraint in bed. The nurse speaks with an unlicensed assistant about toileting the patient. The nurse knows the unlicensed assistant understands the toileting procedure when making which statement? The patient will use the call bell when he or she feels the urge to void. The patient needs to be toileted to maintain a regular toileting schedule. The patient needs to be provided with adult briefs for incontinence. The patient must remain in the restraints all day.

The patient needs to be toileted to maintain a regular toileting schedule.

5) Which substance, when used by the patient with SUD, can cause euphoria, drowsiness, decreased respiratory rate and slurred speech? a) Opioids. b) alcohol. c) cannabis. d) depressants.

a) Opioids.

A patient who is a heavy caffeine user has been NPO all day in preparation for late afternoon in surgery. the nurse monitors the patient for the effects of caffeine withdrawal that may include a) headache. b) nervousness. c) Mild tremors. d) shortness of breath.

a) headache.

A patient with a history of alcohol use disorder is admitted to the hospital following an automobile accident. What is most important for the nurse to assess to plan care for the patient ? a) when the patient last had alcohol intake. b) how much alcohol has recently been used. c) what type of alcohol has recently been ingested. d) the patients current blood alcohol concentration

a) when the patient last had alcohol intake.

The nurse is listening for bowel sounds in a postoperative patient. The bowel sounds are slow, as they are heard only every 3 to 4 minutes. The patient asks the nurse why this is happening. What is the nurse's best response? a. "Anesthesia during surgery and pain medication after surgery may slow peristalsis in the bowel." b. "Some people have a slower bowel than others, and this is nothing to be concerned about." c. "The foods you eat contribute to peristalsis, so you should eat more fiber in your diet." d. "Bowel peristalsis is slow because you are not walking. Get more exercise during the day."

a. "Anesthesia during surgery and pain medication after surgery may slow peristalsis in the bowel."

During an assessment, the patient states that his bowel movements cause discomfort because the stool is hard and difficult to pass. As the nurse, you make which of the following suggestions to assist the patient with improving the quality of his bowel movement? (Select all that apply.) a. Increase fiber intake. b. Increase water consumption. c. Decrease physical exercise. d. Refrain from alcohol. e. Refrain from smoking.

a. Increase fiber intake. b. Increase water consumption.

A young woman is brought to the emergency department by police who found her lying on a downtown sidewalk. The initial nursing assessment finds that she is unresponsive and has a weak pulse of 112; shallow respirations of 8 breaths/minute; and cold, clammy skin. Identify the two medications that would most likely be given immediately to this patient and explain why they would be given. a. b.

a. Naloxone (Narcan) is given when opioids are the cause of central nervous system (CNS) depression. b. Flumazenil (Romazicon) is given when benzodiazepines are the cause of CNS depression.

When conducting a health history assessment, the nurse would want to know what most important information about the patient's elimination status? (Select all that apply.) a. Recent changes in elimination patterns b. Changes in color, consistency, or odor of stool or urine c. Time of day patient defecates d. Discomfort or pain with elimination e. List of medications taken by patient f. Patient's preferences for toileting

a. Recent changes in elimination patterns b. Changes in color, consistency, or odor of stool or urine d. Discomfort or pain with elimination e. List of medications taken by patient

4) What are the physiologic effects associated with cocaine and amphetamines select all that apply. a) Drowsiness. b) nasal damage. c) constricted pupils. d) sexual dysfunction. e) increase in appetite. f) tachycardia with hypertension.

b) nasal damage. d) sexual dysfunction f) tachycardia with hypertension.

To stop that behavior that leads to the most preventable cause of death in United States, the nurse should support programs that a) prohibit alcohol use in public places. b) prevent put tobacco use in children and adolescents. c) motivate individuals to enter addiction treatment. d) recognize addictions as an illnesses is rather than crimes.

b) prevent put tobacco use in children and adolescents.

The third day after an alcohol dependent patient was admitted to the hospital for acute pancreatitis, the nurse determines at the patient is experiencing alcohol withdrawal delerium. what are the signs of withdrawal delerium on which the nurse base is this judgment select all that apply? a) Apathy. b) seizures. c) disorientation. d) severe depression. e) cardiovascular collapse. f) visual and auditory hallucinations.

b) seizures. c) disorientation. f) visual and auditory hallucinations.

A patient who was diagnosed with senile dementia has become incontinent of urine. The patient's daughter asks the nurse why this is happening. The best response by the nurse is: a. "The patient is angry about the dementia diagnosis." b. "The patient is losing sphincter control due to the dementia." c. "The patient forgets where the bathroom is located due to the dementia." d. "The patient wants to leave the hospital."

b. "The patient is losing sphincter control due to the dementia."

The nurse is caring for a patient who has suffered a spinal cord injury and is concerned about the patient's elimination status. What is the nurse's best action? a. Speak with the patient's family about food choices. b. Establish a bowel and bladder program for the patient. c. Speak with the patient about past elimination habits. d. Establish a bedtime ritual for the patient.

b. establish a bowel and bladder program for the patient.

A patient in alcohol withdrawal Has a nursing diagnosis of ineffective Protection related to sensorimotor deficits, seizure activity, and confusion. Which nursing intervention Is most important for the patient? a) Provide a dark and come a quiet environment free from external stimuli. b) Force fluids to assist in diluting the alcohol concentration in the blood. c) Monitor vital signs frequently to detect an extreme autonomic nervous system response. d) Use restraints as necessary to prevent the patient from reacting Violently to hallucinations.

c) Monitor vital signs frequently to detect an extreme autonomic nervous system response.

Which question is the best approach by the nurse to assess in newly admitted patients use of addictive drugs? a) how do you relieve your stress? b) you don't use any illegal drugs do you? c) Which alcohol or recreational drugs do you use d) Do you have any addictions we should know about to prevent complications?

c) Which alcohol or recreational drugs do you use

What is an important post operative intervention indicated for the patient with AUD who is alcohol intoxicated and is undergoing emergency surgery? a) Monitor weight because of malnutrition . b) give an emergency dose of IV magnesium. c) Decrease pain medication to prevent cross tolerance to opiates. d) Closely monitor for signs of withdrawal and respiratory and cardiac problems.

d) Closely monitor for signs of withdrawal and respiratory and cardiac problems.

An admission to the hospital for knee replacement, a patient who has smoked for 20 years expresses an interest in quitting. what is the best response by the nurse? a) Good for you! you should talk to your doctor about that. b) Why did you ever start in the 1st place? it's so hard to quit. c) Since you won't be able to smoke while you were in the hospital, just don't start again when you were discharged. d) Great! while you are here, I'll help you make a plan and work with your doctor to get you what you need to quit smoking.

d) Great! while you are here, I'll help you make a plan and work with your doctor to get you what you need to quit smoking.

What is the definition of substance use disorder a) Compulsive need to experience pleasure b) Behavior associated with maintaining an addiction c) Absence of a substance will cause withdrawal symptoms d) Overuse and dependence on a substance that negatively affects functioning

d) Overuse and dependence on a substance that negatively affects functioning

16) The nurses working with a patient at the clinic who does not want to quit smoking even though he is having trouble breathing at times and has a frequent cough. Which clinical practice guideline strategies should the nurse use with this patient. a) Cost, cough, cleanliness, chantix. b) Ask, advise, asses, assist, arrange. c) deduce, describe, decide, deadline. d) Relevance, risks, rewards, roadblocks, repetition

d) Relevance, risks, rewards, roadblocks, repetition

What are the physiologic effects associated with cocaine and amphetamines (select all that apply)? a. Drowsiness b. Nasal damage c. Sexual arousal d. Constricted pupils e. Increase in appetite f. Tachycardia with hypertension

b, c, f. Cocaine and amphetamines cause nasal damage when snorted, sexual arousal, and tachycardia and hypertension. Drowsiness and constricted pupils are seen with sedative-hypnotics and opioids. There is anorexia with cocaine, not increased appetite.

The patient talks with the nurse about bladder health. What is one of the most important recommendations the nurse can make for this patient? Eat foods high in fiber. Exercise in the morning and evening. Drink 6 to 8 glasses of noncaffeinated fluids daily. Visit the urologist once yearly.

Drink 6 to 8 glasses of noncaffeinated fluids daily

List two major health problems commonly seen in the acute care setting related to the abuse of the following substances. Nicotine a. b. Alcohol a. b. Cocaine and amphetamines a. b. Opioids a. b. Cannabis a. b.

Nicotine a. Chronic obstructive pulmonary disease (COPD) b. Cancers: lung, mouth, larynx, esophagus, stomach, bladder, pancreas Others: coronary artery disease, peripheral artery disease, peptic ulcer disease, gastroesophageal reflux disease (GERD) (see Table 11-2) Alcohol a. Dementia b. Cirrhosis Others: peripheral neuropathy, increased risk for several cancers, anemia, coronary artery disease (CAD), hypertension, GERD (see Table 11-7) Cocaine and amphetamines a. Cardiac dysrhythmias b. Psychosis Others: nasal sores, myocardial infarction (MI), stroke (see Table 11-2) Opioids a. Gastric ulcer b. Glomerulonephritis Other: sexual dysfunction (see Table 11-2) Cannabis a. Bronchitis, chronic sinusitis b. Memory impairment Other: impaired immune system, reproductive dysfunction (see Table 11-2)

To prevent Wernicke's encephalopathy from heavy alcohol use, the nurse anticipates an order for which medications? a. Benzodiazepine b. Thiamine and B complex IV c. Vitamins C and D3 d. Klonopin

The B vitamins will prevent or reverse Wernicke's if given early enough. Benzodiazepines are often used to prevent and treat DTs and to decrease respiratory depression and hypertension. Vitamins C and D3 are not related to alcohol withdrawal. Klonopin is administered for hypertension and anxiety related to withdrawal.

Which manifestations are experienced by a patient when withdrawing from sedative hypnotic addiction select all that apply? a) seizures. b) violence. c) suicidal thoughts. d) tremmor and chills. e) sweating, nausea, and cramps.

a.seizures

Gastrointestinal elimination serves which primary physiologic purpose? Electrolyte homeostasis Peristaltic activity Gastrointestinal integrity Waste product excretion

Waste product excretion

Which question is the best approach by the nurse to assess a newly admitted patient's use of addictive drugs? a. "How do you relieve your stress?" b. "You don't use any illegal drugs, do you?" c. "Which alcohol or recreational drugs do you use?" d. "Do you have any addictions we should know about to prevent complications?"

c. Open-ended questions indicating that substance use is normal or at least understandable are helpful in eliciting information from patients who are reluctant to disclose substance use.

When the nurse is encouraging a woman who smokes 1½ packs of cigarettes per day to quit with the use of nicotine replacement therapy, the woman asks how the nicotine in a patch or gum differs from the nicotine she gets from cigarettes. What should the nurse explain about nicotine replacement? a. It includes a substance that eventually creates an aversion to nicotine. b. It provides a noncarcinogenic nicotine, unlike the nicotine in cigarettes. c. It prevents the weight gain that is a concern to women who stop smoking. d. It eliminates the thousands of toxic chemicals that are inhaled with smoking.

d. Nicotine replacement contains the same nicotine as that in tobacco but with slower absorption. The nicotine will help to prevent withdrawal symptoms because its use is reduced gradually. While the addiction is treated, the carcinogens and gases associated with tobacco smoke are eliminated.

Patho/Pharm 2 Week 3 Combined

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