Instant download Medical-Surgical Nursing: Clinical Reasoning in Patient Care, 5th Edition pdf docx epub after payment.

 

Product Details:

• ISBN-10 ‏ : ‎ 0135075947
• ISBN-13 ‏ : ‎ 978-0135075944
• Author:   Priscilla LeMone (Author), Karen M. Burke (Author), Gerene Bauldoff (Author)

“Medical-Surgical Nursing: Critical Thinking in Patient Care, 5e”has been revised and updated to provide the knowledge and skills needed to care for adult patients to promote health, facilitate recovery from illness and injury, and provide support when coping with disability or loss. Throughout the text, the authors make every effort to communicate that both nurses and patients may be male or female; and that patients require holistic, individualized care regardless of their age; gender; or racial, cultural, or socioeconomic background. The goal of the fifth edition is to provide the knowledge and resources that ensure a solid base for critical thinking and clinical judgment and that can be applied to provide safe, individualized, and competent clinical nursing care. Multiple learning strategies have been developed to facilitate success-audio, illustrations, teaching tips, and video and animation media. Understandable language and a consistent format are used, and students overwhelmingly report that they actually like reading the text.

 

Table of Content:

Chapter 6

Question 1

Type: MCSA

A patient tells the nurse that both of his parents are alcoholics and wonders about the likelihood of becoming an alcoholic as well. With which of the following should the nurse respond to this patient?

1. “There are studies that support a genetic link for developing alcoholism.”
2. “Why are you concerned about becoming an alcoholic”
3. “You will likely become an alcoholic.”
4. “Don’t worry about that.”

Correct Answer: 1

Rationale 1: Genetic studies have been performed that suggest heredity plays a role in the development of alcoholism. The nurse should respond that that there are studies that support this link.

Rationale 2: The nurse should not question the patient’s request for information about becoming an alcoholic like his parents.

Rationale 3: Although the patient does have an increased risk, stating that he will become an alcoholic is inappropriate.

Rationale 4: Telling the patient not to worry about becoming an alcoholic is also an inappropriate response.

Global Rationale: Genetic studies have been performed that suggest heredity plays a role in the development of alcoholism. The nurse should respond that that there are studies that support this link. The nurse should not question the patient’s request for information about becoming an alcoholic like his parents. Although the patient does have an increased risk, stating that he will become an alcoholic is inappropriate. Telling the patient not to worry about becoming an alcoholic is also an inappropriate response.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Discuss risk factors associated with substance abuse.

 

Question 2

Type: MCSA

The mother of a patient admitted with alcohol abuse tells the nurse that alcohol is not consumed at home and the patient is adopted. The nurse realizes that

1. the patient’s biological parents might have abused alcohol.
2. the patient spent time drinking with friends.
3. consuming alcohol is a symptom of stress.
4. alcoholism is a learned behavior.

Correct Answer: 1

Rationale 1: Genetic studies have been performed that suggest heredity plays a role in the development of alcoholism. Since the patient was adopted, the patient’s biological parents may have abused alcohol.

Rationale 2: There is not enough information to support that the patient is spending time drinking with friends.

Rationale 3: There is not enough information to support that the patient is consuming alcohol as a symptom of stress.

Rationale 4: There is also not enough evidence to support this patient’s alcohol use as being a learned behavior.

Global Rationale: Genetic studies have been performed that suggest heredity plays a role in the development of alcoholism. Since the patient was adopted, the patient’s biological parents may have abused alcohol. There is not enough information to support that the patient is spending time drinking with friends or the patient is consuming alcohol as a symptom of stress. There is also not enough evidence to support this patient’s alcohol use as being a learned behavior.

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Discuss risk factors associated with substance abuse.

 

Question 3

Type: MCSA

A patient tells the nurse that she started to have a glass of wine every evening at home after work to “unwind” and then realized that she cannot continue with her day unless she has the wine. The nurse realizes that this patient used wine to

1. cope with day-to-day problems.
2. deal with difficulty expressing emotions.
3. suppress a genetic need for alcohol.
4. socialize with others.

Correct Answer: 1

Rationale 1: Psychological factors to explain substance abuse include the use of the substance becomes a habit as a form of self-medication to cope with day-to-day problems and overtime, becomes an addiction.

Rationale 2: There is no information to suggest that the patient is having difficulty expressing emotions.

Rationale 3: There is no information to suggest that the patient has a genetic need for alcohol.

Rationale 4: The patient is drinking at home after work so there is no information to support the patient is using alcohol to socialize with others.

Global Rationale: Psychological factors to explain substance abuse include the use of the substance becomes a habit as a form of self-medication to cope with day-to-day problems and overtime, becomes an addiction. There is no information to suggest that the patient is having difficulty expressing emotions or that the patient has a genetic need for alcohol. The patient is drinking at home after work so there is no information to support the patient is using alcohol to socialize with others.

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Discuss risk factors associated with substance abuse.

 

Question 4

Type: MCSA

Which of the following assessment findings would indicate that a patient’s risk for alcohol abuse is low?

1. is from the Asian cultural group
2. diagnosed with type 2 diabetes
3. has two children
4. employed as an accountant

Correct Answer: 1

Rationale 1: Sociocultural factorsoften influence individuals’ decisions regarding substance use. Asian Americans report the lowest prevalence of family history of alcoholism because of a deficiency of aldehyde dehydrogenase, which causes toxic symptoms characterized by vomiting, flushing, and tachycardia. This is the assessment finding that would indicate that a patient’s risk for alcohol abuse is low.

Rationale 2: There is no information to support that the use of alcohol would be avoided in an individual with type 2 diabetes.

Rationale 3: There is no information to support that the use of alcohol would be avoided in an individual with 2 children.

Rationale 4: There is no information to support that the use of alcohol would be avoided in an individual employed as an accountant.

Global Rationale: Sociocultural factorsoften influence individuals’ decisions regarding substance use. Asian Americans report the lowest prevalence of family history of alcoholism because of a deficiency of aldehyde dehydrogenase, which causes toxic symptoms characterized by vomiting, flushing, and tachycardia. This is the assessment finding that would indicate that a patient’s risk for alcohol abuse is low. There is no information to support that the use of alcohol would be avoided in individuals with type 2 diabetes, in those with 2 children, or employment as an accountant.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Discuss risk factors associated with substance abuse.

 

Question 5

Type: MCSA

A nurse is concerned about potential substance abuse by a coworker. Which of the following behaviors warrants further investigation?

1. The coworker frequently wastes medications.
2. The coworker frequently requests the largest patient care assignment for the shift.
3. The coworker prefers not to be the “medication nurse” on the shift.
4. The coworker declines to take scheduled breaks.

Correct Answer: 1

Rationale 1: Excessive medication wasting could be a sign that a nurse is using or diverting drugs.

Rationale 2: Requesting a large patient care assignment would not be a characteristic of a nurse who is abusing substances. The nurse who is unable or unwilling to manage a patient care assignment could be a substance abuser.

Rationale 3: Requesting not to be the medication nurse would reduce access to potentially abusive substances.

Rationale 4: Taking frequent or lengthy breaks might signal substance abuse. Declining scheduled breaks is not consistent with a substance abuser.

Global Rationale: Excessive medication wasting could be a sign that a nurse is using or diverting drugs. Requesting a large patient care assignment would not be a characteristic of a nurse who is abusing substances. The nurse who is unable or unwilling to manage a patient care assignment could be a substance abuser. Requesting not to be the medication nurse would reduce access to potentially abusive substances. Taking frequent or lengthy breaks might signal substance abuse. Declining scheduled breaks is not consistent with a substance abuser.

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Recognize the manifestations of potential substance abuse in co-workers.

 

Question 6

Type: MCSA

A nurse consistently arrives to work wearing a long-sleeved blouse despite the temperature as being warm and humid. When colleagues mention her attire, the nurse becomes defensive and isolates herself from others. Which of the following does the nurse’s behavior suggest?

1. substance abuse
2. a long-standing illness
3. introverted behavior
4. low self-esteem

Correct Answer: 1

Rationale 1: Signs of drug use include wearing long sleeves in hot weather to cover up arms. The defensive behavior and isolation are also signs of substance abuse.

Rationale 2: There is not enough information to support the nurse has a long-standing illness.

Rationale 3: There is also not enough information to support that the nurse routinely engages in introvert behavior.

Rationale 4: There is also not enough information to support that the nurse has low self-esteem.

Global Rationale: Signs of drug use include wearing long sleeves in hot weather to cover up arms. The defensive behavior and isolation are also signs of substance abuse. There is not enough information to support the nurse has a long-standing illness. There is also not enough information to support that the nurse routinely engages in introvert behavior or that the nurse has low self-esteem.

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Recognize the manifestations of potential substance abuse in co-workers.

 

Question 7

Type: MCMA

The nurse manager is concerned that one staff nurse is demonstrating signs of substance abuse. Which of the following behaviors did the manager observe in the staff nurse?

Standard Text: Select all that apply.

1. Calling for days off or illness before scheduled days off
2. using the bathroom frequently
3. excessive use of mouthwash
4. volunteering to transfer a patient to the intensive care unit
5. following up with nursing assistants on patient care needs

Correct Answer: 1,2,3

Rationale 1: Nurses experience many pressures in the workplace and have easy access to drugs, a temptation that may result in greater vulnerability for substance abuse and dependence. There are many observable warning signs of potential abuse (a more complete list appears in table 6-4, Warning Signs of Impaired Nurses in the Workplace) including: Calling for days off before scheduled days off can be a sign of role strain.

Rationale 2: Nurses experience many pressures in the workplace and have easy access to drugs, a temptation that may result in greater vulnerability for substance abuse and dependence. There are many observable warning signs of potential abuse (a more complete list appears in table 6-4, Warning Signs of Impaired Nurses in the Workplace) including:. Using the bathroom frequently could indicate easy access to prescription drugs.

Rationale 3: Nurses experience many pressures in the workplace and have easy access to drugs, a temptation that may result in greater vulnerability for substance abuse and dependence. There are many observable warning signs of potential abuse (a more complete list appears in table 6-4, Warning Signs of Impaired Nurses in the Workplace) including: Excessive use of mouthwash could indicate alcohol use.

Rationale 4: Volunteering to transfer a patient to the intensive care unit is not an indication of substance abuse.

Rationale 5: Following up with nursing assistants on patient care needs is not an indication of substance abuse.

Global Rationale: Nurses experience many pressures in the workplace and have easy access to drugs, a temptation that may result in greater vulnerability for substance abuse and dependence. There are many observable warning signs of potential abuse (a more complete list appears in table 6-4, Warning Signs of Impaired Nurses in the Workplace) including: Calling for days off before scheduled days off can be a sign of role strain. Using the bathroom frequently could indicate easy access to prescription drugs. Excessive use of mouthwash could indicate alcohol use. Volunteering to transfer a patient to the intensive care unit or following up with nursing assistants on patient care needs are not indications of substance abuse.

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Recognize the manifestations of potential substance abuse in co-workers.

 

Question 8

Type: MCSA

Which of the following warning signs would indicate that a nurse is experiencing depression associated with substance abuse?

1. leaves the unit and unable to be located for long periods of time
2. uses the visitor bathroom instead of employee bathroom
3. wastes prescribed narcotics several times each shift
4. complains of a stomach ache every day at work

Correct Answer: 1

Rationale 1: Behavior indications of depression associated with substance abuse include the nurse leaving the unit and unable to be located for long periods of time.

Rationale 2: Using the visitor bathroom instead of employee bathroom is an indication of easy access to prescription medications.

Rationale 3: Excessive wasting of medications is an indication of easy access to prescription medications.

Rationale 4: Complaining of a stomach ache every day at work is an indication of withdrawal.

Global Rationale: Behavior indications of depression associated with substance abuse include the nurse leaving the unit and unable to be located for long periods of time. Using the visitor bathroom instead of employee bathroom and excessive wasting of medications are indications of easy access to prescription medications. Complaining of a stomach ache every day at work is an indication of withdrawal.

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Recognize the manifestations of potential substance abuse in co-workers.

 

Question 9

Type: MCSA

A patient, recovering from out-patient carpal tunnel surgery, returns to the surgical center the next day and tells the nurse that the pain is “excruciating” and wants stronger pain medication now. Which of the following does this suggest to the nurse?

1. The patient could have a substance abuse problem.
2. A nerve was cut during the procedure.
3. The patient was not given strong enough postoperative pain medication.
4. The patient is under stress to return to work.

Correct Answer: 1

Rationale 1: Abusers often have a low tolerance for frustration and pain. Since the patient had surgery the day before and returns to the center stating excruciating pain and demanding more pain medication now, this could indicate that the patient has a substance abuse problem.

Rationale 2: There would be a sensorimotor deficit if the nerve was cut during the procedure.

Rationale 3: There is not enough information to determine if the patient was not given strong enough postoperative pain medication.

Rationale 4: There is also not enough information to determine if the patient is under stress to return to work.

Global Rationale: Abusers often have a low tolerance for frustration and pain. Since the patient had surgery the day before and returns to the center stating excruciating pain and demanding more pain medication now, this could indicate that the patient has a substance abuse problem. There would be a sensorimotor deficit if the nerve was cut during the procedure. There is not enough information to determine if the patient was not given strong enough postoperative pain medication. There is also not enough information to determine if the patient is under stress to return to work.

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe common characteristics of substance abusers.

 

Question 10

Type: MCSA

A patient, complaining of back pain, tells the nurse that he needs several refills on any prescription since he takes the medication more frequently than prescribed. Which of the following does this information suggest to the nurse?

1. The patient has lost control over the consumption of the pain medication.
2. The patient is impulsive.
3. The patient uses the pain medication to fit in with a peer group.
4. The patient uses the pain medication to overcome low self-esteem.

Correct Answer: 1

Rationale 1: Addictive behavior associated with substance use is characterized by loss of control over consumption. The patient states that he is taking the medication more frequently that prescribed, which could indicate a loss of control.

Rationale 2: There is not enough information to support that the patient is being impulsive.

Rationale 3: There is also not enough information to support that the patient is using the pain medication to fit in with a peer group.

Rationale 4: There is also not enough information to support that the patient is using the pain medication to overcome low self-esteem.

Global Rationale: Addictive behavior associated with substance use is characterized by loss of control over consumption. The patient states that he is taking the medication more frequently that prescribed, which could indicate a loss of control. There is not enough information to support that the patient is being impulsive. There is also not enough information to support that the patient is using the pain medication to fit in with a peer group or using the pain medication to overcome low self-esteem.

 

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe common characteristics of substance abusers.

 

Question 11

Type: MCSA

A patient is brought into the emergency department with a gunshot wound obtained while attempting to rob a convenience store. For which of the following health problems should this patient be assessed?

1. drug and alcohol abuse
2. cardiovascular disease
3. respiratory disease
4. mental health disorder

Correct Answer: 1

Rationale 1: Because drug users are often rebellious against social norms and engage in risky behaviors such as stealing, the nurse should assess the patient for drug and alcohol abuse.

Rationale 2: Cardiovascular disease is not usually manifested by engagement in risk-taking behavior.

Rationale 3: Respiratory disease is not usually manifested by engagement in risk-taking behavior.

Rationale 4: The patient may or may not have a mental health disorder. This type of disorder might be assessed while assessing for drug and alcohol abuse.

Global Rationale: Because drug users are often rebellious against social norms and engage in risky behaviors such as stealing, the nurse should assess the patient for drug and alcohol abuse. Cardiovascular disease and respiratory disease are not usually manifested by engagement in risk-taking behavior. The patient may or may not have a mental health disorder. This type of disorder might be assessed while assessing for drug and alcohol abuse.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe common characteristics of substance abusers.

 

Question 12

Type: MCSA

A patient tells the nurse that he becomes very angry and abusive to his friends and family when he is unable to obtain an illegal substance. With which of the following should the nurse respond to this patient?

1. “Have you considered seeking treatment for this behavior”
2. “You must not have many friends left.”
3. “Are you this argumentative when at work”
4. “What does your family say about this”

Correct Answer: 1

Rationale 1: The patient demonstrates anger and abusive behavior when unable to obtain an illegal substance. This information should indicate to the nurse that the patient has a substance abuse problem. The best response for the nurse to make is to ask the patient if he has considered seeking treatment for this behavior.

Rationale 2: The nurse should not comment about the patient’s number of friends.

Rationale 3: Asking if the patient is argumentative at work could incite the patient’s anger and abusiveness.

Rationale 4: Asking the patient about his family could also incite the patient’s behavior.

Global Rationale: The patient demonstrates anger and abusive behavior when unable to obtain an illegal substance. This information should indicate to the nurse that the patient has a substance abuse problem. The best response for the nurse to make is to ask the patient if he has considered seeking treatment for this behavior. The nurse should not comment about the patient’s number of friends. Asking if the patient is argumentative at work could incite the patient’s anger and abusiveness. Asking the patient about his family could also incite the patient’s behavior.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe common characteristics of substance abusers.

 

Question 13

Type: MCSA

After surgery, the nurse notes a patient is unable to achieve pain relief from the analgesics prescribed. A review of the patient’s medical records reveals a history of alcohol abuse. What inferences can the nurse make?

1. The patient is likely cross-tolerant to the prescribed analgesic.
2. The patient has an unreported addiction to the pain medication being prescribed.
3. The patient has a history of using this medication at home.
4. The patient has a dual diagnosis relating to alcohol and drug addiction.

Correct Answer: 1

Rationale 1: Cross-tolerance results when tolerance to one substance also results in a tolerance to another drug. The patient’s heavy use of alcohol likely has resulted in a tolerance to alcohol and, by association, to the prescribed analgesic.

Rationale 2: There are no data to support a suspicion that the patient is addicted to the medication.

Rationale 3: There are no data to support a suspicion that the patient takes the medication at home.

Rationale 4: There are no data to support a suspicion that the patient or has a dual diagnosis related to alcohol and drug addiction.

Global Rationale: Cross-tolerance results when tolerance to one substance also results in a tolerance to another drug. The patient’s heavy use of alcohol likely has resulted in a tolerance to alcohol and, by association, to the prescribed analgesic. There are no data to support a suspicion that the patient takes the medication at home, is addicted to the medication, or has a dual diagnosis related to alcohol and drug addiction.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 14

Type: MCSA

A patient involved in a minor accident reports having used “crank” an hour ago. The patient denies having used the drug before. Which of the following manifestations can the nurse anticipate occurring with this patient?

1. report feelings of increased strength and intelligence
2. display increased strength and cognition
3. drowsiness
4. exhibit hallucinations and paranoia

Correct Answer: 1

Rationale 1: Crank is a form of methamphetamine. It will cause the patient to have feelings of increased strength and intelligence. These are simply the patient’s impressions, and are not present in reality.

Rationale 2: The patient will not display increased strength and cognition.

Rationale 3: Drowsiness might be seen in an individual who has been using crank for a long period of time.

Rationale 4: Hallucinations and paranoia might be seen in an individual who has been using crank for a long period of time.

Global Rationale: Crank is a form of methamphetamine. It will cause the patient to have feelings of increased strength and intelligence. These are simply the patient’s impressions, and are not present in reality. The patient will not display increased strength and cognition. Drowsiness, hallucinations, and paranoia might be seen in an individual who has been using crank for a long period of time.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 15

Type: MCSA

A patient comes into the emergency department wanting to be checked for sexual activity since she was out the other night at a rave and cannot remember what occurred. The nurse realizes that which of the following addictive substances would cause this effect in the patient?

1. ecstasy
2. crank
3. marijuana
4. alcohol

Correct Answer: 1

Rationale 1: Ecstasy is classified as a hallucinogen and has been associated with “date rape” and used during raves. This drug will cause the user to have thoughts and feelings similar to those in dreams.

Rationale 2: Crank is a stimulant and would heighten the user’s awareness.

Rationale 3: Marijuana does not usually cause an individual to forget events.

Rationale 4: Unless taken in high quantities over long periods of time, alcohol does not usually cause an individual to forget events.

Global Rationale: Ecstasy is classified as a hallucinogen and has been associated with “date rape” and used during raves. This drug will cause the user to have thoughts and feelings similar to those in dreams. Crank is a stimulant and would heighten the user’s awareness. Marijuana does not usually cause an individual to forget events. Unless taken in high quantities over long periods of time, alcohol does not usually cause an individual to forget events.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 16

Type: MCSA

A patient, admitted with seizures, is diagnosed with a perforated nasal septum. The nurse realizes that this patient most likely has abused which of the following substances?

1. cocaine
2. marijuana
3. alcohol
4. barbiturates

Correct Answer: 1

Rationale 1: Long-term intranasal use of cocaine is associated with a perforated nasal septum. Severe overdose of cocaine can lead to a seizure disorder.

Rationale 2: Seizures and a perforated nasal septum are not associated with marijuana.

Rationale 3: Seizures and a perforated nasal septum are not associated with alcohol.

Rationale 4: Seizures and a perforated nasal septum are not associated with barbiturate abuse.

Global Rationale: Long-term intranasal use of cocaine is associated with a perforated nasal septum. Severe overdose of cocaine can lead to a seizure disorder. Seizures and a perforated nasal septum are not associated with marijuana, alcohol, or barbiturate abuse.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 17

Type: MCSA

A teenage patient, brought to the emergency department by his parents, was reported to have taken barbiturates with alcohol. Which of the following will be the greatest concern for this patient?

1. respiratory depression
2. seizure activity
3. signs of withdrawal
4. signs of hallucinations

Correct Answer: 1

Rationale 1: Barbiturates are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The patient who has ingested both items is at risk for varying degrees of sedation, up to coma and death.

Rationale 2: Seizure activity is not the greatest risk for this patient.

Rationale 3: Signs of withdrawal are not the greatest risk for this patient.

Rationale 4: Hallucinations are not the greatest risk for this patient.

Global Rationale: Barbiturates are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The patient who has ingested both items is at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and hallucinations are not the greatest risks for this patient.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 18

Type: MCSA

A patient comes to the emergency department with a PCP overdose. Which of the following interventions can the nurse anticipate that the patient will need?

1. Administer Haldol as prescribed.
2. Induce vomiting.
3. Obtain materials to assist with lavage.
4. Administer Narcan as prescribed.

Correct Answer: 1

Rationale 1: PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The nurse should anticipate administering Haldol as prescribed.

Rationale 2: Inducing vomiting is not treatment for PCP overdose.

Rationale 3: Lavage is not indicated for PCP overdose.

Rationale 4: Narcan is not a treatment for PCP overdose.

Global Rationale: PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The nurse should anticipate administering Haldol as prescribed. Inducing vomiting is not treatment for PCP overdose. Lavage is not indicated for PCP overdose. Narcan is not a treatment for PCP overdose.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 19

Type: MCSA

A patient is brought into the emergency department with dilated pupils, respiratory rate of six per minute, and seizure activity. Which of the following should the nurse prepare to administer to this patient?

1. Narcan
2. activated charcoal
3. ammonium chloride
4. Diazepam

Correct Answer: 1

Rationale 1: Dilated pupils, respiratory depression, and seizure activity are signs of heroine overdose. The nurse should prepare to administer Narcan to reverse the effects of central nervous system depression.

Rationale 2: Activated charcoal is used for alcohol or barbiturate overdose.

Rationale 3: Ammonium chloride is used for cocaine overdose.

Rationale 4: Diazepam is used for LSD overdose.

Global Rationale: Dilated pupils, respiratory depression, and seizure activity are signs of heroine overdose. The nurse should prepare to administer Narcan to reverse the effects of central nervous system depression. Activated charcoal is used for alcohol or barbiturate overdose. Ammonium chloride is used for cocaine overdose. Diazepam is used for LSD overdose.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 20

Type: MCSA

A patient with a history of chronic alcohol use is underweight and malnourished. Which of the following may be prescribed to manage the patient’s nutritional status?

1. vitamin B₁
2. diazepam
3. methadone
4. Narcan

Correct Answer: 1

Rationale 1: Vitamin B₁ is necessary to prevent the complications of chronic alcoholism such as Wernicke’s syndrome.

Rationale 2: Diazepam is used in the acute treatment of LSD overdose.

Rationale 3: Methadone is prescribed to manage heroin cravings.

Rationale 4: Narcan is used to treat the effects of central nervous system depression.

Global Rationale: Vitamin B₁ is necessary to prevent the complications of chronic alcoholism such as Wernicke’s syndrome. Diazepam is used in the acute treatment of LSD overdose. Methadone is prescribed to manage heroin cravings. Narcan is used to treat the effects of central nervous system depression.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 21

Type: FIB

The patient has been included in a research study along with 4,204 other patients who live in the United States. Two thousand two hundred of these patients are male. Of the female patients, how many are likely to be smokers? Round the answer to the nearest whole number.

Standard Text:

Correct Answer: 449

Rationale : An estimated 22.4% women in the United States are current smokers. If there are 4,205 patients included in this study and 2,200 patients are male, then 2,005 patients are female; 22.4% of 2,005 is 449.12. When rounded to the nearest whole number 449.12 is 449.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1: Discuss risk factors associated with substance abuse.

 

Question 22

Type: MCSA

The patient has consumed 660 milligrams of caffeine during the last eight hours. The patient states that he consumes this amount of caffeine on a regular basis. After reviewing the information included in the chart above, which of the following statements by the patient is consistent with the information provided?

1. “I don’t know why but I just can’t get to sleep.”
2. “I always feel cold.”
3. “I have been so constipated.”
4. “I have no appetite.”

Correct Answer: 1

Rationale 1: A caffeine intake of over 600 mg per day is considered excessive and is not recommended. Caffeine that is consumed in large quantities can cause higher total cholesterol levels and insomnia.

Rationale 2: Patients who consume large quantities of caffeine are also more likely to feel warm.

Rationale 3: Patients who consume large quantities of caffeine are more likely to have increased frequency of stools.

Rationale 4: Patients who consume large quantities of caffeine are more likely to have an increased appetite.

Global Rationale: A caffine intake of over 600 mg per day is considered excessive and is not recommended. Caffeine that is consumed in large quantities can cause higher total cholesterol levels and insomnia. Patients who consume large quantities of caffeine are also more likely to feel warm, have increased frequency of stools, and have an increased appetite.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 : Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 23

Type: MCSA

The patient states she has been using an illegal drug for the last nine years. Based on the information included in the chart above, which of the following statements is most consistent with the type of illegal drug she has been abusing?

1. “My husband and I smoke our fair share of ‘broccoli.’”
2. “I should tell you tell that I drink quite a bit of hootch.”
3. “I am probably addicted to ‘Big D.’”
4. “I use the ‘white stuff.’”

Correct Answer: 1

Rationale 1: Chronic long-term use of cannabis can lead to airway constriction, bronchitis, and sinusitis. The reproductive system is also affected by marijuana. It causes decreased spermatogenesis and testosterone levels in males and suppresses follicle-stimulating and luteinizing hormones in females.

Rationale 2: “Hootch” is a term used to describe alcohol.

Rationale 3: “Big D” is a term used to describe hallucinogens.

Rationale 4: “White stuff” is a term used to describe heroin or morphine.

Global Rationale: Chronic long-term use of cannabis can lead to airway constriction, bronchitis, and sinusitis. The reproductive system is also affected by marijuana. It causes decreased spermatogenesis and testosterone levels in males and suppresses follicle-stimulating and luteinizing hormones in females. “Hootch” is a term used to describe alcohol. “Big D” is a term used to describe hallucinogens. “White stuff” is a term used to describe heroin or morphine.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 24

Type: MCMA

The patient has been diagnosed with substance dependence. The patient has been using “Bennies” for the last three years. Which of the following patient statements are associated with substance dependence?

Standard Text: Select all that apply.

1. “I am so tired and I feel so confused about everything that is happening around me.”
2. “I really tried to cut down my use, but I fail miserably every time.”
3. “The only thing I care about right now is getting my fix.”
4. “I have to use a lot more right now to get the same high as I did before.”
5. “I have a great job where I work full-time as a mechanical engineer, so that part of my life is very fulfilling.”

Correct Answer: 1,2,3,4

Rationale 1: Fatigue and confusion are withdrawal symptoms associated with the use of amphetamines.

Rationale 2: When patients are unsuccessfully attempting to cut down on their use of the substance, this is another behavior associated with substance dependence.

Rationale 3: When patients are unsuccessfully attempting to cut down on their use of the substance, this is another behavior associated with substance dependence.

Rationale 4: Patients are more likely to develop tolerance to the drug.

Rationale 5: It is unlikely that a patient with substance dependence is continuing to keep a full-time job because the patient will usually spend a lot of time procuring and using the drug. They invest less time with occupational activities.

Global Rationale: “Bennies” is a term used to describe amphetamines. Substance dependence can be associated with withdrawal symptoms from the substance. Fatigue and confusion are withdrawal symptoms associated with the use of amphetamines. When patients are unsuccessfully attempting to cut down on their use of the substance, this is another behavior associated with substance dependence. Patients are more likely to develop tolerance to the drug. It is unlikely that a patient with substance dependence is continuing to keep a full-time job because the patient will usually spend a lot of time procuring and using the drug. They invest less time with occupational activities.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 25

Type: MCMA

The student nurse is learning about some issues related to substance abuse from an experienced nurse who works in an addiction detoxification unit. The student nurse asks the nurse about the importance of requesting information from the patients about a family history of substance abuse. Which of the following responses by the nurse are appropriate?

Standard Text: Select all that apply.

1. “There is a genetic link between having an alcoholic parent and developing problems related to substance use.”
2. “These genetic issues are more often related to alcohol, marijuana, and tobacco use.”
3. “One type of genetically-related alcoholism is associated with an antisocial personality disorder, early use, and an inability to stop drinking.”
4. “The patient has an increased likelihood of developing substance use problems when the mother of the patient is an alcoholic.”
5. “Some studies indicate that adolescents who are more genetically prone to develop alcoholism were less likely to have other types of substance use problems.”

Correct Answer: 1,2,3

Rationale 1: Children of alcoholics have a greater risk for developing substance use problems. These types of genetic issues lead to problems with alcohol, marijuana, and tobacco use.

Rationale 2: These types of genetic issues lead to problems with alcohol, marijuana, and tobacco use.

Rationale 3: One type of alcoholism seen mostly in the sons of alcoholic fathers is associated with an inability to abstain, early onset, and an antisocial personality.

Rationale 4: One type of alcoholism seen mostly in the sons of alcoholic fathers is associated with an inability to abstain, early onset, and an antisocial personality. These types of genetic issues are typically found in male relatives.

Rationale 5: Results of one study revealed that adolescent boys of alcoholics with the D2 dopamine receptor gene used alcohol and became intoxicated from alcohol more often than boys without this genetic marker. In addition, they tried and used more substances overall. Boys with this allele used more tobacco and experienced a marijuana high at an earlier age than boys without this genetic alteration.

Global Rationale: Children of alcoholics have a greater risk for developing substance use problems. These types of genetic issues lead to problems with alcohol, marijuana, and tobacco use. One type of alcoholism seen mostly in the sons of alcoholic fathers is associated with an inability to abstain, early onset, and an antisocial personality. These types of genetic issues are typically found in male relatives. Results of one study revealed that adolescent boys of alcoholics with the D2 dopamine receptor gene used alcohol and became intoxicated from alcohol more often than boys without this genetic marker. In addition, they tried and used more substances overall. Boys with this allele used more tobacco and experienced a marijuana high at an earlier age than boys without this genetic alteration.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Discuss risk factors associated with substance abuse.

 

Question 26

Type: MCMA

The patient has been admitted to an addiction detoxification unit. The nurse has educated the patient about the medications that have prescribed to help with withdrawal symptoms. Which of the following statements made by the patient indicate that further education is required?

Standard Text: Select all that apply.

1. “Naltrexone is an antidepressant.”
2. “The Antabuse will help me with my cravings for heroin.”
3. “The clordiazepoxide is also called Librium and it can help with my anxiety.”
4. “The phenobarbital will help prevent me from having another seizure.”
5. “I need folic acid and other vitamin supplements because I haven’t eaten well for so long.”

Correct Answer: 1,2

Rationale 1: Naltrexone helps diminish cravings for alcohol and opiates. It is not an antidepressant.

Rationale 2: Antabuse is given to patients to stop the breakdown of alcohol within the body and make the consequences of drinking alcohol more severe. Methadone will help block heroin cravings.

Rationale 3: Librium can be used to help with anxiety and prevent seizure activity.

Rationale 4: Phenobarbital can help prevent seizure activity.

Rationale 5: Vitamin supplements can help the patient with alcoholism because they are more likely to have developed vitamin deficiencies.

Global Rationale: Naltrexone helps diminish cravings for alcohol and opiates. It is not an antidepressant. Antabuse is given to patients to stop the breakdown of alcohol within the body and make the consequences of drinking alcohol more severe. Methadone will help block heroin cravings. Librium can be used to help with anxiety and prevent seizure activity. Phenobarbital can help prevent seizure activity. Vitamin supplements can help the patient with alcoholism because they are more likely to have developed vitamin deficiencies.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 27

Type: MCMA

The new nurse has been hired onto a medical-surgical unit. The new nurse is concerned because one of the other nurses has exhibited some signs that may indicate that he has a substance use problem. Which of the following behaviors by the nurse may be consistent with this problem?

Standard Text: Select all that apply.

1. The new nurse notes that the other nurse is always sucking on mints and has applied strong-smelling cologne.
2. During the other nurse’s break, two of his patients stated they didn’t feel like the pain medication that he gave them was working at all. The patients stated that the pain medications had been previously effective.
3. The other nurse has volunteered to “waste” all of the new nurse’s narcotic medications.
4. The other nurse has displayed difficulty juggling his patient assignment and seems to be highly unorganized.
5. The narcotic count at the end of the shift is off; two doses of morphine sulfate are missing.

Correct Answer: 1,2,3,4,5

Rationale 1: Eating an excessive number of mints and wearing strong-smelling cologne can be used to mask odors of alcohol on the nurse’s breath.

Rationale 2: If the nurse’s patients are complaining that they are not achieving pain relief, it may be because the nurse is procuring the medication for himself.

Rationale 3: Offering to “waste” the new nurse’s narcotics is consistent with a substance use problem.

Rationale 4: Unorganized thinking and erratic behavior are consistent with a substance use problem.

Rationale 5: The narcotic count is off while this nurse is working. This is consistent with a nurse who uses narcotics from the hospital supply.

Global Rationale: All of these behaviors are consistent with a substance use problem. Eating an excessive number of mints and wearing strong-smelling cologne can be used to mask odors of alcohol on the nurse’s breath. If the nurse’s patients are complaining that they are not achieving pain relief, it may be because the nurse is procuring the medication for himself. Offering to “waste” the new nurse’s narcotics is consistent with a substance use problem. The nurse with a substance use problem is more likely to self-administer medications rather than “waste” them in an acceptable manner. Unorganized thinking and erratic behavior are consistent with a substance use problem. The narcotic count is off while this nurse is working. This is consistent with a nurse who uses narcotics from the hospital supply.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 : Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 28

Type: MCMA

The patient is exhibiting some addictive behaviors and has been admitted to using illegal drugs. Which of the following statements by the patient are consistent with addictive behaviors?

Standard Text: Select all that apply.

1. “I think even as a child I was much more anxious than my friends.”
2. “When I was in the hospital for appendicitis, they told me they had to give me more pain medications than normal because I was still in pain.”
3. “Sometimes I steal things from stores just to see if I can get away with it.”
4. “I like to play it safe. When my friends were bungee jumping off the bridge, I just watched.”
5. “I have always been very slow to anger.”

Correct Answer: 1,2,3

Rationale 1: People who are displaying addictive behaviors associated with substance use are more likely to be anxious.

Rationale 2: They are more likely to have a low tolerance for pain.

Rationale 3: They are more likely to participate in risky behaviors such as stealing.

Rationale 4: They are more likely to participate in risky behaviors such as bungee jumping without regard for social norms or their own safety.

Rationale 5: They are more likely to become angry than others who are not using substances.

Global Rationale: People who are displaying addictive behaviors associated with substance use are more likely to be anxious. They are more likely to have a low tolerance for pain. They are more likely to participate in risky behaviors such as stealing and bungee jumping without regard for social norms or their own safety. They are more likely to become angry than others who are not using substances.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 29

Type: MCMA

The patient states, “I think I am actually addicted to nicotine.” Which of the following assessment findings by the nurse are consistent with this type of addiction?

Standard Text: Select all that apply.

1. The blood pressure is 182/86.
2. The patient states, “Sometimes, I feel so nauseated after I smoke cigarettes.”
3. The patient states, “I have never been able to stop smoking for more than two weeks at a time because the cravings get so bad.”
4. An apical heart rate is 72 beats per minute.
5. A respiratory rate is 14 breaths per minute.

Correct Answer: 1,2,3

Rationale 1: Nicotine use results the release of norepinephrine and epinephrine which produces vasoconstriction. Vasoconstriction will increase the patient’s blood pressure.

Rationale 2: Patients who use nicotine will find that it promotes vomiting.

Rationale 3: Quitting smoking is thought to be more difficult because of dopamine release, which reinforces the craving for more.

Rationale 4: Due to the effects of the norepinephrine and epinephrine the patient’s heart rate would increase.

Rationale 5: Due to the effects of the norepinephrine and epinephrine the patient’s respiratory rate would increase.

Global Rationale: Nicotine use results the release of norepinephrine and epinephrine which produces vasoconstriction. Vasoconstriction will increase the patient’s blood pressure. Patients who use nicotine will find that it promotes vomiting. Quitting smoking is thought to be more difficult because of dopamine release, which reinforces the craving for more. Due to the effects of the norepinephrine and epinephrine the patient’s heart rate and respiratory rate would both increase.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 30

Type: MCMA

The patient has been dealing with chronic alcoholism for the last 25 years. The patient has entered an addiction detoxification unit and has displayed progress with recovery. The nurse has educated the patient regarding some of the long-term effects of alcohol use. Which of the following statements by the patient indicate that the patient requires further education?

Standard Text: Select all that apply.

1. “My yellow skin is really just caused by the thiamine deficiency.”
2. “My problems with COPD weren’t because I smoke; it’s because I was drinking so much.”
3. “I was surprised to learn that my coronary artery disease may have been worsened by my drinking.”
4. “I think I would’ve stopped drinking a long time ago if I had known that it may have caused my impotence.”
5. “My mom was an alcoholic and died from breast cancer and it may have been the result of her drinking.”

Correct Answer: 1,2

Rationale 1: Patients who have severely damaged their livers because of alcohol abuse may be more likely to exhibit yellow skin and sclera. Jaundice is unrelated to a vitamin B₁ deficiency.

Rationale 2: The patient who smokes cigarettes is more likely to develop asthma. Asthma is not necessarily associated with drinking alcohol.

Rationale 3: The patient had an increased risk of developing heart problems by drinking alcohol.

Rationale 4: The patient had an increased chance of developing impotence by drinking.

Rationale 5: The patient’s mother had an increased risk of developing breast cancer due to her alcoholism.

Global Rationale: Patients who have severely damaged their livers because of alcohol abuse may be more likely to exhibit yellow skin and sclera. Jaundice is unrelated to a vitamin B₁ deficiency. The patient who smokes cigarettes is more likely to develop asthma. Asthma is not necessarily associated with drinking alcohol. The patient had an increased risk of developing heart problems by drinking alcohol. The patient had an increased chance of developing impotence by drinking. The patient’s mother had an increased risk of developing breast cancer due to her alcoholism.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 : Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 31

Type: MCMA

The patient has been brought to the emergency department after the patient was found by his mother at home. The patient’s blood alcohol level is currently 0.51%. Which of the following findings are consistent with this information?

Standard Text: Select all that apply.

1. A sternal rub was performed, no response elicited.
2. The patient’s respiratory rate is eight breaths per minute.
3. The patient’s radial and pedal pulses are bounding.
4. The patient states, “I sleep for a long time, but I never feel rested when I wake up.”
5. The patient states, “I really think I can drive myself home. I am fine!”

Correct Answer: 1,2

Rationale 1: With this blood alcohol level, the patient is more likely to be in a coma.

Rationale 2: The patient’s respiratory rate may be very depressed.

Rationale 3: The peripheral pulses are more likely to be weak and thready due to peripheral vascular collapse, which would make it difficult for the nurse to palpate.

Rationale 4: The patient is much less likely to be talking to the nurse about the quality of his sleep.

Rationale 5: The patient is much less likely to be talking to the nurse about his ability to drive.

Global Rationale: With this blood alcohol level, the patient is more likely to be in a coma. The patient’s respiratory rate may be very depressed. The patient is less likely to have bounding peripheral pulses. The peripheral pulses are more likely to be weak and thready due to peripheral vascular collapse, which would make it difficult for the nurse to palpate. The patient is much less likely to be talking to the nurse about the quality of his sleep or about his ability to drive.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 : Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 32

Type: MCMA

The patient has been admitted to the hospital after a motor vehicle accident. The patient states that she frequently smokes “ice” and had smoked some as recently as two hours prior to the accident. Which of the following assessment findings are consistent with this information?

Standard Text: Select all that apply.

1. Apical heart rate is 112 beats per minute.
2. Preventricular contractions are noted during electrocardiogram.
3. The patient weighs 92 pounds and is 5’5” tall.
4. The patient is complaining of chest pain.
5. Blood pressure is 96/72.

Correct Answer: 1,2,3,4

Rationale 1: The patient will most likely exhibit tachycardia.

Rationale 2: The patient will most likely exhibit dysrhythmias.

Rationale 3: The patient’s appetite has been suppressed by the methamphetamine use and the patient will mostly likely be thin.

Rationale 4: Angina is a common complaint among people who use methamphetamines.

Rationale 5: The patient’s blood pressure is likely to be elevated due to the vasoconstriction that is produced by this type of drug use.

Global Rationale: The patient will most likely exhibit tachycardia and dysrhythmias. The patient’s appetite has been suppressed by the methamphetamine use and the patient will mostly likely be thin. Angina is a common complaint among people who use methamphetamines. The patient’s blood pressure is likely to be elevated due to the vasoconstriction that is produced by this type of drug use.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 33

Type: MCMA

A patient has substance dependence when clinically significant distress is manifested by which of the following?

Standard Text: Select all that apply.

1. tolerance is present
2. substance is taken for longer periods than intended
3. spends more time in private using the substance
4. desire to control substance use
5. persistent continued use despite intrapersonal problems

Correct Answer: 1,2,3,4

Rationale 1: Substance dependence is demonstrated by tolerance to the drug.

Rationale 2: Substance dependence is demonstrated by using the drug longer than intended.

Rationale 3: Substance dependence is demonstrated by spending more time using the substance in private.

Rationale 4: There is an unsuccessful persistent desire to cut down or control the substance.

Rationale 5: Substance abuse manifestations include continued use despite intrapersonal problems.

Global Rationale: Substance dependence is demonstrated by tolerance to the drug, using the drug longer than intended, and spending more time using the substance in private. The dependent patient will also spend more time getting, taking, and recovering from use; there is an unsuccessful persistent desire to cut down or control the substance, there is more withdrawal from family and friends, and there is continued use despite knowledge of adverse effects. Substance abuse manifestations include continued use despite intrapersonal problems, failure to fulfill major roles, and involvement in physically hazardous situations while impaired.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 34

Type: MCMA

The effects of cannabis sativa (marijuana) are dose related and can include which of the following?

Standard Text: Select all that apply.

1. fetal CNS disturbances
2. tachycardia
3. asthma with long term use
4. diuresis
5. hypertension

Correct Answer: 1,2,3

Rationale 1: The use of cannabis during pregnancy can cause fetal CNS changes.

Rationale 2: It also causes tachycardia.

Rationale 3: With long term use, it can cause asthma.

Rationale 4: Diuresis is not caused by cannabis, but is caused by the use of caffeine.

Rationale 5: Hypertension is found in cocaine users.

Global Rationale: The use of cannabis during pregnancy can cause fetal CNS changes, it crosses the placental barrier, interferes with breast feeding. It also causes tachycardia and with long term use, can cause asthma, bronchitis, and can increase the risk of respiratory cancer. Diuresis is not caused by cannabis, but is caused by the use of caffeine. Hypertension is found in cocaine users.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Discuss risk factors associated with substance abuse.

 

Question 35

Type: SEQ

A patient has overdosed on benzodiazepines and is admitted in a comatose state. The best order for treatment is which of the following?

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Clear airway.

Choice 2. Prepare to intubate.

Choice 3. Vital signs every 15 min.

Choice 4. Prepare for gastric lavage.

Choice 5. Prepare for possible dialysis.

Choice 6. Institute seizure precautions.

Correct Answer: 1,2,3,4,5,6

Rationale 1: With the overdosed and comatose patient, the airway is the first consideration (follows the ABCs).

Rationale 2: Next, the nurse needs to prepare for intubation of the patient as this is the second priority.

Rationale 3: Then vital signs need to be closely monitored for changes.

Rationale 4: Gastric lavage may be done to try and remove any remaining drug.

Rationale 5: The patient may need dialysis to remove the drug that has reached the blood.

Rationale 6: Seizure precautions are instituted as the patient may experience seizure activity.

Global Rationale: With the overdosed and comatose patient, the airway is the first consideration (follows the ABCs). Next, the nurse needs to prepare for intubation of the patient as this is the second priority, then vital signs need to be closely monitored for changes, gastric lavage may be done to try and remove any remaining drug, the patient may need dialysis to remove the drug that has reached the blood and seizure precautions are instituted as the patient may experience seizure activity.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 36

Type: FIB

A patient withdrawing from alcohol has an order for diazepam (Valium), 10 mg every 4 hours for 4 doses, then 5 mg every 4 hours for 4 doses. The drug comes in a concentration of 5 mg/mL. The total mL given the patient are_________(fill in the blank).

Standard Text:

Correct Answer: 12

Rationale : the drug comes in 5 mg/mL, and at 10 mg ordered, each dose is 2 mL. 2 mL x 4 doses = 8 mL. The four doses of 5 mg = 4 mL. 4 + 8 = 12.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 37

Type: MCHS

Abusive substances act at brain receptor sites as agonists or antagonists. Place an “X” on the picture that represents an antagonistic effect.

Correct Answer:

Rationale : With antagonistic effects (antagonist inhibits action between physiological process), the drug interferes with release of neurotransmitter, the drug acts as a false transmitter, and the drug causes leakage of the neurotransmitter from synaptic vesicles. Agonistic action is a drug that has a specific cellular affinity and produces a predictable response.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 38

Type: MCMA

Vitamins the nurse expects an alcoholic patient to receive include which of the following?

Standard Text: Select all that apply.

1. thiamine (vitamin B₁)
2. folic acid
3. cyanocobalamin (vitamin B₁₂)
4. vitamin E
5. potassium chloride

Correct Answer: 1,2

Rationale 1: Patients using alcohol over a long period of time will have a vitamin deficiency, especially of thiamine and folic acid. These two vitamins help prevent Wernicke’s encephalopathy.

Rationale 2: Patients using alcohol over a long period of time will have a vitamin deficiency, especially of thiamine and folic acid. These two vitamins help prevent Wernicke’s encephalopathy.

Rationale 3: The other vitamins may be important, but would be found in a multivitamin.

Rationale 4: The other vitamins may be important, but would be found in a multivitamin.

Rationale 5: Potassium chloride is incorrect as it is a mineral/electrolyte.

Global Rationale: Patients using alcohol over a long period of time will have a vitamin deficiency, especially of thiamine and folic acid. These two vitamins help prevent Wernicke’s encephalopathy. The other vitamins may be important, but would be found in a multivitamin. Potassium chloride is incorrect as it is a mineral/electrolyte.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 39

Type: FIB

A loading dose of magnesium sulfate 4g is ordered for a patient. The concentration available is 4g/250 mL to be given over 30 minutes. The IV pump will have the rate set at _________(fill in the blank).

Standard Text:

Correct Answer: 500

Rationale : 4g/30 min = X mL/h. 250mL/30 min = X mL/h. 250 mL/30 min X 2/2 = 500 mL/60 min = 500 mL/h.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 40

Type: MCMA

During assessment of a patient with a substance abuse, the nurse uses open-ended questions. Examples include which of the following?

Standard Text: Select all that apply.

1. On average, how many days a week do you drink or use drugs?
2. How often and how much do you usually use?
3. What is the greatest number of drinks you have had at any one time in the past month?
4. Do you drink beer or whiskey?
5. Did you drink beer before coming to the hospital?

Correct Answer: 1,2,3

Rationale 1: Options 1, 2, and 3 are open-ended questions that will allow the patient to discuss his or her use of drugs/alcohol. Since they are open-ended, the patient will need to answer more than “Yes” or “No.”

Rationale 2: Options 1, 2, and 3 are open-ended questions that will allow the patient to discuss his or her use of drugs/alcohol. Since they are open-ended, the patient will need to answer more than “Yes” or “No.”

Rationale 3: Options 1, 2, and 3 are open-ended questions that will allow the patient to discuss his or her use of drugs/alcohol. Since they are open-ended, the patient will need to answer more than “Yes” or “No.”

Rationale 4: Options 4 and 5 are closed questions and require that the patient only answer “Yes” or “No.”

Rationale 5: Options 4 and 5 are closed questions and require that the patient only answer “Yes” or “No.”

Global Rationale: Options 1, 2, and 3 are open-ended questions that will allow the patient to discuss his or her use of drugs/alcohol. Since they are open-ended, the patient will need to answer more than “Yes” or “No.” Options 4 and 5 are closed questions and require that the patient only answer “Yes” or “No.”

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 41

Type: MCSA

A nurse has been convicted of driving while under the influence. The nurse’s license will be affected by which of the following?

1. state board of nursing
2. Employee Assistance Program
3. state court system
4. American Nurses Association

Correct Answer: 1

Rationale 1: The nurse has been convicted, so the state board in his or her state will investigate and take action including censure, probation, or suspension of the nursing license.

Rationale 2: The Employee Assistance Program may be involved but will not investigate the conviction.

Rationale 3: With the conviction, the court system has taken action and would be in the county, not the state.

Rationale 4: The American Nurses Association will not be involved.

Global Rationale: The nurse has been convicted, so the state board in his or her state will investigate and take action including censure, probation, or suspension of the nursing license. The Employee Assistance Program may be involved but will not investigate the conviction. With the conviction, the court system has taken action and would be in the county, not the state. The American Nurses Association will not be involved.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Explain the effects of addictive substances on physiological, cognitive, psychological, and social well-being.

 

Question 42

Type: MCMA

Factors that decrease substance abuse in healthcare workers include which of the following?

Standard Text: Select all that apply.

1. strong religious practices
2. treatment for depression
3. role strain
4. workplace stress
5. history of abuse

Correct Answer: 1,2

Rationale 1: Studies show that strong religious practices reduce substance abuse in healthcare workers.

Rationale 2: Studies show that treatment for depression will significantly reduce substance abuse in healthcare workers.

Rationale 3: Role strain will increase substance abuse.

Rationale 4: Workplace stress will increase substance abuse.

Rationale 5: A history of abuse will increase substance abuse.

Global Rationale: Studies show that strong religious practices and treatment for depression will significantly reduce substance abuse in healthcare workers. Role strain, workplace stress, and a history of abuse will increase substance abuse.

 

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Discuss risk factors associated with substance abuse.

 

Question 43

Type: MCMA

Imbalanced Nutrition: Less than Body Requirements is the nursing diagnosis written for a patient hospitalized for substance abuse. Interventions include which of the following?

Standard Text: Select all that apply.

1. Monitor the CBC and liver enzymes.
2. Collaborate with the dietician.
3. Administer vitamins and diet supplements.
4. Provide high fat, high carbohydrate diet.
5. Restrict fluid intake to 1500 mL per day.

Correct Answer: 1,2,3

Rationale 1: For the stated nursing diagnosis, the interventions will include monitoring the lab values to evaluate the extent of malnourishment.

Rationale 2: For the stated nursing diagnosis, the dietician is needed to provide adequate nutrition and realistic weight gain.

Rationale 3: For the stated nursing diagnosis, vitamins, and dietary supplements may be ordered to prevent complications from chronic alcoholism such as Wernicke’s syndrome.

Rationale 4: A high fat, high carbohydrate diet is not appropriate as the patient needs a balanced nutritional intake to provide for calories, proteins, vitamins, minerals, and carbohydrates.

Rationale 5: The fluid intake will not be restricted as there is no physiological reason unless the patient has a co-morbidity.

Global Rationale: For the stated nursing diagnosis, the interventions will include monitoring the lab values to evaluate the extent of malnourishment, the dietician is needed to provide adequate nutrition and realistic weight gain, vitamins, and dietary supplements may be ordered to prevent complications from chronic alcoholism such as Wernicke’s syndrome. A high fat, high carbohydrate diet is not appropriate as the patient needs a balanced nutritional intake to provide for calories, proteins, vitamins, minerals, and carbohydrates. The fluid intake will not be restricted as there is no physiological reason unless the patient has a co-morbidity.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

Question 44

Type: MCMA

Screening tools that assist in determining the degree of addiction or dependence includes which of the following?

Standard Text: Select all that apply.

1. Michigan Alcohol Screening test
2. the CAGE questionnaire
3. Brief Drug Abuse Screening Test
4. the Clinical Institute Withdrawal Assessment of Alcohol-Revised
5. Clinical Opiate Withdrawal Scale

Correct Answer: 1,2,3

Rationale 1: These screening tools provide a nonjudgmental, brief, and easy method to determine patterns of substance abuse behaviors.

Rationale 2: These screening tools provide a nonjudgmental, brief, and easy method to determine patterns of substance abuse behaviors.

Rationale 3: These screening tools provide a nonjudgmental, brief, and easy method to determine patterns of substance abuse behaviors.

Rationale 4: The Clinical Institute Withdrawal Assessment of Alcohol-Revised is an assessment tool for withdrawal from alcohol and drugs and can indicate the need for pharmacologic treatment to manage withdrawal.

Rationale 5: The Clinical Opiate Withdrawal Scale is an assessment tool for withdrawal from alcohol and drugs and can indicate the need for pharmacologic treatment to manage withdrawal.

Global Rationale: These screening tools provide a nonjudgmental, brief, and easy method to determine patterns of substance abuse behaviors. The Clinical Institute Withdrawal Assessment of Alcohol-Revised and the Clinical Opiate Withdrawal Scale are assessment tools for withdrawal from alcohol and drugs and can indicate the need for pharmacologic treatment to manage withdrawal.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5. Support interdisciplinary care for the patient with substance abuse problems, including diagnostic tests, emergency care for overdose, and treatment of withdrawal.

 

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