Chapter 12: Addictive Behaviors My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 12: Addictive Behaviors

Test Bank

MULTIPLE CHOICE

1. When assessing a patient who has a history of alcohol abuse, the nurse will plan to assess for

a.

low blood pressure.

b.

decreased heart rate.

c.

elevated temperature.

d.

abdominal tenderness.

ANS: D

Abdominal pain associated with gastrointestinal tract and liver dysfunction is common in patients with chronic alcohol use. The other problems are not associated with alcohol abuse.

DIF: Cognitive Level: Application REF: 175

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

2. A patient who smokes a pack of cigarettes daily is admitted to the hospital for surgery. When planning postoperative care, the nurse should include measures to

a.

improve sleep.

b.

enhance appetite.

c.

decrease diarrhea.

d.

prevent sore throat.

ANS: A

Insomnia is a characteristic of nicotine withdrawal. Diarrhea, sore throat, and anorexia are not symptoms associated with nicotine withdrawal.

DIF: Cognitive Level: Application REF: 169 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

3. A new 21-year-old patient who is scheduled for an annual physical examination arrives in the clinic smelling of cigarette smoke and carrying a pack of cigarettes. Which action will the nurse plan to take?

a.

Urge the patient to quit smoking as soon as possible.

b.

Avoid confronting the patient about smoking at this time.

c.

Wait for the patient to start the discussion about quitting smoking.

d.

Explain that the cold turkey method is most effective in stopping smoking.

ANS: A

Current national guidelines indicate that health care professionals should urge patients who smoke to quit smoking at every encounter. The other actions will not help decrease the patients health risks related to smoking.

DIF: Cognitive Level: Application REF: 170-172 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

4. A patient admitted to the hospital after an automobile accident has a blood alcohol concentration (BAC) of 220 mg/dl (0.22 mg%). The patient is alert and does not appear highly intoxicated. An appropriate nursing action is to

a.

maintain the patient on NPO status.

b.

avoid the use of intravenous (IV) fluids.

c.

administer acetaminophen for headache.

d.

monitor frequently for anxiety, hyperreflexia, and sweating.

ANS: D

The patients assessment data indicate physiologic dependence on alcohol, and the patient is likely to develop acute withdrawal such as anxiety, hyperreflexia, and sweating, which could be life-threatening. Acetaminophen is not recommended because it is metabolized by the liver. IV thiamine and IV glucose solutions usually are given to intoxicated patients to prevent Wernickes encephalopathy, and there is no indication that the patient should be NPO.

DIF: Cognitive Level: Application REF: 174

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. A patient who is alcohol-intoxicated must undergo emergency surgery for abdominal trauma. The nurse anticipates that during the perioperative period, the patient

a.

will require an increased dose of the general anesthetic medication.

b.

will need frequent monitoring for bleeding and respiratory complications.

c.

is likely to develop withdrawal symptoms within a few hours after surgery.

d.

should be stimulated every hour to prevent prolonged postoperative sedation.

ANS: B

Patients who are intoxicated at the time of surgery are at increased risk for problems with bleeding and respiratory complications such as aspiration. In an intoxicated patient, a lower dose of anesthesia is used because of the synergistic effect of the alcohol. Withdrawal is likely to occur later in the postoperative course because the medications used for anesthesia, sedation, and pain will delay withdrawal symptoms. The patient should be monitored frequently for oversedation but does not need to be stimulated.

DIF: Cognitive Level: Application REF: 180 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

6. A patient with alcohol dependence is admitted to the hospital with chest pain. Twenty-four hours after admission, the patient becomes very tremulous and anxious. An appropriate intervention by the nurse is to

a.

insert an IV line and infuse fluids.

b.

promote oral intake to 3000 ml/day.

c.

provide a quiet, well-lit environment.

d.

administer opioids to provide sedation.

ANS: C

The patients symptoms suggest acute alcohol withdrawal, and a quiet and well-lit environment will help to decrease agitation, delusions, and hallucinations. There is no indication that the patient is dehydrated. Benzodiazepines, rather than opioids, are used to prevent withdrawal. IV lines are avoided whenever possible.

DIF: Cognitive Level: Application REF: 175-176

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

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

a.

I am older and wiser now, and I know I can change my drinking behavior.

b.

Alcohol has never bothered my stomach. I think its likely that I have the flu.

c.

I think my drinking is affecting my stomach, but maybe some drugs will help.

d.

People say that I drink too much, but I really feel pretty good most of the time.

ANS: C

This statement indicates that the patient recognizes that alcohol use is the reason for the gastritis but is not yet willing to make a change. The statement I am older and wiser now, and I know I can change my drinking behavior indicates a patient at the preparation stage. The remaining two statements are typical of the precontemplation stage.

DIF: Cognitive Level: Application REF: 181

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

8. A patient who smokes a pack of cigarettes daily develops tachycardia and irritability on the second day after abdominal surgery. Which action is best for the nurse to take at this time?

a.

Escort the patient outside where smoking is allowed.

b.

Request a prescription for a nicotine replacement agent.

c.

Move the patient to a private room and allow smoking.

d.

Tell the patient that this is a good time to quit smoking.

ANS: B

Nicotine replacement agents should be prescribed for patients who are hospitalized to avoid withdrawal symptoms. Allowing the patient to smoke encourages ongoing smoking. Urging the patient to quit smoking is appropriate, but the first action should be to obtain appropriate medications to prevent withdrawal symptoms.

DIF: Cognitive Level: Application REF: 172-173

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

9. A patient who is admitted to the hospital for treatment of an abscess on the left thigh admits to using fentanyl (Sublimaze) illegally. The nurse will monitor the patient for manifestations of withdrawal such as

a.

nausea and diarrhea.

b.

tremors and seizures.

c.

lethargy and disorientation.

d.

delusions and hallucinations.

ANS: A

Symptoms of opioid withdrawal include gastrointestinal symptoms such as nausea, vomiting, and diarrhea. The other symptoms are seen during withdrawal from other substances such as alcohol, sedative-hypnotics, or stimulants.

DIF: Cognitive Level: Comprehension REF: 178

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A patient in the outpatient clinic who is using a nicotine patch (Nicoderm CQ) tells the nurse about waking frequently during the night. Which action is best for the nurse to take?

a.

Question the patient about use of the patch at night.

b.

Suggest that the patient go to bed earlier in the evening.

c.

Ask the health care provider about prescribing a sedative drug for nighttime use.

d.

Remind the patient that the benefits of the patch outweigh the short-term insomnia.

ANS: A

Insomnia can occur when nicotine patches are used all night. This can be resolved by removing the patch in the evening. The other actions may be helpful in improving the patients sleep, but the initial action should be to ask about nighttime use of the patch and suggest removal of the patch at bedtime.

DIF: Cognitive Level: Application REF: 171

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

11. During physical assessment of a patient who has sinus headaches, the nurse finds nasal sores and necrosis of the nasal septum. The nurse should ask the patient specifically about the use of

a.

heroin.

b.

cocaine.

c.

tobacco.

d.

marijuana.

ANS: B

When cocaine is inhaled, it causes ischemia of the nasal septum, leading to nasal sores and necrosis. These symptoms are not associated with the use of heroin, tobacco, or marijuana.

DIF: Cognitive Level: Application REF: 168

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12. A patient admitted with chest pain who is a pack-a-day smoker tells the nurse, I am just not ready to quit smoking yet. The best response by the nurse is

a.

This would be a really good time to quit.

b.

Your smoking is the cause of your chest pain.

c.

Do you think that smoking has caused any health problems?

d.

Are you familiar with the various nicotine replacement options?

ANS: C

The patient is in the precontemplation stage of change, and the nurses role is to assist the patient in identifying motivators to quitting. The current Clinical Practice Guidelines indicate that the nurse should ask the patient to identify any negative consequences from smoking. The responses This would be a really good time to quit and Your smoking is the cause of your chest pain express judgmental feelings by the nurse and are not likely to motivate the patient. Providing information about the various nicotine replacement options would be appropriate for a patient who has expressed a desire to quit smoking.

DIF: Cognitive Level: Application REF: 172 | 181

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

13. A disoriented and agitated patient comes to the emergency department after using methamphetamine. Vital signs are blood pressure 162/98, heart rate 142 and irregular, and respirations 32. The most important intervention by the nurse is to

a.

reorient the patient at frequent intervals.

b.

monitor the patients ECG and vital signs.

c.

keep the patient in a quiet and darkened room.

d.

obtain a health history including prior drug use.

ANS: B

The priority is to ensure physiologic stability given that methamphetamine use can lead to complications such as myocardial infarction. The other actions also are appropriate but are not of as high a priority.

DIF: Cognitive Level: Application REF: 176

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. A patient who takes methadone (Dolophine) daily to prevent a relapse of heroin addiction is admitted for knee surgery. To promote effective pain control postoperatively, the nurse will plan to

a.

use a mixed opioid agonist-antagonist drug for pain relief.

b.

administer opioid analgesics on a regularly scheduled basis.

c.

avoid use of opioids and use alternatives such as NSAIDs instead.

d.

give prescribed doses of opioid pain medication as needed for pain.

ANS: B

A patient addicted to opioids should receive them on an around-the-clock basis to prevent withdrawal. Normal opioid doses given on a PRN basis will not effectively relieve pain in a patient who has developed tolerance. NSAIDs may be used as adjuncts, but they should not be the primary analgesic used. Mixed opioid agonist-antagonist drugs can precipitate withdrawal in patients who have tolerance to opioids.

DIF: Cognitive Level: Application REF: 181 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

15. A 69-year-old who has been taking alprazolam (Xanax) calls the clinic asking for a refill of the prescription 1 month before the Xanax should need to be refilled. The best response by the nurse to the patient is

a.

The prescription cannot be refilled for another month. What happened to all of your pills?

b.

Do you have any muscle cramps and tremors if you dont take the medication frequently?

c.

I will ask the doctor to prescribe a few more pills, but you will not be able to get any more for another month.

d.

I am concerned that you may be overusing the Xanax. Lets make an appointment for you to see the doctor today.

ANS: D

The patient should be assessed for problems that are causing overuse of the Xanax, such as anxiety or memory loss. The other responses by the nurse will not allow for the needed assessment and possible referral for support services or treatment of drug dependence.

DIF: Cognitive Level: Application REF: 182

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

16. A 20-year-old patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath. Which of these actions ordered by the health care provider will the nurse implement first?

a.

Obtain a 12-lead ECG.

b.

Start O2 at 4 L/minute.

c.

Draw blood for drug screening.

d.

Infuse normal saline at 100 ml/hr.

ANS: B

The priority here is to ensure that oxygenation is adequate. The other orders also should be accomplished as soon as possible but are not the first priority.

DIF: Cognitive Level: Application REF: 176

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

17. An agitated individual is brought to the emergency department by friends who state that the patient took a hallucinogenic drug at a party and then tried to jump from a second-story window. The priority nursing diagnosis for the patient is

a.

risk for injury related to altered perception.

b.

ineffective health maintenance related to drug use.

c.

powerlessness related to loss of behavioral control.

d.

ineffective denial related to lack of control of life situation.

ANS: A

Although all the diagnoses may be appropriate for the patient, the highest priority is to address the patients immediate risk for injury.

DIF: Cognitive Level: Application REF: 180

OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity

18. A 19-year-old patient comes to the emergency department with severe chest pain and agitation. Which action should the nurse take first?

a.

Give the PRN naloxone (Narcan) IV.

b.

Ask about any use of stimulant drugs.

c.

Assess orientation to person, place, and time.

d.

Check blood pressure, pulse, and respirations.

ANS: C

The patient has symptoms consistent with the use of cocaine or amphetamines and is at risk for fatal tachydysrhythmias or complications of hypertension such as stroke or myocardial infarction. The nurse also will ask about drug use and assess orientation, but these are not the priority actions. Naloxone may be given if the patient develops symptoms of CNS depression, but this patients current symptoms indicate stimulant use.

DIF: Cognitive Level: Application REF: 176

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Psychosocial Integrity

19. All the following medications are ordered for a patient admitted with a blood alcohol concentration of 0.18 mg%. Which one will the nurse give first?

a.

thiamine (vitamin B1) 100 mg daily

b.

lorazepam (Ativan) 1 mg as needed

c.

folic acid (Vitamin B9) 0.4 mg daily

d.

dextrose 5% in 0.45 saline over 8 hours

ANS: A

Thiamine is given to all patients with alcohol intoxication to prevent Wernickes encephalopathy. Because Wernickes encephalopathy can be precipitated by the administration of glucose solutions, the thiamine should be given before (or concurrently with) the 5% dextrose solution. Lorazepam would not be appropriate while the patient still has an elevated blood alcohol concentration (BAC). Folic acid also may be administered but is not as important as thiamine.

DIF: Cognitive Level: Application REF: 175

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

20. Which information obtained by the nurse about a patient who has been using varenicline (Chantix) is most important to report to the health care provider?

a.

The patient continues to smoke a few cigarettes every day.

b.

The patient complains of headaches that occur almost daily.

c.

The patient complains of new-onset sadness and depression.

d.

The patient says, I have decided that I am not ready to quit.

ANS: C

Adverse affects of varenicline include depression and attempted suicide. The patients symptoms require immediate assessment and discontinuation of the drug. The other information also will be reported, but it does not indicate any life-threatening problems associated with the medication.

DIF: Cognitive Level: Application REF: 170-171

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

21. A patient who has a history of ongoing opioid abuse is hospitalized for surgery. After a visit by a friend, the nurse finds that the patient is unresponsive with pinpoint pupils. Which of these prescribed medications will the nurse administer immediately?

a.

naloxone (Narcan)

b.

diazepam (Valium)

c.

clonidine (Catapres)

d.

methadone (Dolphine)

ANS: A

The patients assessment indicates an opioid overdose, and naloxone should be given to prevent respiratory arrest. The other medications may be used to decrease symptoms associated with opioid withdrawal but would not be appropriate for an overdose.

DIF: Cognitive Level: Application REF: 169 | 177

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Psychosocial Integrity

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

Leave a Reply