Medical Surgical Nursing 10th Ed By Lewis – Test Bank

Medical Surgical Nursing 10th Ed By Lewis – Test Bank

Chapter 10: Substance Use Disorders
Lewis: Medical-Surgical Nursing, 10th Edition

MULTIPLE CHOICE

1. Which assessment finding would alert the nurse to ask the patient about alcohol use?
a. Low blood pressure c. Elevated temperature
b. Decreased heart rate d. Abdominal tenderness

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

DIF: Cognitive Level: Apply (application) REF: 151
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. The nurse plans postoperative care for a patient who smokes two packs of cigarettes daily. Which goal should the nurse include in the plan of care for this patient?
a. Improve sleep c. Decrease diarrhea
b. Enhance appetite d. Prevent sore throat

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

DIF: Cognitive Level: Apply (application) REF: 150
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

3. A young adult patient scheduled for an annual physical examination arrives in the clinic smelling of cigarette smoke and carrying a pack of cigarettes. Which action will the nurse plan to take?
a. Urge the patient to quit smoking as soon as possible.
b. Avoid confronting the patient about smoking at this time.
c. Wait for the patient to start a discussion about quitting smoking.
d. Explain that the “cold turkey” method is most effective in stopping smoking.

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

DIF: Cognitive Level: Apply (application) REF: 146
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

4. A patient admitted to the hospital after an automobile accident is alert and does not appear to be highly intoxicated. The blood alcohol concentration (BAC) is 110 mg/dL (0.11 mg%). Which action by the nurse is appropriate?
a. Restrict oral and IV fluids.
b. Maintain the patient on NPO status.
c. Administer acetaminophen for headache.
d. Monitor for hyperreflexia and diaphoresis.

ANS: D
The patient’s assessment data indicate probable physiologic dependence on alcohol, and the patient is likely to develop acute withdrawal such as anxiety, hyperreflexia, and sweating, which could be life threatening. Acetaminophen is not recommended because it is metabolized by the liver. Alcohol has a dehydrating effect so fluids should not be restricted and there is no indication that the patient should be NPO.

DIF: Cognitive Level: Apply (application) REF: 155
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. An alcohol-intoxicated patient with a penetrating wound to the abdomen is undergoing emergency surgery. What will the nurse expect the patient to need during the perioperative period?
a. An increased dose of the general anesthetic medication
b. Interventions to prevent withdrawal symptoms within 2 hours
c. Frequent monitoring for bleeding and respiratory complications
d. Stimulation every hour to prevent prolonged postoperative sedation

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

DIF: Cognitive Level: Apply (application) REF: 149
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

6. A patient with alcohol dependence is admitted to the hospital with back pain following a fall. Twenty-four hours after admission, the patient becomes tremulous and anxious. Which action by the nurse is appropriate?
a. Encourage increased oral intake.
b. Insert an IV line and infuse fluids.
c. Provide a quiet, well-lit environment.
d. Administer opioids to provide sedation.

ANS: C
The patient’s symptoms suggest acute alcohol withdrawal, and a quiet and well-lit environment will help 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: Apply (application) REF: 150
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. A patient with a history of heavy alcohol use is diagnosed with acute gastritis. Which statement by the patient indicates a willingness to stop alcohol use?
a. “I am older and wiser now, and I can change my drinking behavior.”
b. “Alcohol has never bothered my stomach before. I think I have the flu.”
c. “People say that I drink too much, but I feel pretty good most of the time.”
d. “My drinking is affecting my stomach, but medication will help me feel better.”

ANS: A
The statement “I am older and wiser now, and I can change my drinking behavior” indicates the patient expresses willingness to stop alcohol use and an initial commitment to changing alcohol intake behaviors. In the remaining statements, the patient recognizes that alcohol use is the reason for the gastritis but is not yet willing to make a change.

DIF: Cognitive Level: Apply (application) REF: 154
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. What is the nurse’s best action at this time?
a. Escort the patient outside where smoking is allowed.
b. Request a prescription for a nicotine replacement agent.
c. Tell the patient to calm down and not to think about smoking.
d. Ask the patient’s family to bring in chewable tobacco products.

ANS: B
Nicotine replacement agents should be prescribed for patients who smoke and are hospitalized to avoid withdrawal symptoms. Allowing the patient to smoke or use other tobacco products encourages ongoing tobacco use. Telling the patient to calm down will not relieve withdrawal symptoms.

DIF: Cognitive Level: Apply (application) REF: 150
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. A patient who is admitted to the hospital for wound debridement admits to using fentanyl (Sublimaze) illegally. What withdrawal signs does the nurse expect?
a. Tremors and seizures c. Lethargy and disorientation
b. Vomiting and diarrhea d. Delusions and hallucinations

ANS: B
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: Understand (comprehension) REF: 152
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A newly admitted patient complains of waking frequently during the night. The nurse observes the patient wearing a nicotine patch on the right upper arm. Which action should the nurse take first?
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 patient’s 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: Analyze (analysis) REF: 150
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

11. During physical assessment of a patient who has frequent nosebleeds, the nurse finds nasal sores and necrosis of the nasal septum. The nurse should ask the patient specifically about the use of which drug?
a. Heroin c. Tobacco
b. Cocaine d. Marijuana

ANS: B
Inhaled cocaine causes ischemia of the nasal septum, leading to nasal sores and necrosis. These symptoms are not associated with the use of heroin, tobacco, or marijuana.

DIF: Cognitive Level: Apply (application) REF: 146
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12. A patient admitted with shortness of breath and chest pain who is a pack-a-day smoker tells the nurse, “I am just not ready to quit smoking yet.” Which response by the nurse is appropriate for the patient’s stage of change?
a. “This would be a really good time to quit.”
b. “Your smoking is the cause of your chest pain.”
c. “Are you familiar with nicotine replacement products?”
d. “What health problems do you think smoking has caused?”

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

DIF: Cognitive Level: Apply (application) REF: 146
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

13. A disoriented and agitated patient comes to the emergency department and admits using methamphetamine. Vital signs are blood pressure 164/94 mm Hg, heart rate 136 beats/min and irregular, and respirations 32 breaths/min. Which action by the nurse is most important?
a. Reorient the patient at frequent intervals.
b. Monitor the patient’s electrocardiogram (ECG).
c. Keep the patient in a quiet and darkened room.
d. Obtain a health history including prior drug use.

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

DIF: Cognitive Level: Apply (application) REF: 146
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. A 73-yr-old patient is admitted for pancreatitis. Which tool would be the most appropriate for the nurse to use during the admission assessment?
a. Mini-Mental State Examination
b. Drug Abuse Screening Test (DAST-10)
c. Screening Test-Geriatric Version (SMAST-G)
d. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

ANS: C
Because alcohol use is a common factor associated with the development of pancreatitis, the first assessment step is to screen for alcohol use using a validated screening questionnaire. The SMAST-G is a short-form alcoholism screening instrument tailored specifically to the needs of the older adult. If the patient scores positively on the SMAST-G, then the CIWA-Ar would be a useful tool for determining treatment. The DAST-10 provides more general information regarding substance use. The Mini-Mental State Examination is used to screen for cognitive impairment.

DIF: Cognitive Level: Apply (application) REF: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity