Ignatavicius: Medical-Surgical Nursing, 6th Edition

Chapter 7: Substance Abuse and Medical-Surgical Nursing Test an! M"#TI$#E C%&ICE 1. The nurse suspects a colleague of diverting narcotics for personal use. Which intervention will the nurse implement first? a Discusses suspicions with the colleague in question . b Reports suspicions to the nursing supervisor . c Begins documenting colleagues actions . d Reports suspicions to the board of nursing . !"# D The nurse should report suspicious behavior to the board of nursing. The nurse can then report what has occurred to the nursing supervisor. $t is not the nurses responsibilit% to document a colleagues actions& nor should the nurse confront the colleague. 'egall%& there is no place for the nurse to document the colleagues actions. The nurse ma% not be equipped to handle a confrontation of this nature. This is better left to a supervisor or someone in an authorit% position who has the resources to assist the nurse. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcome . )lient !eeds )ategor%# /h%siological $ntegrit% 0Basic )are and )omfort1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

3. The nurse is monitoring a client after a cocaine overdose. Which s%mptom requires immediate intervention? a )omplaints of nasal congestion . b $4 site cool to touch . c 5eart rate 116 beats+min . d 7rinar% output 86 m'+hr . !"# )

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Test Ban:

.D3

Because cocaine is a cardiac stimulant& observation during overdose or withdrawal includes frequent monitoring of vital signs and cardiac assessments. The nasal mucous membranes ma% be inflamed or congested& but this does not require priorit% assessment because it does not ;eopardi<e the clients immediate health. The client ma% need intravenous fluids to be monitored. 2anic episodes are not usuall% a concern& but depression ma% result during the withdrawal period. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcome 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

=. Which assessment finding in a client who has ta:en an overdose of stimulants requires the nurses immediate action? a 7se of accessor% muscles while breathing . b ,ral temperature >8.8? ( 0=@.>? )1 . c *Atreme feeling of being BtiredC . d )onstant tal:ing . !"# 7se of the accessor% muscles to breath indicates serious respirator% insufficienc%. subnormal temperature& eAtreme fatigue& and constant tal:ing are all abnormal s%mptoms but are not lifeDthreatening. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcome 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

E. Which assessment finding in a client eAperiencing opiate intoAication requires immediate action? a Blood pressure& 1=6+>6 mm+hg . b Blood pressure& .6+E6 mm+hg . c /ulse rate& 166 beats+min . d /ulse rate& @6 beats+min .

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Test Ban:

.D=

!"# B ,f the s%mptoms listed& onl% decreased blood pressure would be the earliest indication of opiate intoAication. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcome @ )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

@. Which client will the nurse assess for the possibilit% of opiate addiction? a middleDaged woman who is eAperiencing cancer of the th%roid . b n older man who has eAperienced a m%ocardial infarction . c %oung woman who is eAperiencing sic:le cell anemia . d %oung man who has eAperienced a closed head in;ur% . !"# ) "ic:le cell anemia places the client at high ris: for opiate addiction because of the painful nature of the illness. The client with a closed head in;ur% will not be given opiates because of their sedating properties. The client with cancer of the th%roid and m%ocardial infarction should not require opiates. D$(# ,B-# T,/# 2")# )ognitive 'evel# )omprehension R*(# p. >6 'earning ,utcomes =& @ )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

8. The nurse is attempting to promote a safe environment for a client who has a histor% of methamphetamine use. What is the nurses priorit% action? a rranges for the client to be medicated with sedatives during his hospitali<ation . b Reorients the client frequentl% to his surroundings and reassures him of the . nurses presence c Discusses the need to participate in counseling sessions on discharge . d /laces the client on suicide watch and documents all findings . !"# B

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Test Ban:

.DE

The client who has been using methamphetamine will tend to be disoriented. 5e will not necessaril% be suicidal and probabl% will not benefit from counseling immediatel% on discharge& because there is no evidence that he has undergone treatment. The client will probabl% not be medicated with sedatives because of his current chemical dependenc%. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcome 3 )lient !eeds )ategor%# /s%chosocial $ntegrit% 0Therapeutic *nvironment1 $ntegrated /rocess# !ursing /rocess 0$mplementation1

.. What is the most important idea for the nurse to communicate to students about substance abuse? a "ubstance abuse is an individuali<ed problem rather than a problem of societ%. . b )hemical abuse can be ;ust as detrimental as chemical dependenc%. . c "ubstance abuse is primaril% locali<ed to those in the lower classes. . d )ocaine is the most commonl% abused substance. . !"# B The students should understand that chemical abuse can be ;ust as detrimental to a client as chemical dependenc%. "ubstance abuse is a universal societal issue. There are man% abused substances. D$(# ,B-# T,/# 2")# )ognitive 'evel# )omprehension R*(# !+ for pplication and above 'earning ,utcome 1 )lient !eeds )ategor%# /h%siological $ntegrit% 0Basic )are and )omfort1 $ntegrated /rocess# Teaching+'earning

F. Wh% is it important for the nursing supervisor to identif% clients who ma% eAperience withdrawal in the clinical setting? a To prepare staff so that the% can protect themselves . b To allow for additional care and staffing . c To prepare the staff for manipulative behavior b% the client . d To inform authorities about illegal behavior . !"# B

*lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.

Test Ban:

.D@

The client who is eAperiencing withdrawal will require additional care and consequentl% will need more staff members involved in his care. "taff will not require protection& will not need to prepare for manipulative behavior b% the client& and will not need to be prepared to inform authorities about illegal behavior. D$(# )ognitive 'evel# )omprehension R*(# p. FE ,B-# 'earning ,utcome > T,/# )lient !eeds )ategor%# "afe and *ffective )are *nvironment 0"afet% and $nfection )ontrol1 2")# $ntegrated /rocess# !ursing /rocess 0 ssessment1 >. What propert% of stimulants increases their potential for abuse? a The% are not habit forming. . b The% have sedating qualities. . c The% increase general metabolism. . d Their use is not controlled b% the Drug Enforcement Administration 0D* 1. . !"# ) "timulants increase metabolism& and are often used to control weight. The% are habit forming. These drugs do not have sedative properties. lso& stimulants are D* D controlled. D$(# ,B-# T,/# 2")# )ognitive 'evel# )omprehension R*(# p. F@ 'earning ,utcome E )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

16. The client has narcoleps%. The nurse should be prepared to teach the client about which drug categor% that has potential for abuse in this situation? a mphetamines . b Ben<odia<epines . c Barbiturates . d /henc%clidines . !"# legitimate medical use of amphetamines is the treatment of narcoleps%. Thus& it is the onl% drug of the ones listed that has the potential for abuse in this situation.

*lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.

Test Ban:

.D8

D$(# ,B-# T,/# 2")#

)ognitive 'evel# Gnowledge R*(# p. F@ 'earning ,utcome 3 )lient !eeds )ategor%# /s%chosocial $ntegrit% 0Behavioral $nterventions1 $ntegrated /rocess# Teaching+'earning

11. What s%mptom in a client with head trauma assists the nurse in ma:ing a diagnosis of suspected opioid overdose? a /inpoint pupils . b Respirator% depression . c 5%porefleAive deep tendon refleAes . d *vidence that the client has vomited . !"# ,pioid ingestion causes pupillar% constriction. Respirator% depression does not occur in opioid overdose& nor do h%porefleAive deep tendon refleAes. There will not necessaril% be vomiting with opioid overdose. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcomes @& 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

13. Which clinical manifestation causes the nurse to suspect cocaine abuse rather than barbiturate abuse in a client? a "hallow respirations . b /upillar% constriction . c Tach%cardia . d (lushing . !"# ) The s%stemic effects of cocaine include peripheral vasoconstriction& tach%cardia& h%pertension& chills& fever& pupillar% dilation& and paranoia. "hallow respirations& constriction of the pupils& and flushing are not characteristics of cocaine abuse. D$(# )ognitive 'evel# pplication R*(# !+ for pplication and above

*lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.

Test Ban: ,B-# 'earning ,utcome @ T,/# )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 2")# $ntegrated /rocess# !ursing /rocess 0 ssessment1 1=. What information obtained from a client during assessment alerts the nurse to the possibilit% of alcohol addiction? a The client sa%s that he or she drin:s alcohol to feel less stressed and have a good . time. b The client has been arrested once for driving under the influence of alcohol. . c The client uses alcohol to stop his or her hands from sha:ing. . d The client drin:s alcohol dail%. .

.D.

!"# ) The ma;or distinction between abusing alcohol and being addicted to alcohol is the presence of withdrawal s%mptoms when the client is not drin:ing. The fact that alcohol is used to prevent or stop the s%mptoms of withdrawal 0tremors of the hands1 is a strong indicator of ph%sical addiction to alcohol. !one of the other s%mptoms are as indicative of alcohol addiction. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcome @ )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

1E. Which nursing diagnosis is appropriate for a woman who abuses anabolic steroids and has begun to eAperience side effects from the medication? a Ris: for $n;ur% related to decreased muscle coordination . b 5%pothermia related to decreased metabolic rate . c )hronic )onfusion related to sodium and water retention . d Disturbed Bod% $mage related to presence of facial hair . !"# D The use of anabolic steroids 0testosterone1 in women causes the ph%sical changes of growth of facial hair& male pattern baldness& deepened voice& and changes in menstrual patterns. The other nursing diagnoses would not be as applicable. D$(# )ognitive 'evel# )omprehension R*(# !+ for pplication and above

*lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.

Test Ban: ,B-# 'earning ,utcomes E& @ T,/# )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 2")# $ntegrated /rocess# !ursing /rocess 0 nal%sis1

.DF

1@. Which assessment finding in a postoperative client is suggestive of a histor% of substance abuse? a (requent vomiting after surger% . b 1@ mg morphine subcutaneous has not relieved pain . c $nabilit% to void . d $ncreased wound drainage . !"# B 2an% of the liver en<%mes that detoAif% abused substances also degrade morphine and other opioids. When people abuse drugs& even alcohol& the level of these degradative en<%mes increases& and opioid medications are degraded more rapidl%. This increases the clientHs tolerance to these medications& even though he or she ma% never have had an opioid previousl%. n increased amount of the drug is required to provide adequate pain relief. D$(# )ognitive 'evel# pplication R*(# !+ for pplication and above ,B-# 'earning ,utcome 3 T,/# )lient !eeds )ategor%# /s%chosocial $ntegrit% 0)hemical and ,ther Dependencies1 2")# $ntegrated /rocess# !ursing /rocess 0 ssessment1 18. The client has been transferred to the medicalDsurgical unit from the emergenc% department with an admitting diagnosis of Bbarbiturate overdose.C Which is the nurses priorit% intervention? a /erforming neurologic chec:s and assessing vital signs ever% E hours . b /roviding emotional support as needed . c Restricting visitors to immediate famil% onl% . d /alpating peripheral pulses ever% E hours . !"#

*lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.

Test Ban:

.D>

Barbiturates depress the central nervous s%stem and cause sedation& drowsiness& and a decrease in motor activit%. ,verdose s%mptoms include respirator% depression& which can best be determined b% assessing vital signs rather than b% carr%ing out the other options. /roviding emotional support& restricting visitors& and palpating peripheral pulses are all important interventions& but are not as significant as assessment of neurologic status and vital signs. D$(# ,B-# T,/# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning ,utcome F )lient !eeds )ategor%# /h%siological $ntegrit% 0Reduction of Ris: /otential1 $ntegrated /rocess# !ursing /rocess 0$mplementation1

M"#TI$#E 'ES$&NSE 1. What findings indicate potential substance abuse? (Select all that apply.) a )raves alcohol . b Drin:s one 13Do< beer each da% . c (ails to fiA meals at home . d (requent sic: da%s at wor: . e Irades at school drop . f 'oss of control . g /h%sical dependence . !"# & D& (& I lcohol abuse occurs when a person has problems with alcohol use. 5is or her use of alcohol interferes with the abilit% to carr% out activities of dail% living and to meet dail% responsibilities at home& wor:& school& or in the communit%. $t is not necessaril% related to the quantit% of alcohol consumed or the frequenc% of alcohol consumption. D$(# ,B-# T,/# 2")# )ognitive 'evel# )omprehension R*(# !+ for pplication and above 'earning ,utcomes @& 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1

3. Which criterion helps support a nursing diagnosis of substance abuse? (Select all that apply.) a The client uses the substance dail%. .

*lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.

Test Ban: b . c . d . The clientHs behavior when using the substance is not sociall% acceptable. The client continues to use the substance& even though he or she has eApressed a desire to stop. The client continues to use the substance& even though it causes chronic h%pertension.

.D16

!"# B& )& D number of criteria are used to ma:e a nursing diagnosis of substance abuse& including the following# 011 the client loses control of the drugJ 031 the client ta:es the drug& even though the drug has caused adverse conditions in his or her bod%J and 0=1 the client demonstrates cognitive& behavioral& and ph%sical disturbances. 2an% drugs& including substances that have potential for abuse& can be ta:en or used on a dail% basis for %ears without causing problems or being considered abused. D$(# ,B-# T,/# 2")# )ognitive 'evel# )omprehension R*(# p. F3 'earning ,utcome @ )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 nal%sis1

*lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.