a. Drowsiness b. Nasal damage c. Constricted pupils d. Sexual dysfunction e. Increase in appetite
f. Tachycardia with hypertension
7. Which substance, when used by the patient with SUD, can cause euphoria, drowsiness, decreased respiratory rate, and slurred speech?
a. Opioids b. Alcohol c. Cannabis d. Depressants
8. Which manifestation(s) is (are) experienced by a patient when withdrawing from sedative- hypnotic addiction (select all that apply)?
a. Seizures b. Violence
c. Suicidal thoughts d. Tremors and chills
e. Sweating, nausea, and cramps
9. When the nurse is encouraging a woman who smokes packs of cigarettes per day to quit with the use of nicotine replacement therapy, the woman asks how the nicotine in a patch or gum differs from the nicotine she gets from cigarettes. What should the nurse explain about nicotine replacement?
a. It includes a substance that eventually creates an aversion to nicotine.
b. It provides a noncarcinogenic nicotine, unlike the nicotine in cigarettes.
c. It prevents the weight gain that is a concern to women who stop smoking.
d. It eliminates the thousands of toxic chemicals that are inhaled with smoking.
10. Match the following drugs used for treatment of cocaine toxicity with their specific uses (answers may be used more than once).
_____ a. haloperidol (Haldol) 1. Tachycardia 2. Hallucinations 3. Dysrhythmias 4. Seizures _____ b. IV lidocaine
_____ c. IV diazepam (Valium) _____ d. propranolol (Inderal) _____ e. bretylium _____ f. IV lorazepam (Ativan) _____ g. procainamide
11. A patient who is a heavy caffeine user has been NPO all day in preparation for a late afternoon surgery. The nurse monitors the patient for effects of caffeine withdrawal that may include a. headache.
b. nervousness.
c. mild tremors.
d. shortness of breath.
12. The third day after an alcohol-dependent patient was admitted to the hospital for acute pancreatitis, the nurse determines that the patient is experiencing alcohol withdrawal delirium.
What are the signs of withdrawal delirium on which the nurse bases this judgment (select all that apply)?
a. Apathy b. Seizures c. Disorientation d. Severe depression
e. Cardiovascular collapse
f. Visual and auditory hallucinations
13. Which question is the best approach by the nurse to assess a newly admitted patient's use of addictive drugs?
a. “How do you relieve your stress?”
b. “You don't use any illegal drugs, do you?”
c. “Which alcohol or recreational drugs do you use?”
d. “Do you have any addictions we should know about to prevent complications?”
14. To stop the behavior that leads to the most preventable cause of death in the United States, the nurse should support programs that
a. prohibit alcohol use in public places.
b. prevent tobacco use in children and adolescents.
c. motivate individuals to enter addiction treatment.
d. recognize addictions as illnesses rather than crimes.
15. A young woman is brought to the emergency department by police who found her lying on a downtown sidewalk. The initial nursing assessment finds that she is unresponsive and has a weak pulse of 112; shallow respirations of 8 breaths/minute; and cold, clammy skin. Identify the two medications that would most likely be given immediately to this patient and explain why they would be given.
a.
b.
16. Priority Decision: A patient with a history of alcohol use disorder (AUD) is admitted to the hospital following an automobile accident. What is most important for the nurse to assess to plan care for the patient?
a. When the patient last had alcohol intake b. How much alcohol has recently been used c. What type of alcohol has recently been ingested d. The patient's current blood alcohol concentration
17. Priority Decision: A patient in alcohol withdrawal has a nursing diagnosis of ineffective protection related to sensorimotor deficits, seizure activity, and confusion. Which nursing intervention is most important for the patient?
a. Provide a darkened, quiet environment free from external stimuli.
b. Force fluids to assist in diluting the alcohol concentration in the blood.
c. Monitor vital signs frequently to detect an extreme autonomic nervous system response.
d. Use restraints as necessary to prevent the patient from reacting violently to hallucinations.
18. What is an important postoperative intervention indicated for the patient with AUD who is alcohol intoxicated and is undergoing emergency surgery?
a. Monitor weight because of malnutrition.
b. Give an emergency dose of IV magnesium.
c. Decrease pain medication to prevent cross-tolerance to opiates.
d. Closely monitor for signs of withdrawal and respiratory and cardiac problems.
19. Priority Decision: During admission to the emergency department, a patient with chronic alcoholism is intoxicated and very disoriented and confused. Which drug will the nurse administer first?
a. IV thiamine
b. IV benzodiazepines c. IV haloperidol (Haldol) d. IV naloxone in normal saline
20. The nurse is working with a patient at the clinic who does not want to quit smoking even though he is having trouble breathing at times and has a frequent cough. Which clinical practice
guideline strategies should the nurse use with this patient?
a. Cost, cough, cleanliness, Chantix b. Ask, advise, assess, assist, arrange c. Deduce, describe, decide, deadline
d. Relevance, risks, rewards, roadblocks, repetition
21. When assessing an older patient for substance abuse, the nurse specifically asks the patient about the use of alcohol and which other types of medications?
a. Opioids
b. Sedative-hypnotics
c. Central nervous system stimulants
d. Prescription and over-the-counter medications
Case Study
Cocaine Toxicity
(©monkeybusinessimages/iStock/Thinkstock)
Patient Profile
N.C. is a 28-yr-old man who was admitted to the emergency department with chest pain, tachycardia, dizziness, nausea, and severe migraine-like headache.
Subjective Data
• Thinks he is having a heart attack
• Admits he was at a party earlier in the evening drinking alcohol, smoking pot, and snorting cocaine
• States he became irritable and restless
• States he has experienced an increased need for cocaine in the past few months Objective Data
• Appears extremely nervous and irritable
• Appears pale and diaphoretic
• Has tremors
• BP 210/110, HR 100 bpm, RR 30 Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What other information is needed to assess N.C.'s condition?
2. How should questions related to these areas be addressed?
3. What other clues should the nurse be alert for in assessing N.C.'s drug use?
4. Safety: What emergency conditions must be carefully monitored?
6. Patient-Centered Care: What is the best way to approach N.C. to engage him in a treatment program?
7. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?
S E C T I O N 2
Pathophysiologic Mechanisms of Disease
OUTLINE
11 Inflammation and Wound Healing 12 Genetics and Genomics
13 Altered Immune Responses and Transplantation 14 Infection and Human Immunodeficiency Virus Infection 15 Cancer
16 Fluid, Electrolyte, and Acid-Base Imbalances