Ignatavicius: Medical-Surgical Nursing, 6th EditionChapter 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 colleague’s 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. $t is not the nurse’s responsibilit% to document a colleague’s actions& nor should the nurse confront the colleague. 'egall%& there is no place for the nurse to document the colleague’s actions. The nurse ma% not be equipped to handle a confrontation of this nature. This is better left to a supervisor or someone in an authorit% position who has the resources to assist the nurse. D$(# ,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 . !"# ) *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc. 6+E6 mm+hg . The nasal mucous membranes ma% be inflamed or congested& but this does not require priorit% assessment because it does not . D$(# . b . c /ulse rate& 166 beats+min . !"# 7se of the accessor% muscles to breath indicates serious respirator% insufficienc%. D$(# . Which assessment finding in a client who has ta:en an overdose of stimulants requires the nurse’s immediate action? a 7se of accessor% muscles while breathing ./# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning . The client ma% need intravenous fluids to be monitored.B-# T. c *Atreme feeling of being BtiredC . d /ulse rate& @6 beats+min .utcome 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 =.>? )1 . . b Blood pressure& .B-# T. subnormal temperature& eAtreme fatigue& and constant tal:ing are all abnormal s%mptoms but are not lifeDthreatening. Which assessment finding in a client eAperiencing opiate intoAication requires immediate action? a Blood pressure& 1=6+>6 mm+hg . d )onstant tal:ing .Test Ban: .8? ( 0=@. *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.eopardi<e the client’s immediate health./# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning .D3 Because cocaine is a cardiac stimulant& observation during overdose or withdrawal includes frequent monitoring of vital signs and cardiac assessments.ral temperature >8. 2anic episodes are not usuall% a concern& but depression ma% result during the withdrawal period.utcome 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 E. The nurse is attempting to promote a safe environment for a client who has a histor% of methamphetamine use./# 2")# )ognitive 'evel# )omprehension R*(# p. The client with a closed head in. d /laces the client on suicide watch and documents all findings .f the s%mptoms listed& onl% decreased blood pressure would be the earliest indication of opiate intoAication. Which client will the nurse assess for the possibilit% of opiate addiction? a middleDaged woman who is eAperiencing cancer of the th%roid .Test Ban: . D$(# . !"# B *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.D= !"# B . b n older man who has eAperienced a m%ocardial infarction .ur% .B-# T. >6 'earning .ur% will not be given opiates because of their sedating properties. nurses’ presence c Discusses the need to participate in counseling sessions on discharge ./# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning . . b Reorients the client frequentl% to his surroundings and reassures him of the .utcomes =& @ )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 8. c %oung woman who is eAperiencing sic:le cell anemia . d %oung man who has eAperienced a closed head in. !"# ) "ic:le cell anemia places the client at high ris: for opiate addiction because of the painful nature of the illness. D$(# .utcome @ )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 @. The client with cancer of the th%roid and m%ocardial infarction should not require opiates. What is the nurse’s priorit% action? a rranges for the client to be medicated with sedatives during his hospitali<ation .B-# T. There are man% abused substances. .DE The client who has been using methamphetamine will tend to be disoriented.B-# T. Wh% is it important for the nursing supervisor to identif% clients who ma% eAperience withdrawal in the clinical setting? a To prepare staff so that the% can protect themselves . c "ubstance abuse is primaril% locali<ed to those in the lower classes./# 2")# )ognitive 'evel# )omprehension R*(# !+ for pplication and above 'earning . c To prepare the staff for manipulative behavior b% the client . d )ocaine is the most commonl% abused substance.Test Ban: . . D$(# .utcome 3 )lient !eeds )ategor%# /s%chosocial $ntegrit% 0Therapeutic *nvironment1 $ntegrated /rocess# !ursing /rocess 0$mplementation1 . The client will probabl% not be medicated with sedatives because of his current chemical dependenc%. . !"# B *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc. . !"# B The students should understand that chemical abuse can be . 5e will not necessaril% be suicidal and probabl% will not benefit from counseling immediatel% on discharge& because there is no evidence that he has undergone treatment. D$(# . . 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%. d To inform authorities about illegal behavior .utcome 1 )lient !eeds )ategor%# /h%siological $ntegrit% 0Basic )are and )omfort1 $ntegrated /rocess# Teaching+'earning F.ust as detrimental to a client as chemical dependenc%.. b To allow for additional care and staffing .ust as detrimental as chemical dependenc%.B-# T. b )hemical abuse can be . "ubstance abuse is a universal societal issue./# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning . The% are habit forming. These drugs do not have sedative properties. !"# ) "timulants increase metabolism& and are often used to control weight. lso& stimulants are D* D controlled./# 2")# )ognitive 'evel# )omprehension R*(# p.utcome > T. b The% have sedating qualities. The nurse should be prepared to teach the client about which drug categor% that has potential for abuse in this situation? a mphetamines . Thus& it is the onl% drug of the ones listed that has the potential for abuse in this situation. c Barbiturates . What propert% of stimulants increases their potential for abuse? a The% are not habit forming. . . The client has narcoleps%. .B-# 'earning . *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc. c The% increase general metabolism./# )lient !eeds )ategor%# "afe and *ffective )are *nvironment 0"afet% and $nfection )ontrol1 2")# $ntegrated /rocess# !ursing /rocess 0 ssessment1 >.D@ The client who is eAperiencing withdrawal will require additional care and consequentl% will need more staff members involved in his care.B-# T. !"# legitimate medical use of amphetamines is the treatment of narcoleps%. .utcome E )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 16. F@ 'earning . . D$(# )ognitive 'evel# )omprehension R*(# p. "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.Test Ban: . FE . D$(# . d Their use is not controlled b% the Drug Enforcement Administration 0D* 1. b Ben<odia<epines . d /henc%clidines . d (lushing .B-# T. b Respirator% depression .Test Ban: . Which clinical manifestation causes the nurse to suspect cocaine abuse rather than barbiturate abuse in a client? a "hallow respirations .utcomes @& 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 13. c Tach%cardia . !"# . . Respirator% depression does not occur in opioid overdose& nor do h%porefleAive deep tendon refleAes./# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning . d *vidence that the client has vomited . What s%mptom in a client with head trauma assists the nurse in ma:ing a diagnosis of suspected opioid overdose? a /inpoint pupils . D$(# . b /upillar% constriction . 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.B-# T.utcome 3 )lient !eeds )ategor%# /s%chosocial $ntegrit% 0Behavioral $nterventions1 $ntegrated /rocess# Teaching+'earning 11. !"# ) The s%stemic effects of cocaine include peripheral vasoconstriction& tach%cardia& h%pertension& chills& fever& pupillar% dilation& and paranoia./# 2")# )ognitive 'evel# Gnowledge R*(# p. "hallow respirations& constriction of the pupils& and flushing are not characteristics of cocaine abuse. F@ 'earning .D8 D$(# . c 5%porefleAive deep tendon refleAes . There will not necessaril% be vomiting with opioid overdose.pioid ingestion causes pupillar% constriction. d The client drin:s alcohol dail%.or distinction between abusing alcohol and being addicted to alcohol is the presence of withdrawal s%mptoms when the client is not drin:ing. c )hronic )onfusion related to sodium and water retention . 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. 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. D$(# .B-# 'earning . !one of the other s%mptoms are as indicative of alcohol addiction./# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning . !"# 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.Test Ban: . b The client has been arrested once for driving under the influence of alcohol. . !"# ) The ma. d Disturbed Bod% $mage related to presence of facial hair . The other nursing diagnoses would not be as applicable. .utcome @ T.ur% related to decreased muscle coordination . . D$(# )ognitive 'evel# )omprehension R*(# !+ for pplication and above *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.utcome @ )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 1E.D. 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. b 5%pothermia related to decreased metabolic rate .B-# T. c The client uses alcohol to stop his or her hands from sha:ing. . ./# )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 2")# $ntegrated /rocess# !ursing /rocess 0 ssessment1 1=. Which assessment finding in a postoperative client is suggestive of a histor% of substance abuse? a (requent vomiting after surger% . d /alpating peripheral pulses ever% E hours ./# )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 2")# $ntegrated /rocess# !ursing /rocess 0 nal%sis1 .utcomes E& @ T. b /roviding emotional support as needed .Test Ban: . D$(# )ognitive 'evel# pplication R*(# !+ for pplication and above . d $ncreased wound drainage .B-# 'earning . !"# B 2an% of the liver en<%mes that detoAif% abused substances also degrade morphine and other opioids.utcome 3 T. This increases the clientHs tolerance to these medications& even though he or she ma% never have had an opioid previousl%.DF 1@. c $nabilit% to void ./# )lient !eeds )ategor%# /s%chosocial $ntegrit% 0)hemical and .ther Dependencies1 2")# $ntegrated /rocess# !ursing /rocess 0 ssessment1 18.C Which is the nurse’s priorit% intervention? a /erforming neurologic chec:s and assessing vital signs ever% E hours . The client has been transferred to the medicalDsurgical unit from the emergenc% department with an admitting diagnosis of Bbarbiturate overdose. When people abuse drugs& even alcohol& the level of these degradative en<%mes increases& and opioid medications are degraded more rapidl%. !"# *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc. .B-# 'earning . n increased amount of the drug is required to provide adequate pain relief. c Restricting visitors to immediate famil% onl% . b 1@ mg morphine subcutaneous has not relieved pain . *lsevier items and derived items 9 3616& 3668& 3663 b% "aunders& an imprint of *lsevier $nc.B-# T. d (requent sic: da%s at wor: .) a )raves alcohol .verdose s%mptoms include respirator% depression& which can best be determined b% assessing vital signs rather than b% carr%ing out the other options. .Test Ban: . Which criterion helps support a nursing diagnosis of substance abuse? (Select all that apply. 5is or her use of alcohol interferes with the abilit% to carr% out activities of dail% living and to meet dail% responsibilities at home& wor:& school& or in the communit%.B-# T. g /h%sical dependence . /roviding emotional support& restricting visitors& and palpating peripheral pulses are all important interventions& but are not as significant as assessment of neurologic status and vital signs. . D$(# . f 'oss of control ./# 2")# )ognitive 'evel# pplication R*(# !+ for pplication and above 'earning . D$(# .) a The client uses the substance dail%.utcome F )lient !eeds )ategor%# /h%siological $ntegrit% 0Reduction of Ris: /otential1 $ntegrated /rocess# !ursing /rocess 0$mplementation1 M"#TI$#E 'ES$&NSE 1. b Drin:s one 13Do< beer each da% . $t is not necessaril% related to the quantit% of alcohol consumed or the frequenc% of alcohol consumption.utcomes @& 8 )lient !eeds )ategor%# /h%siological $ntegrit% 0/h%siological daptation1 $ntegrated /rocess# !ursing /rocess 0 ssessment1 3. !"# & D& (& I lcohol abuse occurs when a person has problems with alcohol use./# 2")# )ognitive 'evel# )omprehension R*(# !+ for pplication and above 'earning .D> Barbiturates depress the central nervous s%stem and cause sedation& drowsiness& and a decrease in motor activit%. . e Irades at school drop . c (ails to fiA meals at home . What findings indicate potential substance abuse? (Select all that apply. The client continues to use the substance& even though it causes chronic h%pertension.B-# T. 2an% drugs& including substances that have potential for abuse& can be ta:en or used on a dail% basis for %ears without causing problems or being considered abused. d . c .D16 !"# B& )& D number of criteria are used to ma:e a nursing diagnosis of substance abuse& including the following# 011 the client loses control of the drugJ 031 the client ta:es the drug& even though the drug has caused adverse conditions in his or her bod%J and 0=1 the client demonstrates cognitive& behavioral& and ph%sical disturbances. D$(# .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. The client continues to use the substance& even though he or she has eApressed a desire to stop. .Test Ban: b . ./# 2")# )ognitive 'evel# )omprehension R*(# p. F3 'earning . The clientHs behavior when using the substance is not sociall% acceptable.