Nokea
A patient who is alcohol-intoxicated must undergo emergency surgery for abdominal trauma. Which of the following should the nurse anticipate when caring for the patient in the perioperative period?
- A. An increased dose of the general anaesthetic medication
- B. Frequent monitoring for bleeding and respiratory complications
- C. Development of withdrawal symptoms within a few hours after surgery
- D. Stimulation every hour to prevent prolonged postoperative sedation
Correct Answer: B
Rationale: 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.
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A patient who is disoriented and agitated comes to the emergency department after using methamphetamine. Vital signs are blood pressure 162/98, heart rate 142 and irregular, and respirations 32. Which of the following actions is priority for the nurse to implement?
- A. Reorient the patient at frequent intervals.
- B. Monitor the patient's ECG and vital signs.
- C. Keep the patient in a quiet and darkened room.
- D. Obtain a health history including prior drug use.
Correct Answer: B
Rationale: The priority is to ensure physiological 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.
An older adult has been taking alprazolam and calls the clinic asking for a refill of the prescription 1 month before it should need to be refilled. Which of the following responses is most appropriate?
- A. The prescription cannot be refilled for another month. What happened to all of your pills?
- B. Do you have any muscle cramps or tremors if you don't 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 alprazolam. Let's make an appointment for you to see the doctor today.
Correct Answer: D
Rationale: The patient should be assessed for problems that are causing overuse of the alprazolam, 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.
The nurse is caring for a patient who smokes a pack of cigarettes daily and has been admitted to the hospital for surgery. In anticipation of nicotine withdrawal, which of the following goals should the nurse include when planning postoperative care?
- A. Improve sleep.
- B. Enhance appetite.
- C. Decrease diarrhea.
- D. Prevent sore throat.
Correct Answer: A
Rationale: Insomnia is a characteristic of nicotine withdrawal. Diarrhea, sore throat, and anorexia are not symptoms associated with nicotine withdrawal.
Suicide is an overdose effect of which of the following substances?
- A. Alcohol
- B. Inhalants
- C. Opioids
- D. Hallucinogens
Correct Answer: B
Rationale: Suicide is an overdose effect of the use of inhalants. Suicide has not been identified as an overdose effect of alcohol, opioids, or hallucinogens.
The nurse is caring for a young adult patient who has inhaled cocaine and has been admitted to the emergency department with palpitations and shortness of breath. Which of the following 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/hour.
Correct Answer: B
Rationale: 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.