Nokea
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.
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The nurse is caring for a patient who takes methadone daily to prevent a relapse of heroin addiction and has been admitted for knee surgery. Which of the following actions should the nurse include in the plan of care to promote effective pain control postoperatively?
- A. Use a mixed opioid agonist-antagonist drug for pain relief.
- B. Administer opioid analgesics on a regularly scheduled basis.
- C. Avoid use of opioids and use alternatives such as NSAIDs.
- D. Give prescribed doses of opioid pain medication as needed for pain.
Correct Answer: B
Rationale: A patient addicted to opioids should receive them on an around-the-clock basis to prevent withdrawal. Normal opioid doses given on a PRN basis will not effectively relieve pain in a patient who has developed tolerance. NSAIDs may be used as adjuncts, but they should not be the primary analgesic used. Mixed opioid agonist-antagonist drugs can precipitate withdrawal in patients who have tolerance to opioids.
The nurse is assessing a patient who has a history of alcohol use. Which of the following assessment data should the nurse expect?
- A. Low blood pressure
- B. Decreased heart rate
- C. Elevated temperature
- D. Abdominal tenderness
Correct Answer: D
Rationale: Abdominal pain associated with gastrointestinal tract and liver dysfunction is common in patients with persistent alcohol use. The other problems are not typically associated with alcohol use.
The nurse is caring for a patient who has a history of ongoing opioid use and has been hospitalized for surgery. After a visit by a friend, the nurse assesses that the patient is unresponsive with pinpoint pupils. Which of these prescribed medications will the nurse administer immediately?
- A. Naloxone
- B. Diazepam
- C. Clonidine
- D. Methadone
Correct Answer: A
Rationale: The patient's assessment indicates an opioid overdose, and naloxone should be given to prevent respiratory arrest. The other medications may be used to decrease symptoms associated with opioid withdrawal but would not be appropriate for an overdose.
The nurse is caring for a patient with alcohol dependence who has been admitted to the hospital with chest pain. Twenty-four hours after admission, the patient becomes very tremulous and anxious. Which of the following actions should the nurse implement?
- A. Insert an IV line and infuse fluids.
- B. Promote oral intake to 3000 mL/day.
- C. Provide a quiet, well-lit environment.
- D. Administer opioids to provide sedation.
Correct Answer: C
Rationale: The patient's symptoms suggest acute alcohol withdrawal, and a quiet and well-lit environment will help to 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.
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.