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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.
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A young adult patient arrives at the emergency department with severe chest pain and agitation. Which of the following actions should the nurse take first?
- A. Give the PRN naloxone IV.
- B. Ask about any use of stimulant drugs.
- C. Assess orientation to person, place, and time.
- D. Check blood pressure, pulse, respirations, and oxygen saturation.
Correct Answer: D
Rationale: The patient has symptoms consistent with the use of cocaine or amphetamines and is at risk for dysrhythmias, hypotension, heart failure, myocardial infarction, and cardiomyopathy. The nurse also will ask about drug use and assess orientation, but these are not the priority actions. Naloxone may be given if the patient develops symptoms of CNS depression, but this patient's current symptoms indicate stimulant 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.
A patient with a history of heavy alcohol use is seen at the clinic with acute gastritis. Which statement by the patient indicates that the patient is in the contemplation stage of change?
- A. I am older and wiser now, and I know I can change my drinking behaviour.
- B. Alcohol has never bothered my stomach. I think it's likely that I have the flu.
- C. I think my drinking is affecting my stomach, but maybe some drugs will help.
- D. People say that I drink too much, but I really feel pretty good most of the time.
Correct Answer: C
Rationale: This statement indicates that the patient recognizes that alcohol use is the reason for the gastritis but is not yet willing to make a change. The statement 'I am older and wiser now, and I know I can change my drinking behaviour' indicates a patient at the preparation stage. The remaining two statements are typical of the precontemplation stage.
During physical assessment of a patient who has sinus headaches, the nurse finds nasal sores and necrosis of the nasal septum. Patient use of which of the following substances should the nurse include in the assessment?
- A. Heroin
- B. Cocaine
- C. Tobacco
- D. Marijuana
Correct Answer: B
Rationale: When cocaine is inhaled, it causes ischemia of the nasal septum, leading to nasal sores and necrosis. These symptoms are not associated with the use of heroin, tobacco, or marijuana.
The nurse is caring for a patient admitted to hospital with chest pain who is a pack-a-day smoker and tells the nurse, 'I am just not ready to quit smoking yet.' Which of the following responses is the most appropriate?
- A. This would be a really good time to quit.
- B. Your smoking is the cause of your chest pain.
- C. Do you think that smoking has caused any health problems?
- D. Are you familiar with the various nicotine replacement options?
Correct Answer: C
Rationale: The patient is in the precontemplation stage of change, and the nurse's role is to assist the patient in identifying motivators to quitting. The current Clinical Practice Guidelines indicate that the nurse should ask the patient to identify any negative consequences from smoking. The responses 'This would be a really good time to quit.' and 'Your smoking is the cause of your chest pain.' express judgmental feelings by the nurse and are not likely to motivate the patient. Providing information about the various nicotine replacement options would be appropriate for a patient who has expressed a desire to quit smoking.