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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.
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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.
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.
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 preparing to conduct an annual physical examination with a young adult patient who arrives in the clinic smelling of cigarette smoke and carrying a pack of cigarettes. Which action will the nurse plan to take?
- A. Urge the patient to quit smoking as soon as possible.
- B. Avoid confronting the patient about smoking at this time.
- C. Wait for the patient to start the discussion about quitting smoking.
- D. Explain that the 'cold turkey' method is most effective in stopping smoking.
Correct Answer: A
Rationale: Current national guidelines indicate that health care providers should urge patients who smoke to quit smoking at every encounter. The other actions will not help decrease the patient's health risks related to smoking.
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.