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The client who is experiencing alcohol withdrawal has a temperature of 100.6?°F, pulse of 112 beats/minute, and BP 180/102 mm Hg. What would the nurse anticipate doing first?
- A. Encourage the client to rest.
- B. Administer benzodiazepine as ordered.
- C. Monitor for any further changes.
- D. Provide emotional support.
Correct Answer: B
Rationale: The standardized symptom withdrawal flow sheet, Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) as well as the Rule of One Hundreds are indicators of escalating withdrawal. The rise in these vital signs suggests the need for sedative medication. Monitoring hourly vital signs and further changes would be appropriate. Rest and emotional support can be helpful.
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Many healthcare providers are screening applicants for tobacco use. Which is the primary reasoning for this new employment practice?
- A. Clients should not be exposed to the odor of tobacco.
- B. Nurses should be a role model to the clients served.
- C. Shooters take more breaks during the work day.
- D. Nicotine contributes to fatal illnesses.
Correct Answer: D
Rationale: According to the CDC (2020), smoking is responsible for 80% to 90% of deaths from lung cancer.
The nurse is discussing the effects of secondhand smoking with a group of new mothers. What information is most important for the nurse to include?
- A. Higher risk for fractures as they age
- B. Severe asthma attacks in children of smokers
- C. Greater risk for lung cancer
- D. Increased rate for coronary heart disease
Correct Answer: B
Rationale: Children with asthma have a greater frequency and more severe attacks when exposed to secondhand smoke. New mothers who smoked during pregnancy need to know their infants are at increased risk of sudden infant death syndrome. Higher incidence of lung cancer, fractures, and coronary heart disease are all consequences of smoking but not specific to new mothers or their infants.
Disulfiram is prescribed for a client recovering from alcohol dependency. What is the primary reason for prescribing this drug?
- A. Protects the liver from damage
- B. Prevents client from becoming intoxicated
- C. Makes consuming any type of alcohol unpleasant
- D. Prevents the client from drinking alcohol
Correct Answer: C
Rationale: The ingestion of alcohol while taking disulfiram will result in uncomfortable symptoms. Disulfiram does not protect the liver. Disulfiram deters drinking but does not prevent the ingestion of alcohol.
Which of the following assessment findings is observed in a client with opiate use?
- A. Diarrhea
- B. Pinpoint-sized pupils
- C. Weight gain
- D. Bulimia
Correct Answer: B
Rationale: The assessment findings in a client with opiate use are pinpoint-sized pupils, constipation, weight loss, and anorexia. Diarrhea, weight gain, and bulimia are not the assessment findings observed in a client with opiate dependency.
Which of the following refers to the reduction in a drug's effect that follows persistent use?
- A. Addiction
- B. Tolerance
- C. Withdrawal
- D. Dependence
Correct Answer: B
Rationale: Tolerance refers to the reduction in a drug's effect that follows persistent use. Addiction is drug-seeking behaviors that interfere with work, relationships, and normal activities. Withdrawal refers to the physical symptoms and craving for a drug that occur when a person abruptly stops using an abused substance. Dependence means that a person must take a drug to avoid withdrawal symptoms.