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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.
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All the following medications are ordered for a patient admitted with a blood alcohol concentration of 0.8 mg%. Which of the following should the nurse administer first?
- A. Thiamine 100 mg IV daily
- B. Lorazepam 1 mg SL as needed
- C. Folic acid 0.4 mg PO daily
- D. Dextrose 5% in water over 8 hours
Correct Answer: A
Rationale: Thiamine is given to all patients with alcohol intoxication to prevent Wernicke's encephalopathy. Because Wernicke's encephalopathy can be precipitated by the administration of glucose solutions, the thiamine should be given before (or concurrently with) the 5% dextrose solution. Lorazepam would not be appropriate while the patient still has an elevated blood alcohol concentration (BAC). Folic acid also may be administered but is not as important as thiamine.
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.
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.
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.
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.