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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.
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The nurse is caring for a patient who is admitted to the hospital for treatment of an abscess on the left thigh and the patient tells the nurse that they use fentanyl illegally. Which of the following symptoms should the nurse anticipate assessing?
- A. Nausea and diarrhea
- B. Tremors and seizures
- C. Lethargy and disorientation
- D. Delusions and hallucinations
Correct Answer: A
Rationale: Symptoms of opioid withdrawal include gastrointestinal symptoms such as nausea, vomiting, and diarrhea, similar to a bout of the stomach flu. The other symptoms are seen during withdrawal from other substances such as alcohol, sedative-hypnotics, or stimulants.
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 young adult who has a cocaine addiction. Which of the following routes of cocaine administration results in the fastest absorption and the highest 'rush'?
- A. Smoking
- B. Buccal
- C. Oral
- D. Intranasal
Correct Answer: A
Rationale: Smoking and intravenous (IV) methods result in the fastest absorption and the highest 'rush'.
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.
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.