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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.
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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.
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.
The nurse is caring for a patient admitted to the hospital after an automobile accident who has a blood alcohol concentration (BAC) of 48 mmol/L (0.22 mg%). The patient is alert and does not appear highly intoxicated. Which of the following nursing actions should the nurse implement?
- A. Maintain the patient on NPO status.
- B. Avoid the use of intravenous (IV) fluids.
- C. Administer acetaminophen for headache.
- D. Monitor frequently for anxiety, hyper-reflexia, and sweating.
Correct Answer: D
Rationale: The patient's assessment data indicate physiological dependence on alcohol, and the patient is likely to develop acute withdrawal such as anxiety, hyper-reflexia, and sweating, which could be life-threatening. Acetaminophen is not recommended because it is metabolized by the liver. IV thiamine and IV glucose solutions usually are given to intoxicated patients to prevent Wernicke's encephalopathy, and there is no indication that the patient should be NPO.
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.
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.