Question 1

Which assessment finding would alert the nurse to ask the patient about alcohol use?

Accepted Answer

A)  Low blood pressure 
B)  Decreased heart rate 
C)  Elevated temperature 
D)  Abdominal tenderness 
A)  Low blood pressure 
B)  Decreased heart rate 
C)  Elevated temperature 
D)  Abdominal tenderness D

Question 2

A patient is admitted to the emergency department for treatment of a possible opioid overdose.Rank the nursing activities in the correct order from first activity to last activity.(Put a comma and a space between each answer choice [A,B,C,D,E]).
A) Initiate IV access.
B) Take a health history.
C) Obtain a toxicology screen.
D) Administer naloxone (Narcan).
E) Provide respiratory support with a bag-valve mask.

Accepted Answer

E,A,D,C,B
Maintenance of the airway is the first priority for patients with possible depressant overdose.Opioid antagonists are given before toxicology testing is done because reversal of the opioid will prevent respiratory arrest.However,this will require IV access.The toxicology report will help guide further treatment for possible multiple substance ingestions.The health history will guide care after the initial emergency treatment phase.

Question 3

A patient who has a history of ongoing opioid abuse is hospitalized for surgery.After a visit by a friend,the nurse finds that the patient is unresponsive with pinpoint pupils.Which prescribed medication will the nurse administer immediately?

Accepted Answer

A)  Naloxone (Narcan) 
B)  Diazepam (Valium) 
C)  Clonidine (Catapres) 
D)  Methadone (Dolophine) 
A)  Naloxone (Narcan) 
B)  Diazepam (Valium) 
C)  Clonidine (Catapres) 
D)  Methadone (Dolophine) A

Question 4

The nurse cares for an agitated patient who was admitted to the emergency department after taking a hallucinogenic drug and attempting to jump from a third-story window.Which nursing diagnosis should the nurse assign as the highest priority?

Accepted Answer

A)  Risk for injury related to altered perception 
B)  Ineffective health maintenance related to drug use 
C)  Powerlessness related to loss of behavioral control 
D)  Ineffective denial related to lack of control of life situation 
A)  Risk for injury related to altered perception 
B)  Ineffective health maintenance related to drug use 
C)  Powerlessness related to loss of behavioral control 
D)  Ineffective denial related to lack of control of life situation

Question 5

After receiving change-of-shift report on four patients who are undergoing substance abuse treatment,which patient will the nurse assess first?

Accepted Answer

A)  A patient who has just arrived for alcohol abuse treatment and states that the last drink was 3 hours ago 
B)  A patient who is agitated and experiencing nausea, occasional vomiting, and diarrhea while withdrawing from heroin 
C)  A patient who has tremors secondary to benzodiazepine withdrawal and whose last benzodiazepine use was 4 days ago 
D)  A patient who is being treated for cocaine addiction and is irritable and disoriented, with a pulse rate of 112 beats/minute 
A)  A patient who has just arrived for alcohol abuse treatment and states that the last drink was 3 hours ago 
B)  A patient who is agitated and experiencing nausea, occasional vomiting, and diarrhea while withdrawing from heroin 
C)  A patient who has tremors secondary to benzodiazepine withdrawal and whose last benzodiazepine use was 4 days ago 
D)  A patient who is being treated for cocaine addiction and is irritable and disoriented, with a pulse rate of 112 beats/minute

Question 6

A patient presents to the emergency department with a blood alcohol concentration (BAC)of 0.18%.After reviewing the medication orders,which drug should the nurse administer first?

Accepted Answer

A)  Thiamine (vitamin B1) 100 mg daily 
B)  Lorazepam (Ativan) 1 mg as needed 
C)  Folic acid (Vitamin B9) 0.4 mg daily 
D)  Dextrose 5% in 0.45 saline at 125 mL/hr 
A)  Thiamine (vitamin B1) 100 mg daily 
B)  Lorazepam (Ativan) 1 mg as needed 
C)  Folic acid (Vitamin B9) 0.4 mg daily 
D)  Dextrose 5% in 0.45 saline at 125 mL/hr

Question 7

A patient with alcohol dependence is admitted to the hospital with back pain following a fall.Twenty-four hours after admission,the patient becomes tremulous and anxious.Which action by the nurse is most appropriate?

Accepted Answer

A)  Insert an IV line and infuse fluids. 
B)  Promote oral intake to 3000 mL/day. 
C)  Provide a quiet, well-lit environment. 
D)  Administer opioids to provide sedation. 
A)  Insert an IV line and infuse fluids. 
B)  Promote oral intake to 3000 mL/day. 
C)  Provide a quiet, well-lit environment. 
D)  Administer opioids to provide sedation.

Question 8

A disoriented and agitated patient comes to the emergency department and admits using methamphetamine.Vital signs are blood pressure 162/98,heart rate 142 and irregular,and respirations 32.Which action by the nurse is most important?

Accepted Answer

A)  Reorient the patient at frequent intervals. 
B)  Monitor the patient's electrocardiogram (ECG) and vital signs. 
C)  Keep the patient in a quiet and darkened room. 
D)  Obtain a health history including prior drug use. 
A)  Reorient the patient at frequent intervals. 
B)  Monitor the patient's electrocardiogram (ECG) and vital signs. 
C)  Keep the patient in a quiet and darkened room. 
D)  Obtain a health history including prior drug use.

Question 9

An older adult patient who has been taking alprazolam (Xanax)calls the clinic asking for a refill of the prescription 1 month before the alprazolam should need to be refilled.Which response by the nurse is best?

Accepted Answer

A)  "The prescription cannot be refilled for another month. What happened to all of your pills?" 
B)  "Do you have any muscle cramps and tremors if you don't take the medication frequently?" 
C)  "I am concerned that you may be overusing the Xanax. Let's make an appointment for you to see the doctor." 
D)  "I will ask the doctor to prescribe a few more pills, but you will not be able to get any more for another month." 
A)  "The prescription cannot be refilled for another month. What happened to all of your pills?" 
B)  "Do you have any muscle cramps and tremors if you don't take the medication frequently?" 
C)  "I am concerned that you may be overusing the Xanax. Let's make an appointment for you to see the doctor." 
D)  "I will ask the doctor to prescribe a few more pills, but you will not be able to get any more for another month."

Question 10

After the nurse receives report,which patient should the nurse assess first?

Accepted Answer

A)  Patient who has a respiratory rate of 14 after overdosing on oxycodone (OxyContin) 
B)  Patient admitted with cocaine use who has an irregular heart rate of 142 beats/minute 
C)  Patient who is experiencing hallucinations and extreme anxiety after the use of marijuana 
D)  Patient with a history of daily alcohol use who is complaining of insomnia and diaphoresis 
A)  Patient who has a respiratory rate of 14 after overdosing on oxycodone (OxyContin) 
B)  Patient admitted with cocaine use who has an irregular heart rate of 142 beats/minute 
C)  Patient who is experiencing hallucinations and extreme anxiety after the use of marijuana 
D)  Patient with a history of daily alcohol use who is complaining of insomnia and diaphoresis

Question 11

During physical assessment of a patient who has frequent nosebleeds,the nurse finds nasal sores and necrosis of the nasal septum.The nurse should ask the patient specifically about the use of which drug?

Accepted Answer

A)  Heroin 
B)  Cocaine 
C)  Tobacco 
D)  Marijuana 
A)  Heroin 
B)  Cocaine 
C)  Tobacco 
D)  Marijuana

Question 12

A patient admitted to the hospital after an automobile accident is alert and does not appear to be highly intoxicated.The blood alcohol concentration (BAC)is 110 mg/dL (0.11 mg%).Which action by the nurse is most appropriate?

Accepted Answer

A)  Avoid the use of IV fluids. 
B)  Maintain the patient on NPO status. 
C)  Administer acetaminophen for headache. 
D)  Monitor frequently for anxiety, hyperreflexia, and sweating. 
A)  Avoid the use of IV fluids. 
B)  Maintain the patient on NPO status. 
C)  Administer acetaminophen for headache. 
D)  Monitor frequently for anxiety, hyperreflexia, and sweating.

Question 13

The nurse plans postoperative care for a patient who smokes a pack of cigarettes daily.Which goal should the nurse include in the plan of care for this patient?

Accepted Answer

A)  Improve sleep 
B)  Enhance appetite 
C)  Decrease diarrhea 
D)  Prevent sore throat 
A)  Improve sleep 
B)  Enhance appetite 
C)  Decrease diarrhea 
D)  Prevent sore throat

Question 14

A patient who smokes a pack of cigarettes daily develops tachycardia and irritability on the second day after abdominal surgery.What is the nurse's best action at this time?

Accepted Answer

A)  Escort the patient outside where smoking is allowed. 
B)  Move the patient to a private room and allow smoking. 
C)  Tell the patient that this is a good time to quit smoking. 
D)  Request a prescription for a nicotine replacement agent. 
A)  Escort the patient outside where smoking is allowed. 
B)  Move the patient to a private room and allow smoking. 
C)  Tell the patient that this is a good time to quit smoking. 
D)  Request a prescription for a nicotine replacement agent.

Question 15

A patient with a history of heavy alcohol use is diagnosed with acute gastritis.Which statement by the patient indicates a willingness to stop alcohol use?

Accepted Answer

A)  "I am older and wiser now, and I think I can change my drinking behavior." 
B)  "Alcohol has never bothered my stomach before. I think I likely have the flu." 
C)  "My drinking is affecting my stomach, but some drugs will help me feel better." 
D)  "People say that I drink too much, but I really feel pretty good most of the time." 
A)  "I am older and wiser now, and I think I can change my drinking behavior." 
B)  "Alcohol has never bothered my stomach before. I think I likely have the flu." 
C)  "My drinking is affecting my stomach, but some drugs will help me feel better." 
D)  "People say that I drink too much, but I really feel pretty good most of the time."

Question 16

An alcohol-intoxicated patient with a penetrating wound to the abdomen is undergoing emergency surgery.What will the nurse expect the patient to need during the perioperative period?

Accepted Answer

A)  An increased dose of the general anesthetic medication 
B)  Frequent monitoring for bleeding and respiratory complications 
C)  Interventions to prevent withdrawal symptoms within a few hours 
D)  Stimulation every hour to prevent prolonged postoperative sedation 
A)  An increased dose of the general anesthetic medication 
B)  Frequent monitoring for bleeding and respiratory complications 
C)  Interventions to prevent withdrawal symptoms within a few hours 
D)  Stimulation every hour to prevent prolonged postoperative sedation

Question 17

A patient who is admitted to the hospital for wound debridement admits to using fentanyl (Sublimaze)illegally.What finding does the nurse expect?

Accepted Answer

A)  Nausea and diarrhea 
B)  Tremors and seizures 
C)  Lethargy and disorientation 
D)  Delusions and hallucinations 
A)  Nausea and diarrhea 
B)  Tremors and seizures 
C)  Lethargy and disorientation 
D)  Delusions and hallucinations

Question 18

A patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath.What should the nurse do first?

Accepted Answer

A)  Obtain a 12-lead echocardiogram (ECG). 
B)  Start oxygen at 4 L/minute. 
C)  Draw blood for drug screening. 
D)  Infuse normal saline at 100 mL/hr. 
A)  Obtain a 12-lead echocardiogram (ECG). 
B)  Start oxygen at 4 L/minute. 
C)  Draw blood for drug screening. 
D)  Infuse normal saline at 100 mL/hr.

Question 19

A young adult patient comes to the emergency department with severe chest pain and agitation.Which action should the nurse take first?

Accepted Answer

A)  Give naloxone (Narcan) IV. 
B)  Ask about any use of stimulant drugs. 
C)  Assess orientation to person, place, and time. 
D)  Check blood pressure, pulse, and respirations. 
A)  Give naloxone (Narcan) IV. 
B)  Ask about any use of stimulant drugs. 
C)  Assess orientation to person, place, and time. 
D)  Check blood pressure, pulse, and respirations.

Question 20

Which information is most important for the nurse to report to the health care provider about a patient who has been using varenicline (Chantix)?

Accepted Answer

A)  The patient continues to smoke a few cigarettes every day. 
B)  The patient complains of headaches that occur almost daily. 
C)  The patient complains of new-onset sadness and depression. 
D)  The patient says, "I have decided that I am not ready to quit." 
A)  The patient continues to smoke a few cigarettes every day. 
B)  The patient complains of headaches that occur almost daily. 
C)  The patient complains of new-onset sadness and depression. 
D)  The patient says, "I have decided that I am not ready to quit."

Exam 11: Substance Abuse

Which assessment finding would alert the nurse to ask the patient about alcohol use?

A patient who has a history of ongoing opioid abuse is hospitalized for surgery.After a visit by a friend,the nurse finds that the patient is unresponsive with pinpoint pupils.Which prescribed medication will the nurse administer immediately?

The nurse cares for an agitated patient who was admitted to the emergency department after taking a hallucinogenic drug and attempting to jump from a third-story window.Which nursing diagnosis should the nurse assign as the highest priority?

After receiving change-of-shift report on four patients who are undergoing substance abuse treatment,which patient will the nurse assess first?

A patient presents to the emergency department with a blood alcohol concentration (BAC)of 0.18%.After reviewing the medication orders,which drug should the nurse administer first?

A patient with alcohol dependence is admitted to the hospital with back pain following a fall.Twenty-four hours after admission,the patient becomes tremulous and anxious.Which action by the nurse is most appropriate?

A disoriented and agitated patient comes to the emergency department and admits using methamphetamine.Vital signs are blood pressure 162/98,heart rate 142 and irregular,and respirations 32.Which action by the nurse is most important?

An older adult patient who has been taking alprazolam (Xanax)calls the clinic asking for a refill of the prescription 1 month before the alprazolam should need to be refilled.Which response by the nurse is best?

After the nurse receives report,which patient should the nurse assess first?

During physical assessment of a patient who has frequent nosebleeds,the nurse finds nasal sores and necrosis of the nasal septum.The nurse should ask the patient specifically about the use of which drug?

A patient admitted to the hospital after an automobile accident is alert and does not appear to be highly intoxicated.The blood alcohol concentration (BAC)is 110 mg/dL (0.11 mg%).Which action by the nurse is most appropriate?

The nurse plans postoperative care for a patient who smokes a pack of cigarettes daily.Which goal should the nurse include in the plan of care for this patient?

A patient who smokes a pack of cigarettes daily develops tachycardia and irritability on the second day after abdominal surgery.What is the nurse's best action at this time?

A patient with a history of heavy alcohol use is diagnosed with acute gastritis.Which statement by the patient indicates a willingness to stop alcohol use?

An alcohol-intoxicated patient with a penetrating wound to the abdomen is undergoing emergency surgery.What will the nurse expect the patient to need during the perioperative period?

A patient who is admitted to the hospital for wound debridement admits to using fentanyl (Sublimaze)illegally.What finding does the nurse expect?

A patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath.What should the nurse do first?

A young adult patient comes to the emergency department with severe chest pain and agitation.Which action should the nurse take first?

Which information is most important for the nurse to report to the health care provider about a patient who has been using varenicline (Chantix)?

Professional Nursing Practice

Health Disparities and Culturally Competent Care

Health History and Physical Examination

Patient and Caregiver Teaching

Chronic Illness and Older Adults

Complementary and Alternative Therapies

Stress and Stress Management

Sleep and Sleep Disorders

Pain

Palliative Care at End of Life

Inflammation and Wound Healing

Genetics and Genomics

Altered Immune Responses, and Transplantation

Infection and Human Immunodeficiency Virus Infection

Cancer

Fluid, Electrolyte, and Acid-Base Imbalances

Nursing Management: Preoperative Care

Nursing Management: Intraoperative Care

Nursing Management: Postoperative Care

Nursing Assessment: Visual and Auditory Systems

Nursing Management: Visual and Auditory Problems

Nursing Assessment: Integumentary System

Nursing Management: Integumentary Problems

Nursing Management: Burns

Nursing Assessment: Respiratory System

Nursing Management: Upper Respiratory Problems

Nursing Management: Lower Respiratory Problems

Nursing Management: Obstructive Pulmonary Diseases

Nursing Assessment: Hematologic System

Nursing Management: Hematologic Problems

Nursing Assessment: Cardiovascular System

Nursing Management: Hypertension

Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome

Nursing Management: Heart Failure

Nursing Management: Dysrhythmias

Nursing Management: Inflammatory and Structural Heart Disorders

Nursing Management: Vascular Disorders

Nursing Assessment: Gastrointestinal System

Nursing Management: Nutritional Problems

Nursing Management: Obesity

Nursing Management: Upper Gastrointestinal Problems

Nursing Management: Lower Gastrointestinal Problems

Nursing Management: Liver,Pancreas,and Biliary Tract Problems

Nursing Assessment: Urinary System

Nursing Management: Renal and Urologic Problems

Nursing Management: Acute Kidney Injury and Chronic Kidney Disease

Nursing Assessment: Endocrine System

Nursing Management: Diabetes Mellitus

Nursing Management: Endocrine Problems

Nursing Assessment: Reproductive System

Nursing Management: Breast Disorders

Nursing Management: Sexually Transmitted Infections

Nursing Management: Female Reproductive Problems

Nursing Management: Male Reproductive Problems

Nursing Assessment: Nervous System

Nursing Management: Acute Intracranial Problems

Nursing Management: Stroke

Nursing Management: Chronic Neurologic Problems

Nursing Management: Alzheimer's Disease,Dementia,and Delirium

Nursing Management: Peripheral Nerve and Spinal Cord Problems