Medical Surgical Nursing Patient Centered Collaborative Care Ignatavicius 6th Edition Test Bank

Medical-Surgical Nursing Patient-Centered Collaborative Care Ignatavicius 6th Edition Test B
Medical-Surgical Nursing Patient-Centered

Collaborative Care Ignatavicius 6th Edition Test Bank
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Ignatavicius: Medical-Surgical Nursing, 6th Edition
Chapter 7: Substance Abuse and Medical-Surgical Nursing
Test Bank
MULTIPLE CHOICE
1. The nurse suspects a colleague of diverting narcotics for personal use. Which intervention will
the nurse implement first?
a. Discusses suspicions with the colleague in question
b. Reports suspicions to the nursing supervisor
c. Begins documenting colleague’s actions
d. Reports suspicions to the board of nursing
ANS: D
The nurse should report suspicious behavior to the board of nursing. The nurse can then report
what has occurred to the nursing supervisor. It is not the nurse’s responsibility to document a
colleague’s actions, nor should the nurse confront the colleague. Legally, there is no place for the
nurse to document the colleague’s actions. The nurse may not be equipped to handle a
confrontation of this nature. This is better left to a supervisor or someone in an authority position
who has the resources to assist the nurse.
DIF: Cognitive Level: Application REF: N/A for Application and above
OBJ: Learning Outcome 7
TOP: Client Needs Category: Physiological Integrity (Basic Care and Comfort)
MSC: Integrated Process: Nursing Process (Assessment)
2. The nurse is monitoring a client after a cocaine overdose. Which symptom requires immediate
intervention?
a. Complaints of nasal congestion
b. IV site cool to touch
c. Heart rate 110 beats/min
d. Urinary output 60 mL/hr
ANS: C
Because cocaine is a cardiac stimulant, observation during overdose or withdrawal includes
frequent monitoring of vital signs and cardiac assessments. The nasal mucous membranes may
be inflamed or congested, but this does not require priority assessment because it does not
jeopardize the client’s immediate health. The client may need intravenous fluids to be monitored.
Manic episodes are not usually a concern, but depression may result during the withdrawal
period.
TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation)
Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Test Bank 7-2
3. Which assessment finding in a client who has taken an overdose of stimulants requires the
nurse’s immediate action?
a. Use of accessory muscles while breathing
b. Oral temperature 96.6° F (35.9° C)
c. Extreme feeling of being “tired”
d. Constant talking
ANS: A
Use of the accessory muscles to breath indicates serious respiratory insufficiency. A subnormal
temperature, extreme fatigue, and constant talking are all abnormal symptoms but are not life-
threatening.
4. Which assessment finding in a client experiencing opiate intoxication requires immediate action?
a. Blood pressure, 130/90 mm/hg
b. Blood pressure, 70/40 mm/hg
c. Pulse rate, 100 beats/min
d. Pulse rate, 50 beats/min
ANS: B
Of the symptoms listed, only decreased blood pressure would be the earliest indication of opiate
intoxication.
5. Which client will the nurse assess for the possibility of opiate addiction?
a. A middle-aged woman who is experiencing cancer of the thyroid
b. An older man who has experienced a myocardial infarction
c. A young woman who is experiencing sickle cell anemia
d. A young man who has experienced a closed head injury
ANS: C
Sickle cell anemia places the client at high risk for opiate addiction because of the painful nature
of the illness. The client with a closed head injury will not be given opiates because of their
sedating properties. The client with cancer of the thyroid and myocardial infarction should not
require opiates.
DIF: Cognitive Level: Comprehension REF: p. 90

OBJ: Learning Outcomes 3, 5
Test Bank 7-3
6. The nurse is attempting to promote a safe environment for a client who has a history of
methamphetamine use. What is the nurse’s priority action?
a. Arranges for the client to be medicated with sedatives during his hospitalization
b. Reorients the client frequently to his surroundings and reassures him of the nurses’
presence
c. Discusses the need to participate in counseling sessions on discharge
d. Places the client on suicide watch and documents all findings
ANS: B
The client who has been using methamphetamine will tend to be disoriented. He will not
necessarily be suicidal and probably will not benefit from counseling immediately on discharge,
because there is no evidence that he has undergone treatment. The client will probably not be
medicated with sedatives because of his current chemical dependency.
TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Environment)
MSC: Integrated Process: Nursing Process (Implementation)
7. What is the most important idea for the nurse to communicate to students about substance abuse?
a. Substance abuse is an individualized problem rather than a problem of society.
b. Chemical abuse can be just as detrimental as chemical dependency.
c. Substance abuse is primarily localized to those in the lower classes.
d. Cocaine is the most commonly abused substance.
ANS: B
The students should understand that chemical abuse can be just as detrimental to a client as
chemical dependency. Substance abuse is a universal societal issue. There are many abused
substances.
DIF: Cognitive Level: Comprehension REF: N/A for Application and above
TOP: Client Needs Category: Physiological Integrity (Basic Care and Comfort)
MSC: Integrated Process: Teaching/Learning
8. Why is it important for the nursing supervisor to identify clients who may experience withdrawal
in the clinical setting?
a. To prepare staff so that they can protect themselves
b. To allow for additional care and staffing
c. To prepare the staff for manipulative behavior by the client
d. To inform authorities about illegal behavior
ANS: B
Test Bank 7-4
The client who is experiencing withdrawal will require additional care and consequently will
need more staff members involved in his care. Staff will not require protection, will not need to
prepare for manipulative behavior by the client, and will not need to be prepared to inform
authorities about illegal behavior.

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
Control) MSC: Integrated Process: Nursing Process (Assessment)
9. What property of stimulants increases their potential for abuse?

a. They are not habit forming.
b. They have sedating qualities.
c. They increase general metabolism.
d. Their use is not controlled by the Drug Enforcement Administration (DEA).
ANS: C
Stimulants increase metabolism, and are often used to control weight. They are habit forming.
These drugs do not have sedative properties. Also, stimulants are DEA-controlled.

10. The client has narcolepsy. The nurse should be prepared to teach the client about which drug
category that has potential for abuse in this situation?
a. Amphetamines
b. Benzodiazepines
c. Barbiturates
d. Phencyclidines
ANS: A
A legitimate medical use of amphetamines is the treatment of narcolepsy. Thus, it is the only
drug of the ones listed that has the potential for abuse in this situation.
DIF: Cognitive Level: Knowledge REF: p. 85

TOP: Client Needs Category: Psychosocial Integrity (Behavioral Interventions)
MSC: Integrated Process: Teaching/Learning
11. What symptom in a client with head trauma assists the nurse in making a diagnosis of suspected
opioid overdose?
a. Pinpoint pupils
b. Respiratory depression
c. Hyporeflexive deep tendon reflexes
d. Evidence that the client has vomited
Test Bank 7-5
ANS: A
Opioid ingestion causes pupillary constriction. Respiratory depression does not occur in opioid
overdose, nor do hyporeflexive deep tendon reflexes. There will not necessarily be vomiting with
opioid overdose.
12. Which clinical manifestation causes the nurse to suspect cocaine abuse rather than barbiturate
abuse in a client?
a. Shallow respirations
b. Pupillary constriction
c. Tachycardia
d. Flushing
ANS: C
The systemic effects of cocaine include peripheral vasoconstriction, tachycardia, hypertension,
chills, fever, pupillary dilation, and paranoia. Shallow respirations, constriction of the pupils, and
flushing are not characteristics of cocaine abuse.
13. What information obtained from a client during assessment alerts the nurse to the possibility of
alcohol addiction?
a. The client says that he or she drinks alcohol to feel less stressed and have a good
time.
b. The client has been arrested once for driving under the influence of alcohol.
c. The client uses alcohol to stop his or her hands from shaking.
d. The client drinks alcohol daily.
ANS: C
The major distinction between abusing alcohol and being addicted to alcohol is the presence of
withdrawal symptoms when the client is not drinking. The fact that alcohol is used to prevent or
stop the symptoms of withdrawal (tremors of the hands) is a strong indicator of physical
addiction to alcohol. None of the other symptoms are as indicative of alcohol addiction.
Test Bank 7-6
14. Which nursing diagnosis is appropriate for a woman who abuses anabolic steroids and has begun
to experience side effects from the medication?
a. Risk for Injury related to decreased muscle coordination
b. Hypothermia related to decreased metabolic rate
c. Chronic Confusion related to sodium and water retention
d. Disturbed Body Image related to presence of facial hair
ANS: D
The use of anabolic steroids (testosterone) in women causes the physical changes of growth of
facial hair, male pattern baldness, deepened voice, and changes in menstrual patterns. The other
nursing diagnoses would not be as applicable.
MSC: Integrated Process: Nursing Process (Analysis)
15. Which assessment finding in a postoperative client is suggestive of a history of substance abuse?
a. Frequent vomiting after surgery
b. 15 mg morphine subcutaneous has not relieved pain
c. Inability to void
d. Increased wound drainage
ANS: B
Many of the liver enzymes that detoxify abused substances also degrade morphine and other
opioids. When people abuse drugs, even alcohol, the level of these degradative enzymes
increases, and opioid medications are degraded more rapidly. This increases the client's tolerance
to these medications, even though he or she may never have had an opioid previously. An
increased amount of the drug is required to provide adequate pain relief.
TOP: Client Needs Category: Psychosocial Integrity (Chemical and Other Dependencies)
16. The client has been transferred to the medical-surgical unit from the emergency department with
an admitting diagnosis of “barbiturate overdose.” Which is the nurse’s priority intervention?
a. Performing neurologic checks and assessing vital signs every 4 hours
b. Providing emotional support as needed
c. Restricting visitors to immediate family only
d. Palpating peripheral pulses every 4 hours
ANS: A
Barbiturates depress the central nervous system and cause sedation, drowsiness, and a decrease
in motor activity. Overdose symptoms include respiratory depression, which can best be
determined by assessing vital signs rather than by carrying out the other options. Providing
emotional support, restricting visitors, and palpating peripheral pulses are all important
interventions, but are not as significant as assessment of neurologic status and vital signs.
Test Bank 7-7
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential)
MSC: Integrated Process: Nursing Process (Implementation)
MULTIPLE RESPONSE
1. What findings indicate potential substance abuse? (Select all that apply.)
a. Craves alcohol
b. Drinks one 12-oz beer each day
c. Fails to fix meals at home
d. Frequent sick days at work
e. Grades at school drop
f. Loss of control
g. Physical dependence
ANS: A, D, F, G
Alcohol abuse occurs when a person has problems with alcohol use. His or her use of alcohol
interferes with the ability to carry out activities of daily living and to meet daily responsibilities
at home, work, school, or in the community. It is not necessarily related to the quantity of
alcohol consumed or the frequency of alcohol consumption.
2. Which criterion helps support a nursing diagnosis of substance abuse? (Select all that apply.)
a. The client uses the substance daily.
b. The client's behavior when using the substance is not socially acceptable.
c. The client continues to use the substance, even though he or she has expressed a
desire to stop.
d. The client continues to use the substance, even though it causes chronic
hypertension.
ANS: B, C, D
A number of criteria are used to make a nursing diagnosis of substance abuse, including the
following: (1) the client loses control of the drug; (2) the client takes the drug, even though the
drug has caused adverse conditions in his or her body; and (3) the client demonstrates cognitive,
behavioral, and physical disturbances. Many drugs, including substances that have potential for
abuse, can be taken or used on a daily basis for years without causing problems or being
considered abused.

Medical-Surgical Nursing Patient-Centered Collaborative Care Ignatavicius 6th Edition Test B
Test Bank 7-8
MSC: Integrated Process: Nursing Process (Analysis)
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Medical-Surgical Nursing Patient-Centered

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Chapter 7: Substance Abuse and Medical-Surgical Nursing

DIF: Cognitive Level: Comprehension REF: p. 90

MSC: Integrated Process: Nursing Process (Assessment)

DIF: Cognitive Level: Comprehension REF: p. 84

9. What property of stimulants increases their potential for abuse?

DIF: Cognitive Level: Comprehension REF: p. 85

DIF: Cognitive Level: Knowledge REF: p. 85

DIF: Cognitive Level: Comprehension REF: p. 82

Test Bank 7-8

MSC: Integrated Process: Nursing Process (Analysis)

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