NUR-TESTBANK Questions & Answers satisfaction guaranteed success ( CHAPTERS48-68) latest update Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume 11th Edition by Mariann M. Harding PhD RN CNE FAADN (Author

1. Which assessment finding would alert the nurse to ask the patient about alcohol use? a. Low blood pressure b. Decreased heart rate c. Elevated temperature d. Abdominal tenderness ANS: D Abdominal pain associated with gastrointestinal tract and liver dysfunction is common in patients with chronic alcohol use. The other problems are not associated with alcohol abuse. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 2. 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. Improve sleep b. Enhance appetite c. Decrease diarrhea d. Prevent sore throat ANS: A Insomnia is a characteristic of nicotine withdrawal. Diarrhea, sore throat, and anorexia are not symptoms associated with nicotine withdrawal. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 3. A young adult patient scheduled for an annual physical examination 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. ANS: A Current national guidelines indicate that health care professionals should urge patients who smoke to quit smoking at every encounter. The other actions will not help decrease the patients health risks related to smoking. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 4. 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 mostappropriate? 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. ANS: D The patients assessment data indicate probable physiologic dependence on alcohol, and the patient is likely to develop acute withdrawal such as anxiety, hyperreflexia, 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 Wernickes encephalopathy, and there is no indication that the patient should be NPO. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 5. 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. 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 ANS: B 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. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 6. 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. 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. ANS: C The patients symptoms suggest acute alcohol withdrawal, and a quiet and well-lit environment will help decrease agitation, delusions, and hallucinations. There is no indication that the patient is dehydrated. Benzodiazepines, rather than opioids, are used to prevent withdrawal. IV lines are avoided whenever possible. DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 7. 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? 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. ANS: A The statement I am older and wiser now, and I know I can change my drinking behavior indicates the patient expresses willingness to stop alcohol use and an initial commitment to changing alcohol intake behaviors. In the remaining statements, the patient recognizes that alcohol use is the reason for the gastritis but is not yet willing to make a change.