Chapter 11: Substance Use
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is assessing a client who has a history of alcohol use. Which of the following
assessment data should the nurse expect?
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
clients with chronic alcohol use. The other problems are not associated with alcohol use.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. The nurse is caring for a client 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.
ANS: A
Insomnia is a characteristic of nicotine withdrawal. Diarrhea, sore throat, and anorexia are
not symptoms associated with nicotine withdrawal.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
3. The nurse is preparing to conduct an annual physical examination with a young adult
client 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 client to quit smoking as soon as possible.
b. Avoid confronting the client about smoking at this time.
c. Wait for the client 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 providers should urge clients who
smoke to quit smoking at every encounter. The other actions will not help decrease the
client’s health risks related to smoking.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
, 4. The nurse is caring for a client admitted to the hospital after an automobile accident who
has a blood alcohol concentration (BAC) of 48 mmol/L (0.22 mg%). The client is alert
and does not appear highly intoxicated. Which of the following nursing actions should the
nurse implement?
a. Maintain the client 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.
ANS: D
The client’s assessment data indicate physiological dependence on alcohol, and the client
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 clients
to prevent Wernicke’s encephalopathy, and there is no indication that the client should be
NPO.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
5. A client who is alcohol-intoxicated must undergo emergency surgery for abdominal
trauma. Which of the following should the nurse anticipate when caring for the client 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.
ANS: B
Clients 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 client, 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 client should be
monitored frequently for oversedation but does not need to be stimulated.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
6. The nurse is caring for a client with alcohol dependence who has been admitted to the
hospital with chest pain. Twenty-four hours after admission, the client becomes very
tremulous and anxious. Which of the following actions should the nurse implement?
a. Insert an IV line and infuse fluids.
b. Promote oral intake to 3 000 mL/day.
c. Provide a quiet, well-lit environment.
d. Administer opioids to provide sedation.
ANS: C
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is assessing a client who has a history of alcohol use. Which of the following
assessment data should the nurse expect?
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
clients with chronic alcohol use. The other problems are not associated with alcohol use.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. The nurse is caring for a client 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.
ANS: A
Insomnia is a characteristic of nicotine withdrawal. Diarrhea, sore throat, and anorexia are
not symptoms associated with nicotine withdrawal.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
3. The nurse is preparing to conduct an annual physical examination with a young adult
client 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 client to quit smoking as soon as possible.
b. Avoid confronting the client about smoking at this time.
c. Wait for the client 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 providers should urge clients who
smoke to quit smoking at every encounter. The other actions will not help decrease the
client’s health risks related to smoking.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
, 4. The nurse is caring for a client admitted to the hospital after an automobile accident who
has a blood alcohol concentration (BAC) of 48 mmol/L (0.22 mg%). The client is alert
and does not appear highly intoxicated. Which of the following nursing actions should the
nurse implement?
a. Maintain the client 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.
ANS: D
The client’s assessment data indicate physiological dependence on alcohol, and the client
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 clients
to prevent Wernicke’s encephalopathy, and there is no indication that the client should be
NPO.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
5. A client who is alcohol-intoxicated must undergo emergency surgery for abdominal
trauma. Which of the following should the nurse anticipate when caring for the client 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.
ANS: B
Clients 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 client, 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 client should be
monitored frequently for oversedation but does not need to be stimulated.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
6. The nurse is caring for a client with alcohol dependence who has been admitted to the
hospital with chest pain. Twenty-four hours after admission, the client becomes very
tremulous and anxious. Which of the following actions should the nurse implement?
a. Insert an IV line and infuse fluids.
b. Promote oral intake to 3 000 mL/day.
c. Provide a quiet, well-lit environment.
d. Administer opioids to provide sedation.
ANS: C
