During the focused interview, the client admits to regularly ...

[melly21297]

During the focused interview, the client admits to regularly abusing cocaine. Which clinical manifestations support the regular use of cocaine? Select all that apply.
 
  1. The nurse notes that the nasal septum has perforated.
  2. Temporomandibular joint pain when the client opens and closes the mouth.
  3. The septum is noted to be very pale in color.
  4. Yeast infection of nasal mucosa and in mouth.
  5. Difficulty swallowing water.

Question 2

The nursing is performing an otoscopic examination on an adult client and is unable to visualize the tympanic membrane. Which action by the nurse is appropriate in this situation?
 
  1. Pull the pinna up and back, then reinsert the otoscope.
  2. Tell the client to move away from the speculum if they experience any pain as the otoscope is advanced.
  3. Reinsert the otoscope quickly and press against both sides of the inner auditory canal.
  4. Pull the pinna down and back, then reinsert the otoscope.

[strudel15]

Answer to Question 1

Correct Answer: 1, 3

When a client is abusing cocaine, the nurse may note that the nasal septum has broken down and has even perforated. When a client is abusing cocaine, the nasal mucosa might appear vasoconstricted and very pale in color. Temporomandibular joint pain could be the result of otitis externa or might indicate temporomandibular joint dysfunction. It is unrelated to cocaine use. Steroid inhalers can cause growth of Candida in the nose, mouth, or throat. It is unrelated to cocaine use. If the client experiences difficulty in swallowing, this may be due to a neurological or gastrointestinal problem, or it may be related to ill-fitting dentures or malocclusion.

Answer to Question 2

Correct Answer: 1
To avoid trauma to the ear, the otoscope is to be removed and the pinna should be pulled up and back for better visualization. The client should be instructed to state any feelings of discomfort or pain but not to pull away because this may result in injury during this examination. The otoscope should not be inserted quickly and should not be pressed against either side of the inner auditory canal because it would be painful for the client. Pulling down and back is recommended in children because of the shape of their auditory canal.