A patient sustained a fractured femur while driving under the ...

[s.tung]

A patient sustained a fractured femur while driving under the influence of drugs. Family members indicate that the patient has dabbled in drugs for years.
 
  When the patient obtains little relief from the prescribed dose of narcotic analgesic, the nurse suspects the ineffective pain relief is related to: a. drug tolerance to the narcotic prescribed.
  b. the predictable onset of withdrawal symptoms.
  c. insufficient analgesic dosage to manage the pain.
  d. the strong likelihood of a history of substance abuse.

Question 2

The psychiatric nurse is preparing discharge information for a patient diagnosed with schizophrenia.
 
  Knowing that the patient will be discharged to a home shared with the patient's elderly parents, you want to develop evidence-based care for the patient. You will first: a. identify the major support person for the patient.
  b. define the patient's current acute clinical problems.
  c. help the patient to find appropriate, attainable employment.
  d. help the patient to be reoriented to living outside a locked psychiatric unit.

[Ahnyah]

Answer to Question 1

A
Tolerance to opiates develops when used repeatedly (i.e., a larger amount of the drug is needed to produce the desired effect). If the patient uses heroin or another opiate individually or in conjunction with other drugs, tolerance may be present. In addition, cross-tolerance develops among CNS depressants, meaning that as tolerance to one drug develops, tolerance develops to all other drugs in the group as well. Although withdrawal and insufficient analgesic medication dosage may result in pain, this patient's assessment data and history are strong indicators of possible drug tolerance. A history of substance abuse would be a red flag regarding the possibility of withdrawal symptoms when the patient is no longer receiving any analgesic medications.

Answer to Question 2

B
Defining the clinical problem for this patient is the first step in evidence-based care. All other options can be useful to the patient's future care, but with evidence-based care, it is most important to have a clear question to identify the clinical problems, identify the existing nursing interventions, and specify the expected outcome.