The practical nurse (PN) is caring for a client whose urine drug screen is positive for cocaine. Which behavior is most likely seen in this client?

Elevated energy level

Powerful craving for more

High self-esteem

Euphoria

Answer and Explanation

The Correct Answer is A

Cocaine is a powerfully addictive stimulant drug that increases the levels of dopamine in the brain, which is a chemical messenger related to movement, pleasure, and motivation.
Cocaine's eﬀects appear almost immediately and last for a few minutes to an hour, depending on the method of use. Some of the short-term eﬀects of cocaine include extreme happiness and energy, mental alertness, hypersensitivity to sight, sound, and touch, and irritability.
An elevated energy level is one of the most common and noticeable eﬀects of cocaine use, as cocaine stimulates the central nervous system and makes the user feel more alert, active, and confident¹². This eﬀect may also lead to increased physical activity, talkativeness, or aggression.

Therefore, option A is the correct answer, while options B, C, and D are incorrect.

Option B is incorrect because a powerful craving for more cocaine is not a behavior that can be observed by others, but rather an internal feeling that the user may experience due to the addictive nature of the drug.

Option C is incorrect because high self-esteem is not a typical eﬀect of cocaine use, as cocaine may cause paranoia or anxiety in some users.

Option D is incorrect because euphoria is not a behavior that can be observed by others, but rather an emotional state that the user may feel due to the increased dopamine levels in the brain

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Correct Answer is C

Explanation

A. Documenting the client's refusal in the medical record is an important action, but not the first one. The nurse should first try to understand the client's perspective and address any concerns or misconceptions they might have about the blood transfusion. This choice is incorrect.

B. Honoring the client's decision to refuse the blood transfusion is a respectful and ethical action, but not the first one. The nurse should first attempt to educate and persuade the client about the benefits and risks of the treatment, and respect their autonomy only after ensuring that they have made an informed decision. This choice is incorrect.

C. Exploring the client's reasons for refusing the treatment is the first action that the nurse should take. The nurse should use effective communication skills to elicit the client's beliefs, values, fears, and preferences regarding the blood transfusion, and provide factual and evidence-based information to address any knowledge gaps or misconceptions. The nurse should also assess the client's decision-making capacity and determine if they are competent to refuse the treatment. This choice is correct.

D. Discussing the client's refusal with the provider is an appropriate action, but not the first one. The nurse should first try to resolve the issue with the client directly, and involve the provider only if they are unable to do so or if there are legal or ethical implications that require further consultation. This choice is incorrect.

A. Assess fluid intake every 24 hr. B. Ambulate three times a day. C. Assist with deep breathing and coughing. D. Monitor the incision site for findings of infection.

Correct Answer is C

Explanation

A. Assessing fluid intake every 24 hr is important for a postoperative client, but it is not the priority action. The nurse should monitor fluid intake and output more frequently, such as every 8 hr or every shift, to detect any imbalances or complications.

B. Ambulating three times a day is beneficial for a postoperative client, but it is not the priority action. The nurse should encourage early and frequent ambulation to promote circulation, prevent thromboembolism, and enhance bowel function, but only after ensuring that the client is stable and has adequate pain control.

C. Assisting with deep breathing and coughing is the priority action for a postoperative client who had abdominal surgery. The nurse should help the client perform these exercises every 1 to 2 hr to prevent atelectasis, pneumonia, and respiratory failure, which are common and serious complications after abdominal surgery.

D. Monitoring the incision site for findings of infection is important for a postoperative client, but it is not the priority action. The nurse should inspect the wound for signs of infection, such as redness, swelling, warmth, drainage, or odor, but this can be done during routine dressing changes or as needed.

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The practical nurse (PN) is caring for a client whose urine drug screen is positive for cocaine. Which behavior is most likely seen in this client?

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