Substance Abuse, Eating Disorders, Impulse Control Disorders no. 5025

Substance Abuse, Eating Disorders, Impulse Control Disorders no. 5025

QUESTION: A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The ECG shows a 1-mm ST-segment elevation in the anteroseptal leads and T-wave inversion in leads V₃ to V₅. Considering the client's history of drug abuse, the nurse expects the physician to prescribe:

✘O a.) lidocaine (Xylocaine).
✘O b.) procainamide (Pronestyl).
✓O c.) nitroglycerin (Nitro-Bid IV).
✘O d.) epinephrine.

RATIONALE

RATIONALE: The elevated ST segments in this client's ECG indicate myocardial ischemia. To reverse this problem, the physician is most likely to prescribe an infusion of nitroglycerin to dilate the coronary arteries. Lidocaine and procainamide are cardiac drugs that may be indicated for this client at some point but aren't used for coronary artery dilation. If a cocaine user experiences ventricular fibrillation or asystole, the physician may prescribe epinephrine. However, this drug must be used with caution because cocaine may potentiate its adrenergic effects.
NURSING PROCESS STEP: Planning
CLIENT NEEDS CATEGORY: Physiological integrity
CLIENT NEEDS SUBCATEGORY: Physiological adaptation
COGNITIVE LEVEL: Knowledge