A nurse is caring for four patients. The nurse would be concerned about which patient developing a substance use disorder?
a. A college student who reports having experimented with marijuana in the past year
b. An older adult patient with terminal cancer who requires twice the normal dose of morphine for pain relief
c. A patient in moderate to severe pain after a total hip replacement who asks for pain medication an hour before the next dose is due
d. A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain
ANS: D
Patients who use narcotics for minor pains are more likely to be compulsive drug seekers. A college student who experiments with an illegal substance is not necessarily going to develop a substance use disorder. An elderly patient with terminal cancer pain has most likely developed physical dependence and tolerance to morphine but is not a substance abuser. Patients with significant pain who ask for more frequent dosing are not showing substance use disorder.
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