A 45-year-old man with chronic alcoholism appears in the emergency department with disorientation and confusion. A neurologic examination shows ataxia and disconjugate eye movements. What is the most appropriate treatment?
Promethazine 25 mg IV prn
Thiamine (vitamin B1) 100 mg PO BID
Lorazepam (Ativan) 1 mg IV q 4 hr
Potassium (Klor-Con M) 10 mEq PO with food once daily
The Correct Answer is B
Choice A reason: Promethazine is an antiemetic and sedative, but it does not address the underlying neurologic symptoms associated with chronic alcoholism. It is not appropriate for treating Wernicke’s encephalopathy or thiamine deficiency.
Choice B reason: Thiamine deficiency is common in chronic alcoholism and can lead to Wernicke’s encephalopathy, characterized by confusion, ataxia, and ophthalmoplegia. Thiamine supplementation is the first-line treatment and should be administered promptly to prevent progression to Korsakoff syndrome.
Choice C reason: Lorazepam may be used for alcohol withdrawal symptoms but does not treat the neurologic deficits caused by thiamine deficiency. It may worsen confusion and sedation if not properly indicated.
Choice D reason: Potassium supplementation may be necessary in alcoholics due to electrolyte imbalances, but it does not address the acute neurologic symptoms. It is not the most appropriate immediate treatment in this scenario.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: The power of nursing boards is unrelated to the classification of legal cases. Boards regulate licensure and professional conduct but do not determine whether a case is civil or criminal.
Choice B reason: The quality of legal representation does not determine the nature of the case. Civil versus criminal classification is based on the nature of the act and intent, not legal defense.
Choice C reason: Civil cases typically involve negligence or failure to meet a standard of care without malicious intent. In this scenario, the NP made a voluntary error but lacked criminal intent, making it a matter of civil liability rather than criminal prosecution.
Choice D reason: Criminal charges are brought by the state, not the patient. While a patient may choose not to pursue civil damages, dropping criminal charges is not within their authority. The classification depends on the nature of the act.
Correct Answer is B
Explanation
Choice A reason: Reflective practice involves self-examination of one’s clinical decisions and experiences to improve future performance. While it supports evidence-based practice, it does not specifically refer to the systematic use of research findings to change clinical practice.
Choice B reason: Research utilization is the process of applying research findings to clinical practice. It involves synthesizing, disseminating, and implementing evidence to improve patient outcomes. This term specifically describes the operational aspect of evidence-based practice where knowledge is translated into action.
Choice C reason: Critical thinking is a cognitive process used to analyze information, make decisions, and solve problems. It is essential in evaluating research but does not encompass the full process of applying research findings to practice.
Choice D reason: Integration refers broadly to combining various elements into a unified whole. In evidence-based practice, it may describe the merging of clinical expertise, patient preferences, and research evidence, but it does not specifically denote the process of applying research findings.
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