A nurse is planning care for a client who is undergoing alcohol withdrawal and is receiving diazepam. Which of the following interventions should the nurse include in the plan?
Administer the medication subcutaneously.
Initiate seizure precautions.
Administer the medication with an antacid.
Initiate contact precautions.
The Correct Answer is B
A. Administer the medication subcutaneously – Diazepam should be given orally or intravenously in severe cases, not subcutaneously.
B. Initiate seizure precautions – This is the correct answer. Alcohol withdrawal can lead to seizures due to central nervous system hyperactivity. Diazepam, a benzodiazepine, is used to prevent seizures and manage withdrawal symptoms.
C. Administer the medication with an antacid – There is no need to administer diazepam with an antacid; doing so can interfere with absorption.
D. Initiate contact precautions – Alcohol withdrawal is not an infectious condition, so contact precautions are unnecessary.
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Related Questions
Correct Answer is C
Explanation
A. A nurse should explain surgical risks to a client. – Incorrect. The provider (physician or surgeon) is responsible for explaining surgical risks, benefits, and alternatives. The nurse only verifies that informed consent was obtained and clarifies questions.
B. A client who is unable to write cannot provide informed consent. – Incorrect. A client who cannot write may provide consent verbally or with an "X" if witnessed appropriately.
C. A client can refuse a procedure after signing an informed consent form. – Correct. Clients have the right to withdraw consent at any time before the procedure is performed.
D. A client who is blind needs a guardian to provide informed consent. – Incorrect. A blind client can provide informed consent as long as they understand the procedure. The consent form can be read aloud if needed.
Correct Answer is A
Explanation
A. Suctioning device – Correct. A suctioning device is essential to clear the airway in case of excessive secretions during or after a seizure.
B. Bite block – Incorrect. Bite blocks are not used during seizures as they can cause injury. Nothing should be placed in the client’s mouth during a seizure.
C. Vest restraint – Incorrect. Restraints should not be used on clients with seizure disorders as they can cause injury.
D. Padded tongue blade – Incorrect. Tongue blades should never be inserted into the mouth of a seizing client due to the risk of airway obstruction and oral trauma.
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