A nurse is reviewing provider prescriptions for a client who is experiencing alcohol withdrawal.
Complete the following sentence by using the lists of options.
The nurse should first
The Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}
Rationale for correct choices:
- Administer metoclopramide 10 mg IM: The client is experiencing nausea and vomiting, and metoclopramide is an antiemetic that can help alleviate these symptoms. Managing nausea is crucial for preventing further dehydration and discomfort, especially as the client is refusing to eat or drink anything and has been vomiting most of the night.
- Administer diazepam 10 mg PO: Diazepam is a benzodiazepine used to manage alcohol withdrawal symptoms, such as anxiety and the risk of seizures. It should be administered to prevent severe withdrawal symptoms and ensure the client’s safety, once nausea is managed.
Rationale for incorrect choices:
- Offer ice chips and fluids: While ice chips may help with hydration, the priority is to address the nausea and alcohol withdrawal symptoms first. Administering metoclopramide is the first step to manage nausea, making fluid intake more tolerable.
- Do a CBC and basic metabolic profile: These tests are important for monitoring the client’s condition but are not as urgent as managing nausea and alcohol withdrawal symptoms. These tests should be completed once the acute symptoms are addressed.
- Perform alcohol use disorders identification test (AUDIT): The AUDIT is useful for assessing the severity of alcohol use disorder, but it is not an immediate priority. Managing the client's physical symptoms takes precedence before conducting assessments.
- Begin substance use group therapy: Group therapy is an essential part of treatment but should not be initiated before addressing the client’s immediate physical needs, particularly nausea and alcohol withdrawal symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Transfer a client who has delirium from a bed to a wheelchair: Assisting with transfers and mobility is within the scope of practice for an AP, especially if the client is stable and the task does not require clinical decision-making.
B. Inform a client who has schizophrenia about available community services: This task requires clinical judgment and communication skills to ensure that the client understands the information and that the services are appropriate for their needs. It should be performed by a nurse, not an AP.
C. Obtain a list of current medications from a client who is experiencing a manic episode: While obtaining a medication list is an important task, it requires assessment and evaluation of the client's condition, which should be done by a nurse, especially when the client is in a manic state and may have impaired judgment or communication.
D. Insert an NG tube for a client who has acetaminophen toxicity: Inserting an NG tube is an invasive procedure that requires clinical knowledge and skill. It should be performed by a licensed nurse or physician, not an AP.
Correct Answer is D
Explanation
A. Aspiration: Succinylcholine is used during electroconvulsive therapy (ECT) to induce muscle relaxation, but it does not specifically prevent aspiration. Aspiration risk is generally minimized by using an endotracheal tube and appropriate airway management during the procedure, not just succinylcholine.
B. Decreased heart rate: Succinylcholine is not used to manage heart rate. While ECT can cause heart rate fluctuations, other medications, like atropine, are typically used if bradycardia is a concern.
C. Elevated blood pressure: Succinylcholine does not address blood pressure regulation. ECT can cause temporary increases in blood pressure, but succinylcholine is used to relax muscles and does not manage blood pressure.
D. Muscle distress: Succinylcholine is given during ECT to relax muscles and prevent muscle contractions or "muscle distress" during the procedure. Without muscle relaxation, muscle contractions during the procedure could cause injury or severe discomfort.
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