The nurse is caring for a client with Wernicke encephalopathy. The nurse determines that teaching has been effective when the client makes which statement?
"My condition is a degenerative brain disorder caused by nutrient deficiency."
"There is swelling of my brain that is caused by alcohol consumption."
"The inability of my liver to metabolize the alcohol caused this condition."
"Toxins from the alcohol I drank have caused my brain to swell."
The Correct Answer is A
A. "My condition is a degenerative brain disorder caused by nutrient deficiency." Wernicke encephalopathy is caused by thiamine (vitamin B1) deficiency, which is often due to chronic alcoholism. The condition is associated with neurological damage from this nutrient deficiency, making this statement accurate.
B. "There is swelling of my brain that is caused by alcohol consumption." Wernicke encephalopathy is not characterized by brain swelling but by neurological damage due to thiamine deficiency.
C. "The inability of my liver to metabolize the alcohol caused this condition." While liver dysfunction can be associated with alcohol use, Wernicke encephalopathy is specifically due to thiamine deficiency, not liver metabolism issues.
D. "Toxins from the alcohol I drank have caused my brain to swell." This statement is incorrect as Wernicke encephalopathy is related to thiamine deficiency rather than brain swelling from alcohol toxins.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Repetitive thoughts and recurring impulses: OCD is characterized by obsessions (repetitive, intrusive thoughts) and compulsions (recurring impulses or behaviours performed to reduce anxiety). This choice best describes the core features of OCD.
B. Physical signs and symptoms with no physiologic cause: This description does not accurately describe OCD. While OCD symptoms are distressing and impairing, they are not typically categorized as having no physiologic cause.
C. Apprehension: Apprehension or general anxiety can be associated with many mental health disorders, but it is not specific to OCD, which is more about the presence of obsessions and compulsions rather than generalized apprehension.
D. Inability to concentrate: While inability to concentrate can be a symptom in various mental health disorders, it is not specific to OCD. OCD is more specifically characterized by repetitive thoughts and actions.
Correct Answer is A
Explanation
A. "I am not on vacation. I am here with you." This response calmly reassures the client by affirming the mother’s presence, which helps address the son’s confusion without directly challenging his perception.
B. "How can I go on vacation? I do not have any money." This response could increase confusion and does not address the son's needs effectively. It could also lead to unnecessary discussions that might not be helpful.
C. "Stop saying that. You know better. No one told you that." This response is dismissive and confrontational, which may exacerbate the son’s distress and could damage the therapeutic relationship.
D. "Just forget about that and let's talk about something else." This response avoids addressing the son’s concerns, which can make him feel dismissed and not listened to, potentially worsening his symptoms.
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