Two days after being admitted with alcohol withdrawal, a client has constant liquid stools and abdominal cramping. The emesis and stool are hemoccult positive. The client is confused and refusing to take oral medication. Which action should the nurse implement first?

Administer an antianxiolytic medication.

Insert fecal management tube.

Insert peripheral intravenous catheter.

Crush pills and place in applesauce.

Answer and Explanation

The Correct Answer is C

Choice A rationale: Administering an antianxiolytic medication may be appropriate, but addressing the client's fluid and electrolyte imbalance is the priority.

Choice B rationale: Inserting a fecal management tube is not the first action to take in response to hemoccult positive liquid stools; addressing fluid balance is more urgent.

Choice C rationale: Inserting a peripheral intravenous catheter is the priority to address the client's fluid and electrolyte imbalance and provide necessary hydration and medications.

Choice D rationale: Crushing pills and placing them in applesauce may be considered, but the client's fluid and electrolyte imbalance needs prompt attention first.

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Correct Answer is D

Explanation

Choice A rationale: The nurse's response regarding watery eyes and diarrhea is not directly related to the client's concern about the medication's effect on blood glucose levels.

Choice B rationale: This response minimizes the potential side effects, which is not accurate. Second-generation antipsychotics are associated with metabolic side effects, including changes in blood glucose levels.

Choice C rationale: Offering an education sheet is helpful but does not directly address the client's specific concerns about the medication's impact on blood glucose levels.

Choice D rationale: This response acknowledges the client's concern, provides information about the general tolerability of the medication, and invites the client to share more about their specific worries. It encourages open communication and allows the nurse to address the client's concerns more effectively.

A. Changes thought patterns related to problem solving. B. Describes how the family can resolve problems. C. Relates insight into problematic relationships. D. Demonstrates a healthy relationship with husband.

Correct Answer is A

Explanation

Choice A rationale: Changes in thought patterns related to problem-solving demonstrate the effectiveness of cognitive-behavioral techniques. Shifting from hopelessness to active problem-solving reflects positive progress.

Choice B rationale: Describing how the family can resolve problems may involve other therapeutic modalities, but it is not specific to evaluating the effectiveness of cognitive behavioral techniques.

Choice C rationale: Relating insight into problematic relationships is a broad goal and may not specifically measure the impact of cognitive-behavioral techniques. Choice D rationale: Demonstrating a healthy relationship with the husband is an important goal but is not directly related to the evaluation of cognitive-behavioral techniques.

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Two days after being admitted with alcohol withdrawal, a client has constant liquid stools and abdominal cramping. The emesis and stool are hemoccult positive. The client is confused and refusing to take oral medication. Which action should the nurse implement first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Correct Answer is A

Explanation

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