A client is showing symptoms of alcohol intoxication. What question should the nurse ask first?
"Are you experiencing a relapse?"
"What time was your last drink?"
"How long have you had a problem with alcohol?"
"Are you having any liver problems?"
The Correct Answer is B
A) Incorrect. While understanding if the client is experiencing a relapse is important, knowing the timing of the last drink is crucial for assessing the level of intoxication.
B) Correct. Knowing the time of the last drink helps the nurse gauge the current level of alcohol in the client's system, which is crucial in assessing and managing alcohol intoxication.
C) Incorrect. While understanding the duration of the client's problem with alcohol is important, it is not the most immediate concern when the client is showing symptoms of intoxication.
D) Incorrect. Asking about liver problems is relevant but not the first priority when the client is exhibiting signs of alcohol intoxication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "As depression lifts, physical energy becomes available to carry out suicide." This statement highlights a critical consideration in the care of severely depressed clients. When a client's depression starts to improve due to antidepressant therapy, there may be a period where they have increased energy but have not yet gained full relief from their depressive thoughts. This can potentially increase the risk of carrying out suicidal thoughts or plans.
B. "Suicide may be precipitated by a variety of internal and external events." While this statement is true, it does not specifically address the importance of monitoring a client during antidepressant therapy.
C. "Suicidal clients have difficulty using social supports." This statement acknowledges a potential challenge for clients who are experiencing suicidal thoughts, but it does not directly relate to the need for close monitoring during antidepressant therapy.
D. "Suicide is an impulsive act that has no warning." This statement is not entirely accurate. While some suicides can be impulsive, many individuals give warning signs or exhibit changes in behavior before attempting suicide.
Correct Answer is C
Explanation
A) Incorrect. The ability to accomplish activities of daily living is not specific to the diagnosis of schizophreniform disorder.
B) Incorrect. The client's emotional state or demeanor is not a specific indicator of schizophreniform disorder.
C) Correct. Schizophreniform disorder is characterized by the presence of hallucinations,
delusions, and other psychotic symptoms for less than six months. It is considered a provisional diagnosis while the condition is still in its early stages.
D) Incorrect. Euphoria and excessive energy are not specific features of schizophreniform disorder.
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