A nurse is caring for a client admitted for alcohol use disorder who reports using alcohol to deal with stress. Which of the following actions should the nurse take to assist the client in maintaining self-control of the behavior?

Provide the client with periods of alone time for reflection on their behavior.

Discuss strategies with the client to reduce alcohol consumption gradually

Have the client's partner assume responsibility for monitoring the client's alcohol intake.

Give positive feedback to the client for using adaptive coping strategies

Answer and Explanation

The Correct Answer is D

A. Provide the client with periods of alone time for reflection on their behavior: While reflection can be helpful, unsupervised alone time may increase the risk of relapse in clients with alcohol use disorder and does not actively promote self-control.

B. Discuss strategies with the client to reduce alcohol consumption gradually: Gradual reduction is not always safe due to the risk of withdrawal complications. Abstinence under supervision is the recommended approach for alcohol use disorder.

C. Have the client's partner assume responsibility for monitoring the client's alcohol intake: Delegating responsibility to a family member undermines the client’s autonomy and does not foster personal self-control or coping skills.

D. Give positive feedback to the client for using adaptive coping strategies: Reinforcing the use of healthy coping mechanisms encourages self-control, builds confidence, and promotes continued use of adaptive strategies to manage stress without relying on alcohol.

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Correct Answer is B

Explanation

Rationale:

A. Position the child at a 10° to 20° angle after feeding: This angle is too low to effectively reduce the risk of aspiration. The child should remain in at least a 30° to 45° upright position during and after feeding for optimal safety.

B. Measure the tubing from the nose to the distal port: Correct placement measurement involves determining the appropriate tube length from the tip of the nose to the earlobe and then to the xiphoid process. Measuring to the distal port ensures accurate placement for safe feeding.

C. Warm the formula in the microwave: Microwaving can create uneven heating and hot spots that may burn the gastrointestinal mucosa. Formula should be warmed by placing the container in warm water and checking the temperature before administration.

D. Complete the feeding in 5 min: Rapid feeding increases the risk of nausea, vomiting, and aspiration. Feedings should be administered slowly over the recommended time frame to allow for tolerance and digestion.

A. Administer calcium gluconate B. Discontinue the infusion. C. Assess the fetal heart rate. D. Obtain the client's magnesium level.

Correct Answer is B

Explanation

A. Administer calcium gluconate: Calcium gluconate is the antidote for magnesium sulfate toxicity, but it should be given after stopping the infusion and assessing the client’s respiratory status. Immediate discontinuation takes priority.

B. Discontinue the infusion: Difficulty breathing indicates a potential magnesium sulfate toxicity or respiratory depression, which is a life-threatening emergency. The first action is to stop the infusion to prevent further accumulation.

C. Assess the fetal heart rate: Monitoring the fetus is important, but maternal safety takes priority over fetal assessment in a potential toxic reaction. Stabilizing the mother comes first.

D. Obtain the client's magnesium level: Lab assessment is useful for confirming toxicity, but it should not delay immediate intervention. Stopping the infusion takes precedence over obtaining levels.

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A nurse is caring for a client admitted for alcohol use disorder who reports using alcohol to deal with stress. Which of the following actions should the nurse take to assist the client in maintaining self-control of the behavior?

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