Safety is the nursing priority for a client who is at risk for alcohol withdrawal. A care plan for the client who is in withdrawal must include which nursing interventions?
Seizure precautions and vital signs.
Observation for symptoms, vital signs, seizure and fall precautions, medications as ordered.
Suicide precautions because suicide atempts are frequent during withdrawal.
Vital signs and medications as prescribed.
The Correct Answer is B
Choice A reason: Seizure precautions and monitoring vital signs are important but not comprehensive enough for a complete care plan.
Choice B reason: This is the correct choice. It encompasses a broad range of interventions that are critical for a client undergoing alcohol withdrawal, including monitoring for various symptoms, ensuring safety, and administering medications.
Choice C reason: While suicide precautions are important, they are not the only intervention needed for a client in alcohol withdrawal.
Choice D reason: Monitoring vital signs and administering medications are important but do not cover all necessary precautions such as seizure and fall precautions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Implementing relaxation techniques is a helpful goal, but it does not directly address the compulsive behavior which is the focus of response prevention therapy.
Choice B reason: Understanding the benefits of deep breathing is beneficial, but it is not the primary goal of response prevention therapy.
Choice C reason: Confronting the trigger is part of the process, but the ultimate goal is to reduce anxiety associated with delaying or preventing the ritual.
Choice D reason: This is the correct choice. The primary goal of response prevention therapy is to reduce the anxiety associated with OCD rituals, making this the most appropriate goal.
Correct Answer is A
Explanation
Choice A reason: This is the correct choice. These behaviors are indicative of the inatention and hyperactivity- impulsivity symptoms of ADHD.
Choice B reason: Being withdrawn in social contexts but engaging with family does not provide clear evidence of ADHD.
Choice C reason: Stubbornness and resistance to directions alone are not sufficient to diagnose ADHD.
Choice D reason: Cruelty to animals and lack of guilt are not symptoms of ADHD and may indicate other behavioral issues.
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