The nurse is assessing patients for impending alcohol withdrawal. The nurse assesses the patient with which of the following conditions as a priority?

Reporting muscle aches and frequent stumbling

Dozing off in chair and not recognizing staff

Pulse. 118 beats/min; and BP 160/90

Pulse, 58 beats/min; and BP 100/60

Answer and Explanation

The Correct Answer is C

A.   While these symptoms can be associated with alcohol withdrawal, they are not as indicative of an immediate medical emergency as tachycardia and hypertension.
B.   While these symptoms may suggest cognitive impairment, they are not as indicative of impending alcohol withdrawal syndrome as tachycardia and hypertension.
C.   Alcohol withdrawal can lead to various physiological changes, including increased heart rate and blood pressure. A pulse of 118 beats/min and a blood pressure of 160/90 indicate a significant increase in both vital signs, which could be a sign of impending alcohol withdrawal syndrome.
D.   These vital signs are within normal limits and do not indicate a significant risk of alcohol withdrawal syndrome.

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Correct Answer is D

Explanation

A. While this question may provide some insight into the patient's drinking habits, it is not as direct and informative as asking about the quantity of alcohol consumed.
B. This question may reveal a history of alcohol-related problems, but it does not provide information about the patient's current drinking habits.
C. While this question may be relevant in some cases, it is not a universal indicator of alcohol abuse. Many people may drink alone without having a problem with alcohol.
D. To assess an older adult's risk potential for alcohol abuse, it is important to get a sense of their drinking habits. Asking about the number of alcoholic drinks consumed each week is a direct and informative way to assess their drinking patterns.

A. Limit the number of visitors the patient can have B. Suggest shorter visits to the patients visitors C. Require visitors to check in at the front desk D. Only allow family members to visit the patient

Correct Answer is B

Explanation

A. Limiting the number of visitors may be a necessary step if the patient is becoming overwhelmed or tired. However, this approach might not consider the cultural significance of extended family and community in Arab American culture, where family involvement is often highly valued.
B. Suggesting shorter visits is a more balanced approach. It acknowledges the patient's need for rest while still respecting the importance of family and community involvement. This action can help manage the patient's fatigue while allowing them to maintain cultural and familial connections. It’s a compromise that accommodates both the patient's health needs and cultural values.
C. Requiring visitors to check in at the front desk can help manage visitor flow and ensure that the patient is not overwhelmed. However, this action does not directly address the issue of visitor duration or frequency, which might still lead to patient fatigue. It also might not align with cultural expectations of openness and hospitality in Arab American culture, where family and visitors are often seen as central to the patient’s well-being.
D. Allowing only family members to visit might help reduce the number of visitors and ensure that the patient receives support from those closest to them. However, this approach may be too restrictive and could potentially isolate the patient from their broader support network, which might be an important aspect of their cultural practices. It also does not address the underlying issue of managing visitor fatigue.

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The nurse is assessing patients for impending alcohol withdrawal. The nurse assesses the patient with which of the following conditions as a priority?

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Naxlex Comprehensive Predictor Exams

An older adult patient is being assessed for possible alcohol abuse. To best assess the patient's risk potential, the nurse asks:

Correct Answer is D

Explanation

A nurse is caring for an Arab American patient in the hospital. The patient has many visitors who seem to be tiring the patient. What action by the nurse is best?

Correct Answer is B

Explanation

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