The nurse is caring for a client with alcohol use disorder. Which of the following nursing interventions is appropriate for a client to prevent Korsakoff’s syndrome?

Encouraging the client to consume foods high in vitamin B1.

Implementing strict bed rest to conserve energy.

Restricting fluid intake to prevent water intoxication.

Administering thiamine supplements as prescribed.

Answer and Explanation

The Correct Answer is D

Choice A Reason: Encouraging the client to consume foods high in vitamin B1 (thiamine) is beneficial, but it may not be sufficient alone to prevent Korsakoff’s syndrome in individuals with alcohol use disorder. Thiamine is crucial for brain function, and its deficiency can lead to Wernicke-Korsakoff syndrome. However, due to malabsorption issues common in alcohol use disorder, dietary intake alone might not meet the necessary thiamine levels.

Choice B Reason: Implementing strict bed rest to conserve energy is not directly related to preventing Korsakoff’s syndrome. While rest is important for overall health, it does not address the thiamine deficiency that leads to this condition. Korsakoff’s syndrome is primarily caused by a lack of thiamine, and conserving energy does not mitigate this deficiency.

Choice C Reason: Restricting fluid intake to prevent water intoxication is not relevant to preventing Korsakoff’s syndrome. Water intoxication is a separate issue and does not address the thiamine deficiency that causes Korsakoff’s syndrome. Proper hydration is important, but it does not prevent the neurological damage associated with thiamine deficiency.

Choice D Reason: Administering thiamine supplements as prescribed is the most appropriate intervention to prevent Korsakoff’s syndrome. Thiamine supplementation is crucial for individuals with alcohol use disorder because their bodies often cannot absorb enough thiamine from food alone. Thiamine is essential for brain function, and its deficiency can lead to severe neurological damage. Administering supplements ensures that the client receives an adequate amount of this vital nutrient.

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Correct Answer is C

Explanation

d. Speaks another language and is in need of an interpreter to translate.

The correct answer is c. Is accompanied by a family member who will not let the client answer questions.

Choice A Reason: Is from another state and says they are here on a long vacation

This choice is not necessarily indicative of human trafficking. While being from another state and claiming to be on a long vacation might raise some questions, it is not a definitive sign of trafficking. Many people travel for various reasons, and this alone does not suggest that the person is a victim of human trafficking.

Choice B Reason: Has a cell phone that is not working in the emergency department

This choice is also not a strong indicator of human trafficking. A non-working cell phone can be due to many reasons, such as technical issues or lack of service. While traffickers may sometimes control their victims’ communication devices, this alone is not enough to suspect trafficking.

Choice C Reason: Is accompanied by a family member who will not let the client answer questions

This choice is a strong indicator of human trafficking. Traffickers often control their victims’ interactions with others, including healthcare providers. If a family member or companion is overly controlling and does not allow the client to speak for themselves, it raises a significant red flag for potential trafficking. This behavior is often seen in trafficking situations to prevent the victim from disclosing their true circumstances.

Choice D Reason: Speaks another language and is in need of an interpreter to translate

This choice is not a definitive sign of human trafficking. Many people who are not victims of trafficking may speak another language and require an interpreter. While language barriers can complicate communication, they do not alone indicate trafficking. However, if combined with other signs, it could contribute to a suspicion of trafficking.

A. Provide the daughter and client with nutritional counseling B. Request a psychiatric evaluation for the client C. Take the history from the daughter because of the client’s confusion D. Interview the client alone and assess for abuse

Correct Answer is D

Explanation

d. Interview the client alone and assess for abuse

Explanation of Choices

Choice A Reason: Provide the Daughter and Client with Nutritional Counseling

While nutritional counseling is important, especially given the client’s malnourished state, it is not the immediate priority in this scenario. The client’s reluctance to speak and the daughter’s interruptions suggest that there may be underlying issues that need to be addressed first. Nutritional counseling can be provided later, once the immediate concerns have been resolved.

Choice B Reason: Request a Psychiatric Evaluation for the Client

Requesting a psychiatric evaluation may be necessary if there are signs of mental health issues, but it is not the first step in this situation. The priority is to ensure the client’s safety and well-being by addressing any immediate concerns, such as potential abuse. A psychiatric evaluation can be considered after the initial assessment and intervention.

Choice C Reason: Take the History from the Daughter Because of the Client’s Confusion

Taking the history from the daughter might seem practical due to the client’s confusion, but it is not the best approach in this case. The daughter’s constant interruptions and the client’s reluctance to speak raise concerns about the reliability of the information provided by the daughter. It is crucial to gather information directly from the client whenever possible to ensure an accurate assessment.

Choice D Reason: Interview the Client Alone and Assess for Abuse

Interviewing the client alone and assessing for abuse is the most appropriate intervention. The client’s reluctance to speak and the daughter’s interruptions could indicate that the client is being controlled or intimidated. Conducting a private interview allows the client to speak freely and provides an opportunity to identify any signs of abuse or neglect. Ensuring the client’s safety and addressing any immediate risks is the top priority.

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The nurse is caring for a client with alcohol use disorder. Which of the following nursing interventions is appropriate for a client to prevent Korsakoff’s syndrome?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing care for a client who is malnourished and appears exhausted. What data would cause the nurse to suspect the client is a victim of human trafficking? The client:

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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