While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms?
MAST
CAGE
CIWA
DMSE
The Correct Answer is C
A. The Michigan Alcohol Screening Test (MAST) is a tool used to screen for alcohol abuse or dependence, but it does not specifically assess withdrawal symptoms.
B. The CAGE questionnaire is used to screen for alcohol abuse, but it does not assess withdrawal symptoms.
C. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) is a validated tool used to assess the severity of alcohol withdrawal symptoms. It includes various criteria such as agitation, tremor, and hallucinations.
D. The Delirium Rating Scale (DMSE) is used to assess the severity of delirium, which can be caused by various factors including alcohol withdrawal, but it is not specific to alcohol withdrawal.
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Related Questions
Correct Answer is D
Explanation
A. Attempting to deescalate the client is important, but ensuring immediate safety is the top priority.
B. Continuing to observe the client may lead to a further escalation of the situation. Safety measures should be taken first.
C. While offering medications may be necessary, ensuring safety is the immediate priority before any interventions are implemented.
D. Ensuring the safety of the client and others is the priority in situations of escalating agitation.
Correct Answer is ["A","B","C"]
Explanation
A. Brain atrophy is a common physiological change in the brain of individuals with Alzheimer's disease.
B. An overabundance of plaques, specifically amyloid beta, is a characteristic feature of Alzheimer's disease.
C. An overabundance of tangles, specifically tau protein, is also a characteristic feature of Alzheimer's disease.
D. Enlargement of the hippocampus is not typically associated with Alzheimer's disease; rather, it tends to shrink.
E. Enlarged cerebral cortex is not a typical physiological change in Alzheimer's disease; it actually tends to shrink.
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