Review Practice Exercise 4

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Practice Exercise 4

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Total Questions : 5

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Question 1:

The nurse is admitting a malnourished client with alcohol use disorder who presents with confusion.
Which of the following actions should the nurse prioritize?

A. Administer an intravenous dextrose infusion to correct hypoglycemia. B. Provide a high-protein, high-calorie meal as tolerated. C. Administer parenteral thiamine before any glucose is given. D. Initiate folic acid replacement therapy.

Answer and Explanation

Choice A:

Intravenous dextrose given first may correct hypoglycemia but can trigger Wernicke encephalopathy when thiamine is deficient. Glucose should not precede thiamine in this population. It poses a neurologic hazard. Therefore it is not the priority.

Choice B:

A high-protein, high-calorie meal supports long-term nutrition but does not address the acute deficiency. The oral route is also unreliable in a confused client. It is a later intervention. Therefore it is not the priority.

Choice C:

Parenteral thiamine before glucose replenishes the depleted cofactor before any glucose load increases metabolic demand. This sequence prevents precipitating or worsening Wernicke encephalopathy in a confused, malnourished client. It addresses the greatest neurologic risk. It is the priority action.

Choice D:

Folic acid replacement treats megaloblastic anemia but not the acute encephalopathic risk. It is beneficial yet not urgent at admission. It carries lower priority than thiamine. Therefore it is not the priority.

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Question 2:

The nurse is assessing a client with chronic alcohol misuse who cannot form new memories and fabricates detailed accounts to fill the gaps.
Which of the following conditions should the nurse suspect?

A. An alcohol-induced major neurocognitive disorder with acute confusion. B. Wernicke encephalopathy with ophthalmoplegia and ataxia. C. Hepatic encephalopathy with asterixis and elevated ammonia. D. Korsakoff syndrome.

Answer and Explanation

Choice A:

Alcohol-induced major neurocognitive disorder involves broad, global cognitive decline rather than a focused amnestic-confabulatory picture. Acute confusion is not the hallmark described. It lacks the specific confabulation pattern. Therefore it is incorrect.

Choice B:

Wernicke encephalopathy presents acutely with the triad of confusion, ophthalmoplegia, and ataxia. It is potentially reversible with thiamine and precedes Korsakoff. It is not primarily an amnestic disorder. Therefore it is incorrect.

Choice C:

Hepatic encephalopathy features asterixis, elevated ammonia, and fluctuating consciousness from liver failure. It does not produce the fixed amnesia with confabulation described. Its mechanism is metabolic, not amnestic. Therefore it is incorrect.

Choice D:

Korsakoff syndrome is suspected because the inability to form new memories combined with confabulation is its defining feature. Thiamine deficiency injures the mammillary bodies and thalamus. This yields profound amnesia. It is the correct condition.

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Question 3:

The nurse is preparing to manage alcohol withdrawal in a client with established alcoholic cirrhosis.
Which of the following medications should the nurse anticipate as the most appropriate?

A. Chlordiazepoxide B. Diazepam C. Clonidine D. Lorazepam

Answer and Explanation

Choice A:

Chlordiazepoxide is long-acting and undergoes oxidative metabolism with active metabolites. These accumulate in liver disease and prolong sedation. It risks excessive central depression. Therefore it is incorrect.

Choice B:

Diazepam has a long half-life and produces the active metabolite desmethyldiazepam through CYP oxidation. Accumulation in cirrhosis heightens sedation and respiratory risk. It is poorly cleared in liver failure. Therefore it is incorrect.

Choice C:

Clonidine is an alpha-2 agonist that blunts autonomic symptoms but does not prevent withdrawal seizures or delirium. It is adjunctive rather than primary. It leaves the seizure risk unaddressed. Therefore it is incorrect.

Choice D:

Lorazepam is preferred in cirrhosis because it is cleared by glucuronidation rather than oxidative CYP metabolism. It has no active metabolites and does not accumulate with impaired hepatic function. This limits oversedation risk. It is the most appropriate agent.

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Question 4:

The nurse is providing discharge teaching to a client newly prescribed disulfiram.
Which of the following instructions should the nurse include? Select all that apply

A. "You may resume moderate drinking once you skip a single dose." B. "Avoid mouthwash, aftershave, and cough syrups that contain alcohol." C. "A reaction can occur if you drink alcohol up to 14 days after the last dose." D. "This medication works by blocking opioid receptors to reduce your craving." E. "Even hidden amounts of alcohol in sauces or vinegars can trigger a reaction."

Answer and Explanation

Choice A:

Resuming moderate drinking after a skipped dose is false and dangerous. The enzyme inhibition persists for up to two weeks, so a reaction can still occur. This advice invites serious harm. Therefore it is incorrect.

Choice B:

Avoiding alcohol-containing products such as mouthwash, aftershave, and cough syrups prevents an unexpected reaction. Even topical or oral incidental alcohol can be absorbed and trigger symptoms. This teaching promotes safe avoidance. It should be included.

Choice C:

A reaction up to 14 days after the last dose reflects the irreversible enzyme inhibition. New aldehyde dehydrogenase must be synthesized before alcohol can be tolerated. This prolonged effect warrants continued caution. It should be included.

Choice D:

Blocking opioid receptors describes naltrexone, not disulfiram. Disulfiram works by inhibiting aldehyde dehydrogenase to create aversion. This states the wrong mechanism. Therefore it is incorrect.

Choice E:

Hidden alcohol in sauces and vinegars can also provoke the reaction. Clients must read labels and avoid foods prepared with alcohol. This reinforces thorough vigilance. It should be included.Rationale for incorrect answers:

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Question 5:

The nurse is assessing a client with a long history of chronic alcohol misuse.
Which of the following findings should the nurse anticipate? Select all that apply

A. Macrocytic anemia related to folate deficiency. B. Microcytic, hypochromic anemia related to iron overload. C. Atrial fibrillation consistent with "holiday heart syndrome." D. Symmetric distal sensory neuropathy in a stocking-glove pattern. E. Hypertrophic obstructive cardiomyopathy with outflow tract obstruction.

Answer and Explanation

Choice A:

Macrocytic anemia arises from folate deficiency and the direct toxic effect of alcohol on the marrow. Enlarged red cells reflect impaired DNA synthesis. It is an expected hematologic finding. It should be selected.

Choice B:

Microcytic, hypochromic anemia from iron overload is inconsistent with the typical alcohol picture. Alcohol causes macrocytosis, and iron overload does not produce this anemia pattern. It is the wrong morphology. Therefore it is incorrect.

Choice C:

Atrial fibrillation consistent with holiday heart syndrome follows heavy or binge drinking. Alcohol provokes this supraventricular arrhythmia even without structural disease. It is a recognized cardiac finding. It should be selected.

Choice D:

Symmetric distal stocking-glove neuropathy results from thiamine deficiency and axonal toxicity. Sensory loss begins in the feet and hands. It is a classic peripheral neuropathy. It should be selected.Rationale for incorrect answers:

Choice E:

Hypertrophic obstructive cardiomyopathy is a genetic disorder unrelated to alcohol. Chronic alcohol causes dilated, not hypertrophic, cardiomyopathy. It attributes the wrong pathology to alcohol. Therefore it is incorrect.

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