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REF: Pages 22-31, 32 | Pages 22-39, 69 (Table 22-5)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Safe, Effective Care Environment

6. A hospitalized patient diagnosed with alcohol use disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n) a. narcotic analgesic, such as hydromorphone. b. sedative, such as lorazepam or chlordiazepoxide. c. antipsychotic, such as olanzapine or thioridazine. d. monoamine oxidase inhibitor antidepressant, such as phenelzine.

ANS: B

Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-31, 32, 72 (Table 22-6) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. Check the patient every 15 minutes b. One-on-one supervision c. Keep the room dimly lit d. Force fluids

7. A hospitalized patient diagnosed with alcohol use disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated?

ANS: B

One-on-one supervision is necessary to promote physical safety until sedation reduces the patient’s feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels fall.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 22-32, 39, 40, 69 (Table 22-5)

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment a. “Sooner or later, alcohol will kill you. Then what will happen to your children?” b. “I hear a lot of defensiveness in your voice. Do you really believe this?” c. “If you were coping so well, why were you hospitalized again?” d. “Tell me what happened the last time you drank.”

8. A patient diagnosed with alcohol use disorder says, “Drinking helps me cope with being a single parent.” Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively?

ANS: D