Alcoholism (13 Questions)

1. M. Tremblay, 52 years old, is admitted to the medical unit for pancreatitis. He reports drinking 1.5 liters of vodka daily for many years. He has not consumed alcohol for 10 hours. You notice he is sweating, restless, and his hands are shaking.
Vital Signs: BP 150/92, HR 112, Temp 37.8°C.

Question:
What is your priority nursing assessment? *

Assess his level of depression and suicidal ideation.

Assess for early signs of alcohol withdrawal using a standardized tool (CIWA-Ar).

Ask him when he plans to stop drinking permanently.

Encourage him to drink fluids to flush the alcohol.

2. M. Tremblay, 45 years old, is admitted to the surgical unit for a fractured femur after a fall. He tells you he usually drinks a "6-pack of beer" every evening to relax. It has been 24 hours since his last drink. When you enter the room, he startles easily, his hands are shaking (tremors) when he reaches for water, and he is irritable.
Vital Signs: BP 145/90, HR 104, T 37.2°C.

Question:
How do you interpret these clinical signs? *

He is in pain from the fracture; administer the prescribed analgesic.

He is experiencing early Alcohol Withdrawal Syndrome.

He is having an allergic reaction to the hospital linens.

He is developing a post-operative infection (sepsis).

3. M. Gagnon, 55 years old, is admitted to the ER found unconscious in a park. He is known for chronic alcoholism and malnutrition. He is confused, has difficulty walking (ataxia), and cannot move his eyes properly (nystagmus).

Medical Orders:
*IV Normal Saline 100 mL/hr.
*Thiamine (Vitamin B1) 100 mg IM STAT.
*Dextrose 50% IV push if hypoglycemia.

Question:
Which medication should be administered first and why? *

Dextrose, because hypoglycemia kills brain cells.

Normal Saline, to treat the dehydration immediately.

Thiamine, to prevent Wernicke’s Encephalopathy.

Administer all simultaneously to save time.

4.1 Mme Roy, 60 years old, is on Day 3 of admission. She was previously calm but is now screaming that there are bugs crawling all over her bed (tactile hallucinations). She is sweating profusely (diaphoretic), and her heart rate is 130 bpm. She does not know where she is.

Question:
What is the priority intervention? *

Call the family to sit with her to calm her down.

Administer an antipsychotic like Haloperidol to stop the hallucinations.

Turn off the lights and minimize stimulation.

Notify the physician immediately; she is likely experiencing Delirium Tremens (DTs).

4.2 he physician prescribes the following orders STAT:
*Lorazepam (Ativan) 2 mg IV push now.
*Thiamine 100 mg IM.
*Normal Saline 1000 mL IV bolus.
*Physical restraints (4-point) PRN for safety.

Question:
What is your next priority intervention? *

Apply the physical restraints immediately to prevent her from injuring herself while hallucinating.

Administer the Thiamine IM to prevent further neurological damage.

Start the IV fluid bolus to treat her profuse sweating and dehydration.

Administer the Lorazepam (Ativan) 2 mg IV as prescribed.

5. M. Lefebvre is being discharged from a rehabilitation center. He has been prescribed Disulfiram (Antabuse) to help maintain sobriety. You are providing health teaching.

Question:
Which statement by M. Lefebvre indicates he understands the teaching? *

"I can drink one beer occasionally, but I shouldn't have hard liquor."

"I have to read labels on mouthwash, cough syrup, and aftershave to make sure they contain no alcohol."

"If I feel a craving, I should take an extra pill."

"This medication stops the cravings for alcohol."

6. Mme Cloutier is admitted for withdrawal. Medical Order: Lorazepam (Ativan) 1-2 mg PO q 4h PRN based on CIWA score.

You assess Mme Cloutier. She reports nausea (no vomiting), she has moderate tremors with arms extended, she is anxious but re-orientable, and she is sweating lightly on her forehead.

Question:
What is your nursing action regarding the medication? *

Do not administer medication; her symptoms are too mild.

Administer the maximum dose (2 mg) immediately to prevent seizures.

Call the doctor to change the order to IV administration.

Calculate the CIWA-Ar score based on these findings to determine the appropriate dose.

7. M. Dubé is hospitalized for liver cirrhosis. His wife is crying and says, "His drinking has destroyed our family." M. Dubé responds, "She’s overreacting. I have a glass of wine with dinner like everyone else. I can stop whenever I want; I just have bad luck with my liver."

Question:
Which defense mechanism is M. Dubé utilizing? *

Projection.

Rationalization.

Denial.

Displacement.

8. Mme Poirier, 72 years old, visits the clinic for insomnia. She is well-dressed and polite. She mentions she has a "nightcap" to help her sleep. You suspect alcohol misuse.

Question:
You decide to use the CAGE questionnaire. Which question belongs to this screening tool? *

"Do you drink alone?"

"Have you ever felt you should cut down on your drinking?"

"How many drinks do you have in a week?"

"Do you hide alcohol in your home?"

9. M. Fortin, 30 years old, was admitted 12 hours ago. He suddenly cries out, his body stiffens, and he begins to convulse rhythmically (generalized tonic-clonic seizure).
Medical Order: Seizure precautions in place.

Question:
What is your priority intervention during the active seizure? *

Insert a tongue depressor to keep the airway open.

Restrain his limbs to prevent him from falling out of bed.

Turn him to his side and protect his head from injury.

Run to the nursing station to get the Lorazepam.

10. M. Lambert, 58 years old, has end-stage alcoholic cirrhosis with massive ascites (fluid in the abdomen). He is short of breath and his O2 saturation is 92%. He is currently lying flat in bed.

Question:
What is the simplest nursing intervention to improve his respiratory status? *

Elevate the head of the bed to High-Fowler’s position.

Encourage him to cough and deep breathe.

Administer a diuretic immediately.

Turn him on his stomach (prone position).

11. Mme Caron is being discharged after detox. She is worried about relapsing because her husband also drinks heavily at home.

Question:
What advice is most critical for her immediate discharge plan? *

"You just need to use your willpower to say no."

"You should avoid going home if your environment is unsafe for sobriety; let's contact a shelter."

"Ask your husband to promise not to drink in front of you."

"Take your Antabuse only on days you feel weak."

12. M. Lapointe, 48 years old, was admitted yesterday for a tibia fracture. He has a history of daily alcohol consumption. It has been 36 hours since his last drink. He rings the call bell complaining of "shaking inside" and severe nausea. Upon assessment, you note that he is anxious, sweaty, and has a moderate tremor when extending his arms.
Vital Signs: BP 158/96 mmHg, HR 104 bpm.
Assessment: You perform the CIWA-Ar (Clinical Institute Withdrawal Assessment) scale, and M. Lapointe scores a 14 (indicating moderate withdrawal).

Medical Orders:
*Diet as tolerated.
*Diazepam (Valium) 10 mg PO every hour PRN for CIWA score of 10 or greater.
*Vital signs q 4h.

Question:
Based on your assessment and the medical orders, what is your appropriate intervention? *

Document the CIWA score of 14 and re-assess the patient in 4 hours.

Administer an antiemetic for the nausea and teach deep breathing exercises for the anxiety.

Call the physician immediately to request an order for IV fluids.

Administer Diazepam (Valium) 10 mg PO as prescribed.