The police bring a client to the emergency department to be ...

[mpobi80]

The police bring a client to the emergency department to be examined after an automobile accident.
  He is ataxic, has slurred speech, and seems mildly confused. His blood alcohol level is 400 mg/dL
  (0.40 mg).
 
  From the relation between his behavior and his blood alcohol level, the nurse can make
  the assessment that the client
  a. rarely drinks alcohol.
  b. has a high tolerance to alcohol.
  c. has been treated with disulfiram (Antabuse).
  d. has ingested both alcohol and sedative drugs recently.

Question 2

During morning care, the nursing assistant asks a client with dementia How was your night? The
  client replies It was lovely. My husband and I went out to dinner and to a movie..
 
  The nurse who
  overhears this should make the assessment that the client is
  a. demonstrating a sense of humor.
  b. using confabulation.
  c. perseverating.
  d. delirious.

[firehawk60]

Answer to Question 1

B
A nontolerant drinker would be in coma with a blood alcohol level of 400 mg/dL (0.40 mg). The
fact that the client is walking and talking shows a discrepancy between blood alcohol level and
expected behavior and strongly suggests that the client's body has become tolerant to the drug.
Option C: If disulfiram and alcohol are ingested together, an entirely different clinical picture would
result. Option D: The blood alcohol level gives no information about ingestion of other drugs.

Answer to Question 2

B
Confabulation is the making up of stories or answers to questions by a person who does not
remember. It is a defensive tactic to protect self-esteem and prevent others from noticing memory
loss. Option A: The client's response was not given facetiously, so it cannot be assessed as an
attempt at humor. Option C: Perseveration refers to repeating a word or phrase over and over.
Option D: Delirium cannot be assessed as present in this scenario.