Which is the priority nursing intervention for a client admitted ...

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Which is the priority nursing intervention for a client admitted for acute alcohol intoxication?
 
  A. Darken the room to reduce stimuli in order to prevent seizures.
  B. Assess aggressive behaviors in order to intervene to prevent injury to self or others.
  C. Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system.
  D. Teach the negative effects of alcohol on the body.

Question 2

During group therapy, a client diagnosed with alcohol use disorder states, I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her.
 
  How should a nurse interpret this statement?
 
  A. The client is using denial by avoiding responsibility.
  B. The client is using displacement by blaming his wife.
  C. The client is using rationalization to excuse his alcohol dependence.
  D. The client is using reaction formation by appealing to the group for sympathy.

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Answer to Question 1

ANS: B
Symptoms associated with the syndrome of alcohol intoxication include but are not limited to aggressiveness, impaired judgment, impaired attention, and irritability. Safety is a nursing priority in this situation.

Answer to Question 2

ANS: C
The nurse should interpret that the client is using rationalization to excuse his alcohol use disorder. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.

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TYSM

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