A client admitted to the nursing unit for treatment of his heart failure has a history of alcohol abuse. The nurse should:

Question

a. collaborate with the health care provider for a prescription for scheduled doses of chlordiazepoxide.
b. closely monitor the client for delirium tremors common within the first 24 hours after hospital admission.
c. be sure all side rails are in the up position and that the client is properly restrained.
d. have members of the client's family take turns staying at the bedside, so the client is never left alone.

Answer 1

ANS: A

Feedback
A Correct: Being proactive in preparation for DTs at 72 hours will lessen the severity of the DTs, thus improving client safety.
B Incorrect: DTs usually do not occur before 48 hours after cessation of alcohol and usually occur around 72 hours.
C Incorrect: Restraints are not appropriate unless the client poses a safety risk to self.
D Incorrect: This may pose a hardship on the family and is not an appropriate request.