A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?

Correct Answer: A

Rationale: The correct answer is option A: Place in a side-lying position with the head of the bed elevated. This intervention is the priority because the client has a high blood alcohol level and is difficult to arouse, indicating potential risk for aspiration and airway compromise. Placing the client in a side-lying position helps prevent aspiration if vomiting occurs, and elevating the head of the bed can further reduce the risk of aspiration. Option B, administering disulfiram (Antabuse) immediately, is incorrect as it is used in the treatment of alcohol dependence to deter alcohol consumption by causing adverse reactions. However, in this acute situation, the priority is ensuring the client's safety and managing immediate risks. Option C, giving lorazepam (Ativan) PRN for signs of withdrawal, is also incorrect. While managing withdrawal symptoms is important, the priority in this case is addressing the client's compromised airway and potential for aspiration due to the high blood alcohol level. Option D, providing thiamine and folate supplements as prescribed, is important for clients with alcohol use disorder to prevent nutritional deficiencies. However, in the immediate post-admission period for a client with a high blood alcohol level and altered level of consciousness, airway management and safety take precedence over nutritional considerations. In the educational context, it is crucial for nurses to prioritize interventions based on the client's immediate needs and potential risks. Understanding the implications of high blood alcohol levels, altered consciousness, and the risk of aspiration guides nurses in providing safe and effective care for clients with substance use disorders and co-occurring conditions like closed head injuries.

Correct Answer: B

Rationale: The most important instruction to include in the discharge teaching for a male client with schizophrenia who has been stabilized with antipsychotic medications is to adhere to the medication regimen as prescribed. Medication adherence is crucial in managing schizophrenia, preventing relapse, and maintaining stability. While seeing the psychiatrist regularly (Choice A) is important, adherence to medication is more critical for the client's immediate well-being. Avoiding caffeine and alcohol (Choice C) may be beneficial but is not as crucial as medication adherence. Daily exercise (Choice D) is important for overall health but is not the most critical instruction for managing schizophrenia.

Correct Answer: D

Rationale: The priority nursing intervention for an adolescent admitted for self-harming behaviors is to provide a safe environment free of potential self-harm tools. This intervention aims to prevent immediate harm to the client. Assessing suicidal ideation is important but ensuring physical safety takes precedence. While educating about healthy coping mechanisms is crucial for long-term management, immediate safety is the priority. Family therapy sessions are beneficial for holistic care but are not the immediate priority when the client's safety is at risk.

Correct Answer: B

Rationale: The correct answer is B: Improvement in depressive symptoms. Lamotrigine is commonly used as a mood stabilizer and is particularly effective in managing depressive symptoms in bipolar disorder. While it may also help with preventing manic episodes, its primary indication is for treating depressive symptoms. Choices A, C, and D are incorrect because lamotrigine is not specifically indicated for reducing manic episodes, anxiety symptoms, or increasing sleep duration in bipolar disorder.

Correct Answer: B

Rationale: When discontinuing sedative-hypnotic medications, it is crucial to gradually taper them off to prevent withdrawal symptoms. Choice A is incorrect because withdrawal symptoms can be severe, not always mild. Choice C is incorrect as increasing caffeine intake can exacerbate sleep disturbances. Choice D is incorrect because changes in sleep patterns are expected during discontinuation of sedative-hypnotic medications.