A client admitted for alcohol withdrawal is tremulous, diaph… | MyMerci
Family DynamicsPSI
Question
A client admitted for alcohol withdrawal is tremulous, diaphoretic, and reports seeing insects on the wall. Which nursing action is most appropriate?
1Encourage the client to ambulate alone to reduce anxiety.
2Implement seizure precautions and administer prescribed benzodiazepine therapy.✓ Correct answer
3Turn off all lights and leave the client alone to sleep.
4Offer caffeinated beverages to increase alertness.
Explanation
Severe alcohol withdrawal can cause hallucinations, autonomic instability, and seizures. Seizure precautions and prescribed benzodiazepine therapy are appropriate safety-focused interventions. Leaving the client alone or stimulating with caffeine increases risk.
In-depth explanation
Clinical Judgment Use the client cues, timing, labs, and safety risks to select the response that best fits Severe alcohol withdrawal.
Memory Tip Match the strongest cue cluster to the safest nursing judgment.
KR vs US NCLEX items reward cue-based priority thinking rather than isolated recall.
Clinical scenario
Clinical Practice Guide For Severe alcohol withdrawal, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
Caution Do not choose an action from one isolated cue when the full scenario changes priority or safety.
Key concepts
Alcohol Withdrawal — A syndrome after reduced alcohol intake that can include tremor, agitation, hallucinations, and seizures.
Seizure Precautions — Safety measures to reduce injury if a seizure occurs.
Benzodiazepine — A medication class commonly used to manage withdrawal symptoms and seizure risk.