D449 Psychology and Mental Health - Set 3 - Part 3

Correct Answer: CAGE alcohol screening questionnaire

Option d is correct because the CAGE questionnaire is a validated four-question screening tool that assesses alcohol use problems through questions about Cutting down, Annoyance from criticism, Guilt about drinking, and Eye-opener morning drinks. Option a is incorrect because the Columbia Suicide Severity Rating Scale is specifically designed to assess suicidal ideation and behavior, not alcohol use patterns, and contains different screening questions focused on self-harm risk. Option b is incorrect because the Patient Health Questionnaire is a screening instrument designed to identify depression symptoms and severity, and does not include the specific alcohol-focused questions described in this assessment scenario. Option c is incorrect because the Beck Depression Inventory measures the presence and severity of depressive symptoms through self-reported cognitive, affective, and somatic items, not alcohol consumption patterns or related behaviors.

Correct Answer: Have others been annoyed by drinking

Option a is correct because the "A" in CAGE stands for Annoyed, representing the screening question about whether other people have annoyed or criticized the patient about their drinking behavior and consumption patterns. Option b is incorrect because asking about evening alcohol consumption is not part of the validated CAGE screening tool; the tool focuses on qualitative behavioral indicators rather than specific timing or quantity of alcohol consumption. Option c is incorrect because quantifying daily drink consumption is not a CAGE question; the tool deliberately avoids quantity-based questions in favor of assessing behavioral and emotional markers of problematic alcohol use patterns. Option d is incorrect because asking when drinking patterns began explores drinking history rather than current behavioral indicators, and the CAGE tool focuses on present-tense experiences like guilt, annoyance, and the need for morning drinks.

Correct Answer: Check all products for alcohol content

Option c is correct because disulfiram reacts with any form of alcohol including hidden sources like mouthwash, cough syrup, rubbing alcohol, and cooking extracts, and patients must diligently check all products to prevent potentially fatal reactions. Option a is incorrect because avoiding aged cheese and tyramine-rich foods is the dietary restriction for patients taking monoamine oxidase inhibitor antidepressants to prevent hypertensive crisis, not a precaution related to disulfiram therapy. Option b is incorrect because monitoring for fine hand tremors is a nursing consideration for patients taking lithium for bipolar disorder, as tremors can indicate approaching toxicity, and is unrelated to disulfiram alcohol abstinence therapy. Option d is incorrect because maintaining adequate sodium intake is the critical dietary teaching for patients on lithium therapy to prevent toxicity from lithium accumulation, and has no connection to disulfiram treatment for alcohol use disorder.

Correct Answer: BRANDY for disulfiram-alcohol reaction

Option b is correct because BRANDY represents the disulfiram-alcohol reaction: Bodily fluids and sweating, Rapid heart rate, Avoid alcohol, Nausea and vomiting, Decreased blood pressure, and respiratory depression matching this patient's symptoms. Option a is incorrect because ENRAGED describes first-generation antipsychotic side effects including extrapyramidal symptoms, neuroleptic malignant syndrome, seizures, anticholinergic effects, gynecomastia, sexual dysfunction, and damaged liver function. Option c is incorrect because SCHIZO represents second-generation atypical antipsychotic metabolic side effects including sexual dysfunction, cholesterol increase, hyperglycemia, increased weight, sedation, and orthostatic hypotension. Option d is incorrect because LETHAL describes panic-level anxiety symptoms including losing touch with reality, extreme fright, tremors, hallucinations, abdominal distress, and large dilated pupils, not a medication-alcohol interaction.

Correct Answer: Avoid any product containing alcohol entirely

Option d is correct because disulfiram reacts with any amount of alcohol regardless of the source or concentration, and even small quantities in over-the-counter products can trigger a potentially fatal reaction including severe hypotension and respiratory depression. Option a is incorrect because there is no safe threshold of alcohol consumption while taking disulfiram, and even trace amounts of alcohol from products like cold medicine can initiate the dangerous disulfiram-alcohol reaction requiring emergency intervention. Option b is incorrect because the disulfiram-alcohol interaction occurs with any alcohol source regardless of whether the product is prescription or over-the-counter, making all alcohol-containing products equally dangerous during therapy. Option c is incorrect because while selecting alcohol-free alternatives is good advice, the most critical teaching is the absolute prohibition on any alcohol-containing product, as the patient needs to understand the severity of t

Correct Answer: Thiamine administered intravenously

Option a is correct because patients with chronic alcohol dependence are commonly deficient in thiamine, also known as vitamin B1, and replacement is essential during detoxification to prevent dangerous neurological complications like Wernicke's encephalopathy. Option b is incorrect because while vitamin C supports immune function and may be depleted in chronic alcohol users, it is not the priority vitamin supplement specifically required to prevent the serious neurological complications associated with alcohol withdrawal. Option c is incorrect because folic acid deficiency can occur in chronic alcohol use, but thiamine replacement takes clinical priority because thiamine deficiency directly causes Wernicke's encephalopathy, a potentially irreversible neurological emergency. Option d is incorrect because vitamin D supplementation addresses bone health concerns, and while chronic alcohol users may have multiple nutritional deficiencies, preventing Wernicke's encephalopath

Correct Answer: Wernicke's encephalopathy into Korsakoff syndrome

Option c is correct because thiamine deficiency causes Wernicke's encephalopathy, which if untreated can progress to Korsakoff syndrome, an irreversible condition involving severe memory impairment and confabulation that cannot be reversed once established. Option a is incorrect because delirium tremens does not progress into permanent psychosis; it is an acute withdrawal complication treated with benzodiazepines, and preventing it requires different interventions than thiamine supplementation during detoxification. Option b is incorrect because acute dystonia progressing to tardive dyskinesia describes antipsychotic medication complications related to dopamine blockade, which is entirely unrelated to thiamine deficiency or alcohol withdrawal neurological complications. Option d is incorrect because serotonin syndrome and neuroleptic crisis are two separate medication-induced emergencies with different causes and treatments, and neither is related to thiamine deficiency or alcohol

Correct Answer: Oral chlordiazepoxide for stabilization

Option b is correct because oral chlordiazepoxide is commonly used during early alcohol withdrawal to manage mild to moderate symptoms, prevent progression to delirium tremens, and keep patients stable during the detoxification process. Option a is incorrect because intravenous lorazepam is reserved for severe withdrawal symptoms and active delirium tremens, and using it for mild early withdrawal with an oriented cooperative patient represents unnecessarily aggressive intervention. Option c is incorrect because haloperidol is an antipsychotic that lowers the seizure threshold, making it potentially dangerous during alcohol withdrawal when seizure risk is already elevated, and it does not address the underlying withdrawal physiology. Option d is incorrect because naloxone is the specific reversal agent for opioid overdose and works on opioid receptors, having no pharmacological role in managing alcohol withdrawal symptoms or preventing progression to delirium tremens.

Correct Answer: Magnesium level correction

Option d is correct because magnesium depletion is common in chronic alcohol dependence, and replacement is an important component of withdrawal management because low magnesium contributes to seizure risk and cardiac instability. Option a is incorrect because while potassium monitoring is part of general electrolyte management, magnesium replacement is specifically highlighted in alcohol withdrawal protocols because chronic alcohol use preferentially depletes magnesium stores significantly. Option b is incorrect because calcium gluconate is not a primary electrolyte supplement specifically associated with alcohol withdrawal management protocols, and does not address the characteristic magnesium depletion seen in this patient population. Option c is incorrect because sodium bicarbonate is used to correct metabolic acidosis, and while acid-base disturbances can occur in alcohol withdrawal, it is not the specific electrolyte replacement routinely ordered alongside benzodiazepines and thi

Correct Answer: Dehydration from fluid losses

Option c is correct because the combination of profuse diaphoresis and fever during delirium tremens causes significant fluid losses leading to dehydration, which must be corrected with oral or intravenous fluids to prevent cardiovascular collapse. Option a is incorrect because hyperglycemia from metabolic stress is primarily a concern associated with second-generation antipsychotic medications and metabolic syndrome, not a characteristic secondary complication of active delirium tremens. Option b is incorrect because hypernatremia is not the expected electrolyte disturbance during delirium tremens; fluid losses from diaphoresis and fever more commonly cause volume depletion and dehydration requiring fluid replacement therapy. Option d is incorrect because delirium tremens characteristically causes elevated body temperature from autonomic hyperactivity, and the clinical concern is hyperthermia with resulting fluid loss, not hypothermia or temperature dropping.