A nurse in a provider's office is assessing a client who has dementia. Which of the following findings should the nurse expect?

Rationale for correct choices:

• Mood: The client demonstrated a sad mood on Day 1, expressing feelings of hopelessness and suicidal ideation. While the mood lightened by Day 5, continued assessment is necessary to monitor for any further mood changes or shifts, particularly given the prior suicidal ideation.
• Energy level: The client is now requesting to jog and asking for financial planning recommendations, which could suggest increased energy or impulsivity. This shift in energy level after a depressive episode should be carefully assessed to ensure it is not indicative of a manic episode or potential risk for unsafe behavior.

Rationale for incorrect choices:

• Cognitive orientation: The client has been alert and oriented x 4 throughout the assessment, with no signs of cognitive impairment. Therefore, there is no immediate concern regarding cognitive orientation that requires follow-up.
• Family history: Although the family history of anxiety disorder is relevant for understanding the client’s background, it does not require immediate follow-up in this scenario. The priority is addressing the client's current emotional and energy-related changes.
• Substance use history: While the client has a history of opioid and cannabis use, this is important for overall treatment planning and future care. However, the immediate concern is the client's current emotional state and potential changes in mood or energy, rather than a substance use history that has already been considered in the client’s care plan.

A. "I will learn how to voluntarily control my blood pressure and heart rate": This statement refers to biofeedback, which focuses on controlling physiological responses like heart rate and blood pressure. It is not part of cognitive reframing, which targets thoughts.

B. "I will focus on a mental image while concentrating on my breathing.": This is describing guided imagery and relaxation techniques. While these are effective stress management strategies, they are not part of cognitive reframing, which focuses on altering negative thought patterns.

C. "I will progressively relax each of my muscle groups when feeling stressed.": This statement refers to progressive muscle relaxation, which helps with physical relaxation but does not involve changing thought patterns.

D. "I will practice replacing negative thoughts with positive self-statements": This is an accurate description of cognitive reframing. It involves identifying negative thoughts and replacing them with more balanced or positive ones to manage stress and improve emotional well-being.