A nurse is assisting with the plan of care for a client who has dementia and often wanders in the halls at night. Which of the following Interventions should the nurse recommend including in the plan of care?

Turning off the lights in the client's room at bedtime

Limiting the client's physical activity during the day

Having the client wear incontinence briefs after dinner

Labeling the client's bathroom door

Answer and Explanation

The Correct Answer is D

A. Turning off the lights in the client's room at bedtime: Keeping the room well-lit at night can help prevent disorientation and reduce the risk of falls for clients with dementia. Turning off lights may increase confusion and make wandering more dangerous, so this is not an appropriate intervention.

B. Limiting the client's physical activity during the day: Reducing daytime activity can increase restlessness and nighttime wandering. Encouraging safe physical activity during the day helps expend energy and may improve sleep patterns, making limitation counterproductive.

C. Having the client wear incontinence briefs after dinner: While incontinence briefs can prevent accidents, they do not address the underlying cause of nighttime wandering and may contribute to agitation or discomfort if used inappropriately.

D. Labeling the client's bathroom door: Clear visual cues, such as labeled doors, help clients with dementia navigate their environment independently and safely. This intervention reduces confusion, supports orientation, and can decrease wandering behaviors.

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Correct Answer is C

Explanation

A. Inform visitors to remain at least 3 feet away from the client: Maintaining a 3-foot distance is part of droplet precautions, not contact precautions. Contact precautions focus on preventing the spread of infections transmitted by direct or indirect contact, so spatial distancing is not the primary intervention.

B. Apply sterile gloves when entering the client's room: Sterile gloves are not required for routine care under contact precautions. Clean (non-sterile) gloves are appropriate to prevent transmission of pathogens when touching the client or contaminated surfaces. Sterile gloves are reserved for invasive procedures.

C. Leave all equipment that is used routinely in the client's room: Equipment such as stethoscopes, blood pressure cuffs, or thermometers should remain in the room to prevent cross-contamination. Dedicated or disposable equipment helps reduce the spread of infectious agents to other clients, which is a key component of contact isolation.

D. Place the client in a negative-pressure airflow room: Negative-pressure rooms are required for airborne precautions to prevent aerosolized pathogens from leaving the room. Contact isolation does not require negative-pressure airflow, as the primary transmission route is via direct or indirect contact, not airborne particles.

A. A majority of older adults have dementia. B. Most older adults are isolated from family and friends. C. There is an increased rate of depression in older adults. D. Older adults have decreased interest in sexual activity.

Correct Answer is C

Explanation

A. A majority of older adults have dementia: Dementia is not a normal part of aging and does not affect the majority of older adults. While the risk of cognitive impairment increases with age, most older adults maintain functional cognitive abilities. Presenting dementia as typical aging reinforces misconceptions and stigma.

B. Most older adults are isolated from family and friends: Although some older adults experience social isolation, many maintain active relationships with family, friends, and community groups. Social engagement varies widely and is influenced by health status, mobility, and support systems rather than age alone.

C. There is an increased rate of depression in older adults: Older adults may have an increased risk for depression due to factors such as chronic illness, bereavement, reduced independence, and social role changes. Depression in this population is often underdiagnosed because symptoms may overlap with medical conditions.

D. Older adults have decreased interest in sexual activity: Sexual interest and activity can continue throughout the lifespan. While physiologic changes may alter sexual response, desire does not universally decline with age. Many older adults remain sexually active and value intimacy.

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A nurse is assisting with the plan of care for a client who has dementia and often wanders in the halls at night. Which of the following Interventions should the nurse recommend including in the plan of care?

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