A nurse is caring for a client who has dementia and is experiencing an increased number of falls.
Which of the following actions should the nurse take?
Request a consult with recreational therapy.
Lower the window shade in the client's room.
Place the client in a room close to the nurses' station.
Obtain a PRN prescription for a vest restraint.
The Correct Answer is C
Choice A rationale
Recreational therapy may be beneficial, but it is not the primary intervention to reduce the risk of falls.
Choice B rationale
Lowering the window shade could help with sensory overload, but it does not directly address fall prevention.
Choice C rationale
Placing the client near the nurses' station allows for closer monitoring and quicker intervention, which can help prevent falls.
Choice D rationale
Vest restraints should only be used as a last resort after other less restrictive measures have been tried and found ineffective.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Low tolerance for frustration is a risk factor for becoming a perpetrator of child abuse as it can lead to impulsive and aggressive behaviors.
Choice B rationale
Absence of impulsive behaviors is typically a protective factor, not a risk factor, for perpetrating child abuse.
Choice C rationale
Involvement in community activities is a protective factor and not a risk factor for child abuse perpetration.
Choice D rationale
A submissive personality is not a recognized risk factor for becoming a perpetrator of child abuse. Perpetrators often exhibit controlling and aggressive behaviors. .
Correct Answer is A
Explanation
Choice A rationale
Veracity refers to the ethical principle of truthfulness and honesty. Reinforcing information on the potential adverse effects of a medication with the client demonstrates veracity, as it involves providing accurate and complete information to ensure the client's informed decision-making and understanding of their treatment.
Choice B rationale
Encouraging the client to attend a daily exercise program on the unit reflects the principle of beneficence, which is about promoting the client's well-being and acting in their best interests. While it is an important aspect of care, it does not directly demonstrate veracity.
Choice C rationale
Respecting the client's right to refuse to attend a group therapy session aligns with the ethical principle of autonomy, which emphasizes the client's right to make decisions about their own care. It supports the client's independence but is not an example of veracity.
Choice D rationale
Maintaining the client's confidentiality about a substance use disorder adheres to the principle of confidentiality, which involves protecting the client's private information. It ensures the client's privacy but does not specifically address veracity, which is focused on truthfulness in communication. .
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