A nurse is caring for a client who was admitted with delirium five days ago. The client seeks permission from the nurse before performing ADLs. Which of the following actions should the nurse take?
Quiz the client with orientation questions.
Allow the client to function independently.
Prepare the client for discharge.
Determine the client's level of awareness.
The Correct Answer is D
A: Quizzing the client might be part of an assessment but not the initial action.
B: Allowing independent function is important, but assessing cognitive function to tailor support is essential first.
C: Preparing for discharge might be premature without assessing readiness and stability.
D: Assessing awareness and cognitive function helps guide appropriate support and independence levels.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A: While mental illness could be a risk, social isolation is a more direct and immediate risk given the scenario.
B: Geographical and population factors contributing to a lack of social interaction directly suggest social isolation.
C: Substance abuse might develop as a coping mechanism but is not the most immediate risk.
D: Depression could be a consequence of social isolation, but the primary risk here is the isolation itself.
Correct Answer is B
Explanation
A: Exercise is beneficial for clients with Alzheimer’s disease, as it promotes overall health and can help maintain motor skills.
B: Regular orientation helps maintain cognitive function for as long as possible and provides a sense of security.
C: Large group therapy might be overwhelming and ineffective due to cognitive impairments.
D: While some stimulation is good, an overly stimulating environment can be confusing and anxiety-inducing for someone with Alzheimer's.
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