A nurse is creating a plan of care for a newly admitted client who is visually impaired. Which of the following interventions should the nurse include in the plan?

Place a sign on the client's door indicating visual impairment.

Provide the client with a brightly colored plate and utensils.

When ambulating with the client, grasp the client's arm above the elbow.

Speak in an elevated tone of voice when providing care.

Answer and Explanation

The Correct Answer is C

A) Place a sign on the client's door indicating visual impairment:
While indicating the client’s visual impairment to staff can be helpful, privacy and dignity should also be considered. Alternative methods to inform the staff without compromising the client's privacy should be used.

B) Provide the client with a brightly colored plate and utensils:
Brightly colored plates and utensils can help clients with partial vision impairment but may not be significantly beneficial for those who are fully visually impaired.

C) When ambulating with the client, grasp the client's arm above the elbow:
Grasping the client's arm above the elbow is an effective way to guide a visually impaired person. This allows the client to follow the nurse's movements more naturally and ensures better support and guidance.

D) Speak in an elevated tone of voice when providing care:
Elevating the tone of voice is unnecessary and may be misinterpreted as condescending. Clear, normal, and respectful communication is essential for all clients, regardless of visual impairment.

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Correct Answer is D

Explanation

A) Administer a sedative medication to the client: While sedative medications can help manage acute anxiety, they should not be the first intervention. Medication administration comes after attempting non-pharmacological strategies to de-escalate the situation.

B) Encourage strenuous physical activity to decrease tension: Strenuous physical activity can sometimes exacerbate anxiety rather than alleviate it, particularly during a panic-level episode. It might not be safe or effective for immediate calming.

C) Encourage the client to explore feelings that contribute to anxiety: Exploring feelings is more appropriate once the client has been calmed. During a panic-level anxiety episode, the client may not be able to engage in reflective thinking or communication effectively.

D) Speak to the client using short and simple statements in calm voice: Using short, simple statements in a calm voice helps to provide clear and concise communication, which can be grounding and reassuring for someone experiencing panic-level anxiety. This approach helps to de-escalate the situation by reducing confusion and agitation.

A. Limit fluids that contain electrolytes. B. Eliminate sources of probiotics from the diet. C. Take docusate sodium twice daily. D. Avoid foods high in simple sugars.

Correct Answer is A

Explanation

A) "Limit fluids that contain electrolytes":
For a client with gastroenteritis, it is crucial to maintain hydration due to the risk of dehydration from diarrhea and vomiting. However, fluids containing electrolytes can help replenish lost electrolytes and are beneficial. The instruction to "limit" these fluids might be misunderstood as a need to avoid them, which is not appropriate. The aim should be to encourage adequate hydration with fluids that contain electrolytes.

B) "Eliminate sources of probiotics from the diet":
Probiotics can help restore the balance of gut bacteria and may be beneficial in managing gastroenteritis. Eliminating probiotics from the diet is not typically recommended and may not support the recovery process.

C) "Take docusate sodium twice daily":
Docusate sodium is a stool softener, generally used to relieve constipation. In the context of gastroenteritis, which typically involves diarrhea, this medication is not appropriate and could worsen the condition.

D) "Avoid foods high in simple sugars":
Foods high in simple sugars can exacerbate diarrhea by increasing osmotic load in the intestines, leading to more water being drawn into the gut. Avoiding these foods can help manage and reduce symptoms of gastroenteritis.

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A nurse is creating a plan of care for a newly admitted client who is visually impaired. Which of the following interventions should the nurse include in the plan?

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