A nurse is reinforcing teaching about home care with the family of a client who has Alzheimer's disease and wanders at night. Which of the following instructions should the nurse include?

Keep the client's bedroom area dark at night.

Have the client exercise 30 minutes before bedtime.

Place the client's mattress on the bedroom floor.

Encourage the client to nap often during the day.

Answer and Explanation

The Correct Answer is C

Choice A reason: Keeping the client's bedroom area dark at night is not advisable for individuals with Alzheimer's disease who wander. Darkness can increase confusion and the risk of falls. It is better to have a night light or dim lighting to help the client navigate safely if they get up during the night. Proper lighting can reduce disorientation and provide a safer environment for those who wander.

Choice B reason: Having the client exercise 30 minutes before bedtime is not recommended. Exercise close to bedtime can be stimulating and might make it more difficult for the client to fall asleep. It is generally advised to avoid vigorous physical activity at least a few hours before bedtime to promote better sleep. Gentle activities earlier in the day can help improve sleep quality without causing overstimulation.

Choice C reason: Placing the client's mattress on the bedroom floor is a practical safety measure for clients with Alzheimer's disease who wander at night. This approach minimizes the risk of injury from falls, as the client will be closer to the ground. By reducing the height of the bed, families can create a safer sleeping environment and help prevent potential injuries due to wandering and confusion.

Choice D reason: Encouraging the client to nap often during the day can disrupt nighttime sleep patterns. Excessive daytime napping can lead to difficulties falling asleep at night and contribute to nighttime wandering. It is essential to maintain a balanced routine with limited napping during the day to promote better sleep at night. Structured activities and proper sleep hygiene can help improve nighttime rest.

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Correct Answer is D

Explanation

Choice A reason: This response shifts the focus from the client to the nurse, which is not therapeutic in this context. The client needs the opportunity to express their own feelings and experiences rather than hearing about the nurse's personal history. It is important for the nurse to remain professional and centered on the client's needs during conversations about grief and depression.

Choice B reason: Encouraging the client to start participating in usual activities might be premature, especially if they are not ready. Grief is a process that takes time, and clients need to move at their own pace. Instead, it is more supportive to listen and validate their current feelings rather than pushing them to resume normal activities too soon.

Choice C reason: Saying that "everyone feels depressed during the grieving process" can invalidate the client's unique experience and feelings. While it is true that grief is common after a loss, the intensity and way it manifests can vary greatly among individuals. This response may come across as dismissive, implying that the client's feelings are not important or unique.

Choice D reason: Asking the client to talk about their relationship with their partner is a therapeutic approach. This response invites the client to share their memories and feelings, which can help in processing their grief. It shows empathy and provides a safe space for the client to express their emotions, fostering a supportive and healing environment.

A. A client who has borderline personality disorder and acts impulsively B. A client who has avoidant personality disorder and becomes anxious in social situations C. A client who has dependent personality disorder and clings to nursing staff D. A client who has histrionic personality disorder and seeks constant attention E. The correct answer is: a) A client who has borderline personality disorder and acts impulsively

Correct Answer is A

Explanation

Choice A reason: Clients with borderline personality disorder (BPD) who act impulsively can be a significant safety concern. Impulsive behaviors in BPD can include self-harm, suicidal ideation, substance abuse, and other risky actions. These behaviors can pose immediate and severe threats to the client's safety and require close monitoring, intervention, and support from the healthcare team to manage and mitigate these risks effectively.

Choice B reason: While clients with avoidant personality disorder may experience significant anxiety in social situations, this typically does not pose an immediate threat to their physical safety. The primary concern with avoidant personality disorder is social isolation and the impact on their mental health and quality of life. Anxiety in social situations can be distressing, but it does not inherently lead to dangerous behaviors.

Choice C reason: Clients with dependent personality disorder often exhibit clingy and submissive behaviors, relying heavily on others for support and decision-making. While this can create challenges in managing boundaries and fostering independence, it is not typically associated with immediate safety risks. The focus of care for these clients is on building self-reliance and coping skills.

Choice D reason: Clients with histrionic personality disorder often seek constant attention and may display dramatic, exaggerated behaviors. While this can be disruptive and challenging in a therapeutic setting, it does not usually pose a direct threat to the client's safety. The primary concern is managing interpersonal dynamics and ensuring that the client's behaviors do not negatively impact the therapeutic environment.

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