A nurse is reviewing the medical record of an older adult client who is confused to place and time. Which of the following actions should the nurse plan to take?
Place the client on a low-protein diet
Restrict the client's intake of dietary sodium.
Ask the provider to decrease the magnesium hydroxide dosage.
Request a prescription to discontinue diphenhydramine.
The Correct Answer is C
Choice A rationale:
Placing the client on a low-protein diet is not appropriate based solely on the provided information.
Choice B rationale:
Restricting dietary sodium might be considered for specific conditions but is not directly related to the client's confusion.
Choice C rationale:
A high magnesium level can contribute to confusion in older adults. Requesting a reduction in the magnesium hydroxide dosage can help address this issue.
Choice D rationale:
Discontinuing diphenhydramine might be considered if it is contributing to the client's confusion, but there is no specific information provided to support this action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Drainage in the Hemovac is an expected finding postoperatively and is not as urgent as nonreactive pupils.
Choice B rationale:
Periorbital ecchymosis (bruising around the eyes) is not uncommon after a craniotomy and is not as urgent as nonreactive pupils.
Choice C rationale:
Nonreactive pupils can indicate a neurological emergency, such as increased intracranial pressure or potential damage to the cranial nerves. This finding requires immediate attention to prevent further complications.
Choice D rationale:
Hemoglobin level of 11 g/dL is within a normal range and is not a priority concern.
Correct Answer is A
Explanation
Choice A rationale:
Following hypospadias repair, a urinary catheter is often placed to ensure proper healing. The duration of catheterization varies, but about 1 week is a common timeframe.
Choice B rationale:
Clamping the catheter tubing for extended periods is not a standard practice and can cause discomfort and complications.
Choice C rationale:
Applying antifungal ointment is not typically required after hypospadias repair.
Choice D rationale:
A prophylactic antibiotic is not typically prescribed for 6 weeks following hypospadias repair.
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