An older adult client is admitted to the psychiatric unit for assessment of a recent onset of dementia. The practical nurse (PN) notes that in the evening this client often becomes restless, confused, and agitated. Which intervention is most important for the PN to implement?

Administer a prescribed PRN benzodiazepine at the onset of a confused state.

Ensure that the client is assigned to a room close to the nurses' station.

Postpone administration of nighttime medications until after 2300.

Ask family members to remain with the client in the evenings from 1700 to 2000.

Answer and Explanation

The Correct Answer is B

A. Administering a PRN benzodiazepine is a reactive measure and might not be the best first line of intervention for managing the client's restlessness and confusion, as it does not address the underlying issue.
B. Assigning the client to a room close to the nurses' station can help manage restlessness, confusion, and agitation by ensuring the client is monitored more closely and can receive timely interventions.
C. Postponing nighttime medications might not address the immediate issues of restlessness and confusion, and could potentially disrupt the client's sleep-wake cycle.
D. Asking family members to stay with the client provides support but may not be a feasible or consistent solution for managing the client’s evening agitation and restlessness.

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Correct Answer is ["C","D","E"]

Explanation

A. Limiting fresh fruits and vegetables is not necessary for clients with ascites due to cirrhosis unless they are causing specific issues like bloating or discomfort. Fresh fruits and vegetables are generally healthy and can be part of a balanced diet unless restricted for other reasons.
B. Consuming concentrated sweets to boost energy is not a recommended dietary strategy for managing ascites or cirrhosis. This approach may lead to excessive calorie intake without addressing the nutritional needs for a balanced diet.
C. Eating six small meals daily can help manage low appetite and energy levels by providing consistent nutrition throughout the day. Small, frequent meals are easier to consume and can help maintain adequate caloric intake for individuals with low appetite.
D. Choosing small helpings from lean protein sources is a good suggestion for managing ascites and cirrhosis. Lean proteins are important for maintaining muscle mass and supporting overall health without exacerbating liver disease.
E. Avoiding adding salt to foods helps manage fluid retention associated with ascites. Reducing sodium intake is crucial for managing ascites and preventing further fluid accumulation.

A. Course breath sounds B. Irritability C. Seizure activity D. Decreased level of consciousness E. Bradycardia

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"C"},"E":{"answers":"A"}}

Explanation

Coarse breath sounds are typically associated with respiratory distress, indicating fluid or secretions in the airways.

Irritability can be a sign of both cerebral edema and respiratory distress as it may stem from hypoxia or increased intracranial pressure.

Seizure activity is more specifically related to cerebral edema, which can increase intracranial pressure and provoke seizures.

Decreased level of consciousness can occur in both conditions: cerebral edema (due to increased intracranial pressure) and respiratory distress (due to hypoxia).

Bradycardia is more indicative of cerebral edema, especially when associated with increased intracranial pressure and resultant autonomic dysregulation.

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An older adult client is admitted to the psychiatric unit for assessment of a recent onset of dementia. The practical nurse (PN) notes that in the evening this client often becomes restless, confused, and agitated. Which intervention is most important for the PN to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with recurrent ascites from cirrhosis describes having no appetite or energy to the home health practical nurse (PN). What diet suggestions should the PN provide for the client? Select all that apply.

Correct Answer is ["C","D","E"]

Explanation

Exhibits Click to mark whether the following are signs and symptoms of cerebral edema, respiratory distress, or both.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"C"},"E":{"answers":"A"}}

Explanation

The parents of a child with pre-diabetes report to the practical nurse (PN) that the child wants to join a soccer team. Which action is best for the PN to implement?

An older adult client returns to the clinic for a follow-up visit with the healthcare provider for management of depression related to the death of a child, who was killed 6 months ago by a drunk driver. Which finding indicates to the practical nurse (PN) that the client is improving?

The practical nurse (PN) is assisting a client to the bathroom after a right cataract extraction. The client has an eye shield over the right eye. How should the PN assist the client during ambulation?

In assessing a 2-year-old boy with croup, the practical nurse (PN) finds that he has become increasingly irritable and has developed tachypnea and resting stridor. Which intervention is best for the PN to implement?

The practical nurse (PN) is documenting the insertion of a urinary catheter for a female client with urinary retention. What information should the PN include during the electronic documentation of the procedure? Select all that apply.

A client receives a prescription for digoxin 0.25 mg by mouth. The medication is available in 0.125 mg tablets. How many tablets should the practical nurse (PN) administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

In performing a focused assessment, the practical nurse (PN) lifts the client's skin as seen in the photo. Which should the PN do next?