An older client with dementia who is refusing to allow an unlicensed assistive personnel (UAP) bathe her is becoming increasingly agitated and stating the UAP wants to hurt her and tie her up. Which approach should the nurse use with the client?

Reduce the client's interaction with others during the day.

Use distraction and therapeutic communication skills.

Awaken the client earlier for daily morning care.

Clarify reality with the client about delusional thoughts.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Reducing the client's interaction with others during the day is not the most appropriate approach in this situation. It may lead to increased social isolation and worsen the client's agitation and delusions. It does not address the client's emotional distress.

Choice B rationale:

Using distraction and therapeutic communication skills is the most suitable approach for a client with dementia who is experiencing agitation and delusional thoughts. Distraction techniques can help redirect the client's focus away from distressing thoughts, and therapeutic communication skills, such as active listening and validation, can help the client feel understood and supported.

Choice C rationale:

Awakening the client earlier for daily morning care may further disrupt the client's sleep patterns and worsen agitation. It does not address the underlying issue of delusional thoughts and the client's emotional distress.

Choice D rationale:

Clarifying reality with the client about delusional thoughts can be counterproductive in dementia care. The client's cognitive impairment may make it challenging for them to understand or accept the clarification, leading to increased frustration and agitation. It is essential to use a more empathetic and therapeutic approach.

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Correct Answer is B

Explanation

Choice A rationale:

Drinking electrolyte fluid replacements may be necessary if the client is dehydrated due to diabetic ketoacidosis (DKA). However, addressing the increased thirst, which is a sign of DKA, should involve insulin administration to correct the underlying problem of high blood sugar.

Choice B rationale:

Giving a dose of regular insulin as prescribed is the most appropriate action to address increased thirst in a client with type 1 diabetes and early signs of DKA. Elevated blood sugar levels are the cause of the increased thirst, and insulin helps lower blood sugar levels.

Choice C rationale:

Resuming normal physical activity may not be advisable when a client is experiencing early signs of DKA. Strenuous physical activity can exacerbate hyperglycemia, and the primary focus should be on insulin administration and rehydration.

Choice D rationale:

Measuring urine output over the next 24 hours is important for monitoring hydration status in a client with DKA. However, the immediate priority is to address the increased thirst and hyperglycemia with insulin therapy.

A. The client is the oldest of their siblings. B. The client's father lives in the client's home. C. The client's mother has asthma. D. The client has several siblings.

Correct Answer is D

Explanation

Choice A rationale:

The client being the oldest of their siblings is not a contributing factor related to the development of conduct disorder. Family dynamics such as birth order may have some influence on personality traits, but they are not a primary factor in the development of conduct disorder.

Choice B rationale:

The fact that the client's father lives in the client's home is a family dynamic, but it does not necessarily contribute to the development of conduct disorder. Other factors related to parenting style, communication, and family interactions play a more significant role in the development of conduct disorder.

Choice C rationale:

The client's mother having asthma is a medical condition and not a family dynamic that directly contributes to the development of conduct disorder. Conduct disorder is more closely associated with social, environmental, and psychological factors.

Choice D rationale:

The presence of several siblings in the family dynamic can contribute to the development of conduct disorder. Increased family size can lead to competition for attention and resources, which may affect the child's behavior and interactions. Sibling relationships and family dynamics are crucial in shaping a child's behavior and psychological well-being.

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An older client with dementia who is refusing to allow an unlicensed assistive personnel (UAP) bathe her is becoming increasingly agitated and stating the UAP wants to hurt her and tie her up. Which approach should the nurse use with the client?​​​​​​

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When developing a teaching plan for a client with newly diagnosed type 1 diabetes, the nurse should explain that an increased thirst is an early sign of diabetic ketoacidosis (DKA). Which action should the nurse instruct the client to implement if this sign of DKA occurs?

Correct Answer is B

Explanation

A nurse is teaching a newly licensed nurse about contributing factors that can lead to the development of conduct disorder. Which of the following factors related to family dynamics should the nurse include in the teaching?

Correct Answer is D

Explanation

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The unlicensed assistive personnel (UAP) tells the practical nurse (PN) that a male client is angry because the night shift took over 2 hours to bring him the pain medication, he had to request three times. Which action should the PN implement first?

An older client with dementia who is refusing to allow an unlicensed assistive personnel (UAP) bathe her is becoming increasingly agitated and stating the UAP wants to hurt her and tie her up. Which approach should the nurse use with the client?