An older female adult who was admited to a long-term care facility yesterday is confused about what day of the week it is. Her history does not indicate that she was confused prior to admission. What action should the practical nurse (PN) take?
Document the client's loss of memory in the record.
Notify the family of the change in the client's condition.
Remind the client what day of the week it is.
Encourage the client to rest during the day.
The Correct Answer is C
it provides reality orientation and helps the client cope with the change in environment. The client may be experiencing acute confusion or delirium due to stress, medication, infection, or other factors. The PN should remind the client of the date, time, and place frequently and use other strategies such as calendars, clocks, and familiar objects to reduce confusion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This is the best intervention for the PN to implement because it monitors the client's fluid status and helps detect fluid overload, which can cause hypertension and neurological changes. The PN should weigh the client at the same time, on the same scale, and with the same clothing every day.
Correct Answer is ["A","B","D"]
Explanation
A) Correct - Providing contact information for community resources is important as it ensures that parents have access to support and information beyond the hospital setting.
B) Correct - Offering information about pool safety is relevant, especially considering that the child experienced a submersion injury. This education can help prevent future accidents.
C) Incorrect - While discussing child neglect is important, it may not be the most appropriate time to bring up potential charges. The immediate focus should be on education and support.
D) Correct - Informing parents about when to follow up with the child's pediatrician ensures continuity of care and monitoring of the child's condition after discharge.
E) Incorrect - Instructions on how to access long-term home care may not be necessary if the child's condition does not warrant it. This option can be excluded based on the information provided.
F) Incorrect - Assessing the parent's coping skills is important, but it is not part of pre- discharge education. Education related to the child's condition and safety is more pertinent.
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