During the evening shift, a client with Alzheimer's disease becomes agitated, restless, and repeatedly attempts to leave the room unattended. Which intervention should the nurse implement?

Take a walk with the client.

Sit the client in a recliner.

Administer a sleeping medication.

Move the client to a locked unit.

Answer and Explanation

The Correct Answer is A

Choice A reason: Taking a walk with the client is an effective intervention for addressing agitation and restlessness in a client with Alzheimer's disease. Physical activity can help reduce anxiety and agitation, and walking provides a safe and structured way for the client to expend energy while being closely supervised.

Choice B reason: Sitting the client in a recliner may provide temporary comfort, but it does not address the underlying agitation and restlessness. The client may still attempt to leave the room and become more frustrated if their movement is restricted.

Choice C reason: Administering a sleeping medication can have sedative effects, but it should not be the first-line intervention for agitation and restlessness in clients with Alzheimer's disease. Non-pharmacological approaches, such as walking, should be tried first. Sedatives can also increase the risk of falls and other complications.

Choice D reason: Moving the client to a locked unit may be necessary for safety in some cases, but it should not be the initial intervention for agitation and restlessness. The goal is to use less restrictive interventions first to manage the client's behaviour.

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Correct Answer is C

Explanation

Choice A reason: Respiratory acidosis is characterized by a low pH and an elevated PaCO2 due to hypoventilation, which results in CO2 retention. The ABG results in this case show a normal PaCO2, making this option incorrect.

Choice B reason: Metabolic acidosis is characterized by a low pH and a low HCO3 due to an accumulation of acids or loss of bicarbonate. The ABG results show a high pH and a high HCO3, which are opposite to the findings of metabolic acidosis.

Choice C reason: Metabolic alkalosis is characterized by a high pH and an elevated HCO3. This condition can result from excessive loss of stomach acid due to vomiting or the use of diuretics. The ABG results show a pH of 7.50 and HCO3 of 33 me/L, both indicative of metabolic alkalosis.

Choice D reason: Respiratory alkalosis is characterized by a high pH and a low PaCO2 due to hyperventilation, which leads to CO2 loss. The ABG results show a normal PaCO2, ruling out respiratory alkalosis as the correct diagnosis.

A. "I will lift weights every other day." B. "I will avoid sitting and crossing my legs." C. "I will be able to stand as long as my legs do not hurt." D. "I will need to get someone to walk my dog."

Correct Answer is B

Explanation

Choice A reason: Lifting weights every other day might not be harmful, but it is not specifically relevant to managing chronic venous insufficiency. The statement does not indicate an understanding of the specific care needed for this condition.

Choice B reason: Avoiding sitting and crossing the legs is an important measure to prevent worsening of chronic venous insufficiency. Crossing legs can impede blood flow and worsen symptoms. This statement reflects an understanding of how to manage the condition.

Choice C reason: Standing for prolonged periods, even if there is no pain, can exacerbate venous insufficiency. This statement shows a misunderstanding of the importance of movement and elevation of the legs to promote blood flow.

Choice D reason: Walking is generally encouraged to promote circulation in clients with venous insufficiency. The statement about needing someone else to walk the dog may indicate a misunderstanding of the benefits of regular, gentle exercise.

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During the evening shift, a client with Alzheimer's disease becomes agitated, restless, and repeatedly attempts to leave the room unattended. Which intervention should the nurse implement?

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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