In a long-term care facility, a nurse is having a discussion with the nurse aides about ways to deal with dementia clients who are uncooperative with mouth care. Appropriate methods to use include which of the following?
Having another nurse aide assist in holding the client’s mouth open with a tongue depressor
Involving the client in the process of oral hygiene, such as using the hand-over-hand technique to brush the client's teeth
Speaking to the client sternly and instructing the client to open their mouth and cooperate immediately
Quickly performing oral hygiene without explanation since the client is uncooperative
The Correct Answer is B
Choice A reason: This method is not appropriate because it can cause physical and psychological harm to the client. It can injure the client's mouth, trigger a gag reflex, or cause choking. It can also make the client feel violated, frightened, or angry. This can worsen the client's behavior and damage the trust between the client and the caregiver.
Choice B reason: This method is appropriate because it can help the client maintain their dignity, autonomy, and sense of control. It can also stimulate the client's cognitive and motor skills, and encourage the client to participate in their own care. This can improve the client's mood and behavior, and foster a positive relationship between the client and the caregiver.
Choice C reason: This method is not appropriate because it can cause emotional and psychological harm to the client. It can make the client feel disrespected, humiliated, or threatened. It can also increase the client's anxiety, agitation, or resistance. This can worsen the client's behavior and damage the trust between the client and the caregiver.
Choice D reason: This method is not appropriate because it can cause physical and psychological harm to the client. It can injure the client's mouth, trigger a gag reflex, or cause choking. It can also make the client feel ignored, neglected, or devalued. This can worsen the client's behavior and damage the trust between the client and the caregiver.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Serum sodium levels are not the best determination of hydration in this client, as they can be affected by other factors, such as fluid intake, fluid loss, kidney function, or medication use. Serum sodium levels can be normal, high, or low in a dehydrated or overhydrated client, depending on the cause and type of the fluid imbalance.
Choice B reason: BUN stands for blood urea nitrogen, which is a waste product of protein metabolism that is excreted by the kidneys. BUN is not the best determination of hydration in this client, as it can be influenced by other factors, such as protein intake, liver function, or muscle breakdown. BUN can be high or low in a dehydrated or overhydrated client, depending on the cause and type of the fluid imbalance.
Choice C reason: Urine osmolality is the best determination of hydration in this client, as it measures the concentration of solutes in the urine, which reflects the ability of the kidneys to adjust the urine output according to the fluid status. Urine osmolality can indicate the degree of dehydration or overhydration in a client, as it increases or decreases in response to the fluid balance.
Choice D reason: Urine color is not the best determination of hydration in this client, as it can be affected by other factors, such as food, medication, or infection. Urine color can be dark or light in a dehydrated or overhydrated client, depending on the cause and type of the fluid imbalance.
Correct Answer is B
Explanation
Choice A reason: This method is not appropriate because it can cause physical and psychological harm to the client. It can injure the client's mouth, trigger a gag reflex, or cause choking. It can also make the client feel violated, frightened, or angry. This can worsen the client's behavior and damage the trust between the client and the caregiver.
Choice B reason: This method is appropriate because it can help the client maintain their dignity, autonomy, and sense of control. It can also stimulate the client's cognitive and motor skills, and encourage the client to participate in their own care. This can improve the client's mood and behavior, and foster a positive relationship between the client and the caregiver.
Choice C reason: This method is not appropriate because it can cause emotional and psychological harm to the client. It can make the client feel disrespected, humiliated, or threatened. It can also increase the client's anxiety, agitation, or resistance. This can worsen the client's behavior and damage the trust between the client and the caregiver.
Choice D reason: This method is not appropriate because it can cause physical and psychological harm to the client. It can injure the client's mouth, trigger a gag reflex, or cause choking. It can also make the client feel ignored, neglected, or devalued. This can worsen the client's behavior and damage the trust between the client and the caregiver.
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