The nurse is assessing an elder client for hydration. What is the best determination of hydration in this client?

Choice A reason: FACE pain rating scale is not the most useful assessment tool for a cognitively impaired patient who cannot accurately report pain, as it relies on the patient's ability to match their pain intensity to a series of facial expressions. The patient may not be able to understand or use the scale appropriately.

Choice B reason: OLDCART-based assessment tool is not the most useful assessment tool for a cognitively impaired patient who cannot accurately report pain, as it relies on the patient's ability to provide detailed information about the onset, location, duration, characteristics, aggravating factors, relieving factors, and treatment of their pain. The patient may not be able to recall or communicate this information effectively.

Choice C reason: PAINAD scale is the most useful assessment tool for a cognitively impaired patient who cannot accurately report pain, as it relies on the nurse's observation of the patient's behavior and physiological responses to pain. The scale consists of five items: breathing, vocalization, facial expression, body language, and consolability. Each item is scored from 0 to 2, and the total score ranges from 0 to 10. A higher score indicates more pain.

Choice D reason: 0 to 10 numeric pain scale is not the most useful assessment tool for a cognitively impaired patient who cannot accurately report pain, as it relies on the patient's ability to rate their pain intensity on a scale from 0 (no pain) to 10 (worst possible pain). The patient may not be able to comprehend or use the scale correctly.

Choice E reason: None of the above is not the correct answer, as there is one choice that is the most useful assessment tool for a cognitively impaired patient who cannot accurately report pain.

Choice A reason: Wearing sturdy open-toed shoes is not a good idea for a person with diabetes, as it can expose the feet to injuries or infections that can be hard to heal. The nurse would advise the patient to wear well-fitting, closed-toe shoes that protect the feet and prevent blisters or ulcers.

Choice B reason: Monitoring blood glucose levels before and after a walk is a sensible instruction for a person with diabetes, as physical activity can lower blood glucose levels and affect the need for medication or insulin. The nurse would advise the patient to check his blood glucose levels before and after a walk, and adjust his food intake or medication accordingly.

Choice C reason: Omitting antidiabetic medication is a dangerous instruction for a person with diabetes, as it can cause hyperglycemia or high blood glucose levels that can lead to serious complications. The nurse would advise the patient to take his medication as prescribed, and consult his doctor if he needs to change his dosage.

Choice D reason: Preparing to administer insulin is an unnecessary instruction for a person with type 2 diabetes who is not on insulin therapy, as it can cause hypoglycemia or low blood glucose levels that can be life-threatening. The nurse would advise the patient to follow his doctor's recommendations on whether he needs insulin or not, and how to use it safely.