The nurse is caring for an older adult client with Alzheimer's disease who becomes increasingly agitated and is speaking to someone who is not visible to the nurse. Which action should the nurse implement?

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

Awaken the client for reality checks every 4 hours at night.

Clarify reality with the client about delusional thoughts.

Use distraction and therapeutic communication skills.

Answer and Explanation

The Correct Answer is D

Choice A reason: Reducing the client's interaction with others during the day can potentially isolate the client and exacerbate feelings of agitation and confusion. Social interaction is important for cognitive stimulation and emotional well-being, even for clients with Alzheimer's disease.

Choice B reason: Awaking the client for reality checks every 4 hours at night can disrupt the client's sleep pattern, leading to increased agitation and confusion. Proper rest is crucial for clients with Alzheimer's disease to help manage their symptoms effectively.

Choice C reason: Clarifying reality with the client about delusional thoughts can sometimes increase agitation if not done sensitively. Clients with Alzheimer's disease may not respond well to direct confrontation about their delusions. It is often more effective to use techniques that do not directly challenge their perception of reality.

Choice D reason: Using distraction and therapeutic communication skills is the best approach. This strategy helps redirect the client's attention to a different, more calming activity, which can reduce agitation. Therapeutic communication involves understanding and validating the client's feelings while gently guiding them towards a more positive state. This approach respects the client's experience and provides support without escalating their agitation.

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Correct Answer is A

Explanation

Choice A reason: Describing the use of an elimination diet to find trigger foods is appropriate for clients with Crohn's disease. This approach helps identify specific foods that may cause or exacerbate symptoms, allowing the client to avoid them and manage their condition more effectively.

Choice B reason: Instructing the client to avoid foods with gluten is not necessary unless they have a confirmed gluten intolerance or celiac disease. Gluten avoidance is not a standard dietary restriction for Crohn's disease.

Choice C reason: Advising the client to limit foods that are high in calcium and iron is not appropriate, as these nutrients are important for overall health. Crohn's disease patients may need to adjust their diet based on individual needs and deficiencies, but blanket limitations on calcium and iron are not recommended.

Choice D reason: Explaining that the need to restrict fluids is the primary limitation is incorrect. In fact, staying well-hydrated is crucial for managing Crohn's disease. Fluid restriction may be necessary in specific cases, but it is not a general guideline.

A. Use a feminine hygiene spray. B. Limit cranberry juice intake. C. Wear cotton underwear. D. Take daily tub baths.

Correct Answer is C

Explanation

Choice A reason: Using a feminine hygiene spray can irritate the urethra and worsen the symptoms of cystitis. It is generally recommended to avoid products that contain chemicals and fragrances, as they can disrupt the natural balance of bacteria and lead to further infections.

Choice B reason: Limiting cranberry juice intake is not a typical recommendation for clients with cystitis. In fact, cranberry juice is often suggested as it contains compounds that can help prevent bacteria from adhering to the bladder wall, potentially reducing the risk of urinary tract infections.

Choice C reason: Wearing cotton underwear is recommended because it is breathable and helps keep the genital area dry. This can reduce the risk of bacterial growth and infection, making it an important measure in managing and preventing cystitis.

Choice D reason: Taking daily tub baths can increase the risk of introducing bacteria into the urinary tract, especially if the water is not clean. It is generally advised to take showers instead of tub baths to minimize the risk of urinary tract infections.

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The nurse is caring for an older adult client with Alzheimer's disease who becomes increasingly agitated and is speaking to someone who is not visible to the nurse. Which action should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with newly diagnosed Crohn's disease asks the nurse about dietary restrictions. How should the nurse respond?

Correct Answer is A

Explanation

The nurse is planning discharge teaching for a client who has cystitis. Which information should the nurse include in the teaching plan?

Correct Answer is C

Explanation

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