The nurse is performing a history and physical assessment for a client in the clinic with moderate dementia. The client becomes agitated when asked questions and inquires why so many questions are being asked. What are the best actions for the nurse to take to obtain the necessary data? Select all that apply.
Persistently ask the same question until answered.
Give the client ample time to answer the questions asked.
Ask simple questions instead of compound questions.
Provide simple explanations to the client as often as required.
Take frequent breaks during the interview process.
Correct Answer : B,C,D,E
Choice A reason: Persistently asking the same question can increase agitation in clients with dementia.
Choice B reason: Allowing ample time for responses can reduce pressure and agitation in clients with dementia.
Choice C reason: Simple questions are easier for clients with dementia to understand and respond to.
Choice D reason: Providing simple explanations can help clients with dementia understand the purpose of the questions.
Choice E reason: Taking frequent breaks can help prevent fatigue and agitation during the assessment process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This statement reflects assertiveness and self-advocacy rather than suppressed anger. It shows the client's awareness of her value to the team and her willingness to negotiate for fair compensation.
Choice B reason: This statement suggests frustration and possible feelings of being undervalued or obstructed in career advancement, which could be indicative of suppressed anger.
Choice C reason: This statement seems to express gratitude for the accommodation provided for her needs as a new mother, rather than suppressed anger.
Choice D reason: This statement indicates a recognition of her own expertise and the demand for her skills within the team, which is a positive self-assessment and not suggestive of suppressed anger.
Correct Answer is D
Explanation
Choice A reason: A decreased display of emotions, or blunted affect, is common in dementia as the illness affects the brain areas responsible for emotion regulation.
Choice B reason: While personality changes can occur, they do not typically present as complete opposites of original traits.
Choice C reason: Decreased auditory and visual acuity can be part of the cognitive decline associated with dementia.
Choice D reason: Forgetfulness that progresses to disorientation is a hallmark of dementia, reflecting the deterioration of cognitive functions over time.
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