A charge nurse in a long-term care facility is preparing an educational program about delirium for newly hired nurses. Which of the following statements should the nurse plan to include?
"Delirium does not affect a client's perception of her environment.".
"Delirium has a slow progression.".
"Delirium does not affect a client's sleep cycle.".
"Delirium has an abrupt onset.".
The Correct Answer is D
“Delirium has an abrupt onset.” Delirium is a serious change in mental abilities that results in confused thinking and a lack of awareness of someone’s surroundings.
The disorder usually comes on fast — within hours or a few days.
Choice A is wrong because delirium does affect a client’s perception of her environment.
Choice B is wrong because delirium does not have a slow progression, but rather an abrupt onset.
Choice C is wrong because delirium can affect a client’s sleep cycle.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Answer: The correct answer is choice c. Ensure the client is free of metal objects.
Here's the rationale for each choice:
- Choice A: Rationale: Bowel cleansing is not routinely performed before an intravenous pyelogram (IVP) unless there is a specific concern about fecal matter obscuring the urinary tract on the X-rays.
- Choice B: Rationale: While pain in the suprapubic region (lower abdomen) is not a common side effect of an IVP, the nurse should be aware of this possibility and assess the client for any discomfort. However, monitoring for pain is not a specific action to include in preparation for the procedure.
- Choice C: Rationale: Metal objects can interfere with the X-ray images during an IVP. Ensuring the client removes any jewelry or clothing with metal fasteners is an important step in preparation.
- Choice D: Rationale: Oral contrast is not typically used in an IVP. The contrast material for this procedure is administered intravenously.
Correct Answer is A
Explanation
According to a study published on PubMed, it is appropriate to change alimentation tubes and feeding bags every 72 hours rather than every 24 hours.
Choice B, Aspirate residual volume every 4 hr, is not necessary for continuous enteral feedings through a gastrostomy tube.
Choice C, Flush the tubing with 10 mL of water every 2 hr, is not necessary for continuous enteral feedings through a gastrostomy tube.
Choice D, Heat the formula to 40.5° C (105° F), is not necessary for continuous enteral feedings through a gastrostomy tube.
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