A confused older adult client is having trouble sleeping at night and is sometimes found wandering in the hallway. Which nursing intervention should the nurse implement first?
Provide a back rub at bedtime.
Leave the door to the client's room open slightly.
Apply wrist restraints to prevent wandering.
Administer a PRN sedative prescription.
The Correct Answer is A
A. Provide a back rub at bedtime:
This intervention addresses the client's immediate need for comfort and relaxation without resorting to restrictive measures or medications.
B. Leave the door to the client's room open slightly:
Leaving the door open may not prevent wandering and could potentially lead to safety issues.
C. Apply wrist restraints to prevent wandering:
Restraints should only be used as a last resort and when all other interventions have failed. They pose risks to the client's physical and psychological well-being and should be avoided whenever possible.
D. Administer a PRN sedative prescription:
Sedatives should be used judiciously and only after other non-pharmacological interventions have been attempted. Sedating the client may increase the risk of falls or injury and should not be the first-line intervention for managing sleep disturbances or wandering behavior.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["1"]
Explanation
To determine how many tablespoons the client should take with each dose, we need to first calculate the dosage in tablespoons based on the concentration of the oral suspension.
Given:
Dextromethorphan oral suspension concentration: 30 mg per 15 mL
To find out how many milliliters the client should take per dose:
The prescribed dose is 30 mg.
So, if 15 mL contains 30 mg, then 1 mL contains:
30 mg / 15 mL = 2 mg/mL
To find out how many milliliters the client should take for the prescribed dose:
30 mg / 2 mg/mL = 15 mL
Now, we know that the prescribed dose is 15 mL. To convert this to tablespoons, we can use the fact that 1 tablespoon (tbsp) is equal to 15 milliliters.
So, the client should take:
15 mL / 15 mL/tbsp = 1 tablespoon
Therefore, the nurse should instruct the client to take 1 tablespoon with each dose.
Correct Answer is ["0.5"]
Explanation
To find out how many milliliters the nurse should administer, we first need to calculate the volume required to deliver 200 mg of streptomycin.
Given:
Streptomycin concentration: 1 gram/2.5 mL
Dose prescribed: 200 mg
We'll start by converting the dose prescribed from milligrams (mg) to grams (g) since the concentration is given in grams:
200 mg = 0.2 grams
Now, we can set up a proportion to find the volume (x) needed to deliver 0.2 grams of streptomycin:
1 gram / 2.5 mL = 0.2 grams / x
Cross-multiplying:
1 * x = 0.2 * 2.5
x = 0.5 mL
So, the nurse should administer 0.5 milliliters of streptomycin.
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