A nurse in a long-term care facility is admitting a client who has dementia.
Which of the following actions should the nurse take to reduce the risk for client injury?

Assist the client to the toilet frequently.

Raise the side rails up when the client is in bed.

Place the bedside table at the foot of the bed.

Keep the television on during the night.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Clients with dementia often experience difficulties with memory, cognition, and orientation, which can lead to increased risk of falls and injuries, especially when trying to perform activities of daily living such as using the toilet. Assisting the client to the toilet frequently helps prevent accidents and reduces the risk of injury from falls. Timely toileting can also improve the client's comfort and overall quality of life.

Choice B rationale:

Raising the side rails up when the client is in bed can create a physical barrier, but it is not a recommended method to prevent falls in clients with dementia. In fact, it can pose a risk by confining the client and may lead to attempts to climb over the rails, resulting in falls and injuries.

Choice C rationale:

Placing the bedside table at the foot of the bed does not directly address the client's safety needs. While it might be a matter of personal preference or convenience, it does not significantly impact the client's risk of injury.

Choice D rationale:

Keeping the television on during the night does not address the client's physical safety. While it may provide entertainment or a familiar environment, it does not mitigate the risk of falls or injuries, which is the primary concern when caring for clients with dementia.

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Correct Answer is A

Explanation

A. Levothyroxine 75 mcg PO daily at 0600. B. Digoxin 250 PO daily. C. Acetaminophen 650 mg POQ6 hours. D. Ceftriaxone 1 g IV Q 24 hours.

Correct Answer is B

Explanation

Choice A rationale:

The prescription for Levothyroxine 75 mcg PO daily at 0600 does not require clarification. It provides clear instructions for the medication, including the drug name, dosage, route, and timing. The administration time (0600) is specific, allowing the nurse to administer the medication accurately.

Choice B rationale:

The prescription for Digoxin 250 PO daily contains an error. The dosage (250) is missing the unit of measurement (e.g., mcg or mg). Without the unit, it is impossible to accurately administer the medication. This prescription needs clarification from the prescriber to ensure safe and precise administration.

Choice C rationale:

The prescription for Acetaminophen 650 mg PO Q6 hours does not require clarification. It provides clear instructions for the medication, including the drug name, dosage (650 mg), route (PO), and frequency (every 6 hours). The dosing interval is appropriate and within the normal range for acetaminophen administration.

Choice D rationale:

The prescription for Ceftriaxone 1 g IV Q 24 hours does not require clarification. It provides clear instructions for the medication, including the drug name, dosage (1 g), route (IV), and frequency (every 24 hours). The dosing interval is appropriate for this antibiotic and allows for effective treatment of infections.

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A nurse in a long-term care facility is admitting a client who has dementia.Which of the following actions should the nurse take to reduce the risk for client injury?

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A nurse in a long-term care facility is admitting a client who has dementia.
Which of the following actions should the nurse take to reduce the risk for client injury?