A nurse is admitting a client who has dementia related to a traumatic brain injury. Which of the following findings should indicate to the nurse that the client's condition is worsening?
Visual field cuts
Decreased CD4 counts
Shuffling gait
Chorea
The Correct Answer is C
C. Dementia related to a traumatic brain injury can result in a variety of cognitive and physical impairments. A shuffling gait, characterized by short steps with feet barely leaving the ground, is often associated with Parkinsonian symptoms, which can occur in advanced stages of dementia or as the condition progresses. Therefore, a shuffling gait would indicate worsening of the client's condition.
A. While visual disturbance can occur in individuals with dementia, visual field cuts alone may not necessarily indicate worsening of the condition unless they are accompanied by other concerning symptoms.
B. CD4 counts are a measure of immune system function, particularly in relation to HIV/AIDS. Decreased CD4 counts are not typically associated with dementia related to traumatic brain injury and would not be a relevant finding in this context.
D. Chorea is not a common feature of dementia related to traumatic brain injury. The presence of chorea may indicate a different underlying neurological condition or complication
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. This response politely declines the client's request while explaining the reason behind it, which is hospital policy. It maintains professionalism and boundaries.
A nurses should not provide their home address to clients, as it can compromise their privacy and potentially lead to boundary violations or safety concerns.
B. It is important for the nurse to respond to the client's request for personal information in a professional and appropriate manner.
D. It is important for nurses to communicate boundaries firmly but respectfully, without causing unnecessary distress to the client.
Correct Answer is B
Explanation
B. Childhood experiences of physical abuse, such as being hit with fists by a parent, can significantly contribute to the development of aggressive behaviors later in life. Research has shown that individuals who have experienced physical abuse during childhood are at increased risk of displaying aggression towards others, including their partners and children, as adults.
A. This statement is less directly related to the client's own experiences of aggression and may not necessarily contribute directly to their current behavior.
C. and D do not directly address experiences of violence or abuse and are less likely to contribute directly to the client's aggressive behavior towards their partner and child.
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