A nurse is caring for a client who has dementia. Which of the following findings should the nurse expect?

Memory loss that disrupts ADLs

Catatonia

Illusions

Pressured speech

Answer and Explanation

The Correct Answer is A

Dementia is a condition characterized by a decline in cognitive function that aﬀects a person's ability to perform activities of daily living (ADLs). Memory loss is a common symptom of dementia, particularly in the early stages. Memory loss can disrupt a person's ability to carry out tasks they were previously able to do independently, such as dressing, bathing, and eating. Therefore, option A is the correct answer.

Option b, catatonia, is a condition characterized by a lack of movement or activity, which is not typically associated with dementia.

Option c, illusions, involve a misinterpretation of sensory information and may occur in some forms of dementia but are not a defining feature.

Option d, pressured speech, is a symptom commonly associated with mania or bipolar disorder but is not typically seen in dementia.

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Correct Answer is A

Explanation

The nurse should identify the sudden increase in energy as the priority finding to report to the provider. This could be a sign of an emerging manic episode, especially if the client is taking an antidepressant alone without a mood stabilizer.

It may indicate a switch to a manic state or the development of bipolar disorder. The provider needs to be informed promptly so that appropriate assessment and interventions can be implemented to ensure the client's safety and well-being.

A. Weight loss of 1 kg (2.2 lb) in the past 24 hr B. Pale, clammy skin C. Fatigue when ambulating 152 m (500 ft) D. Productive cough with pink, frothy sputum

Correct Answer is D

Explanation

A productive cough with pink, frothy sputum is indicative of pulmonary edema, which is a serious manifestation of left-sided heart failure.

It suggests fluid accumulation in the lungs, impairing gas exchange and oxygenation.

Prompt notification of the provider is crucial for appropriate intervention and management of the client's condition.

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A nurse is caring for a client who has dementia. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has major depressive disorder and is taking an antidepressant. The nurse should identify which of the following findings as the priority to report to the provider?

Correct Answer is A

Explanation

A nurse is collecting data from a client who has left sided heart failure. For which of the following findings should the nurse notify the provider?

Correct Answer is D

Explanation

A nurse is receiving change-of-shift report on four clients. Which of the following clients should the nurse plan to see first?

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