A nurse is caring for a client with delirium who is experiencing illusions. What environmental conditions should the nurse arrange for this client?
Have the client sit by the nurse's desk while awake in a room with the television on
Provide a well-lit room without glare or shadows and limit noise
Keep the room shadowy with soft lighting around the clock, and keep a radio on continuously
Light the room brightly around the clock and awaken hourly to check mental status
The Correct Answer is B
B. This option promotes a calming and supportive environment that minimizes sensory stimuli and helps maintain orientation, reducing the risk of exacerbating symptoms of delirium and illusions.
A. Having the client sit by the nurse's desk may provide some supervision and reassurance, but keeping the television on can contribute to sensory overload and increase confusion, especially if the client is experiencing illusions.
C. Keeping the room shadowy with soft lighting and continuously playing a radio may create an environment that is disorienting and confusing for the client with delirium.
D. Maintaining bright lighting around the clock may disrupt the client's sleep-wake cycle and exacerbate symptoms of delirium. Interrupting the client's sleep by awakening hourly for mental status checks can also contribute to sleep deprivation and increase agitation and confusion
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. MAOIs are a class of antidepressants that work by inhibiting the activity of monoamine oxidase, an enzyme that breaks down neurotransmitters such as serotonin, dopamine, and norepinephrine. MAOIs can interact with certain foods and other medications, potentially leading to a hypertensive crisis characterized by severe hypertension, headache, diaphoresis, and other symptoms.
B. SSRIs are commonly prescribed antidepressants that work by increasing the levels of serotonin in the brain. Serotonin syndrome can present with symptoms such as headache, diaphoresis, tachycardia, and hyperthermia, but it typically doesn't cause severe hypertension.
C. TCAs are another class of antidepressants that work by inhibiting the reuptake of serotonin and norepinephrine. TCAs can cause anticholinergic effects such as dry mouth, blurred vision, constipation, and urinary retention. However, TCAs are less commonly associated with severe hypertension compared to MAOIs.
D. Atypical antipsychotics are used to treat various psychiatric disorders, including schizophrenia and bipolar disorder. While they are not typically associated with causing severe hypertension directly, they can have cardiovascular side effects such as tachycardia and orthostatic hypotension.
Correct Answer is B
Explanation
B. Systematic desensitization is a behavioral therapy technique used to treat phobias, anxiety disorders, and other fear-related conditions. It involves exposing the individual to the feared stimulus or situation gradually, starting with less anxiety-provoking scenarios and progressing to more challenging ones, while simultaneously teaching relaxation techniques to reduce anxiety.
Systematic desensitization is considered a more gentle and controlled approach compared to flooding and is often preferred for individuals with specific phobias or moderate levels of anxiety.
A. Flooding is a behavioral therapy technique that involves exposing the individual to the feared stimulus or situation at full intensity, without any gradual buildup or relaxation techniques. However, flooding can be highly distressing and overwhelming for some individuals, and it may not be suitable for everyone, especially those with severe anxiety or trauma-related disorders.
C. Cognitive restructuring is a cognitive-behavioral therapy technique used to identify and challenge irrational or negative thoughts and beliefs that contribute to emotional distress or maladaptive behaviors. While cognitive restructuring may be incorporated into treatment for anxiety disorders, it focuses more on addressing cognitive distortions rather than directly exposing the individual to feared stimuli or teaching relaxation techniques.
D. Combination therapy refers to the use of multiple therapeutic approaches or techniques simultaneously or sequentially to address a client's psychological symptoms or concerns. While combination therapy may involve elements of systematic desensitization, cognitive restructuring, and other techniques, it does not represent a specific therapeutic approach or technique on its own.
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