A nurse is caring for an older adult client who states, "I am afraid that I may fall while walking to the bathroom during the night." Which of the following actions should the nurse take?

Limit the client's fluid intake in the evening

Put the side rails up and tell the client to call the nurse before voiding

Obtain a bedside commode for the client's use

Leave a nightlight on in the client's room

Answer and Explanation

The Correct Answer is C

Choice A reason: Limiting fluid intake in the evening may reduce the need to urinate at night but does not address the client's fear of falling. It is more important to provide a safer alternative for nighttime voiding.

Choice B reason: Putting the side rails up and instructing the client to call the nurse before voiding may help, but it does not provide the most immediate and practical solution. A bedside commode offers a safer and more accessible option.

Choice C reason: Obtaining a bedside commode for the client's use directly addresses the client's concern about falling. It allows the client to void safely without having to walk to the bathroom at night, reducing the risk of falls.

Choice D reason: Leaving a nightlight on in the room can help improve visibility but does not completely eliminate the risk of falling. A bedside commode is a more effective solution.

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Correct Answer is C

Explanation

Choice A reason: Pyridostigmine is used to treat myasthenia gravis, not for preventing Addisonian crisis in patients undergoing adrenalectomy. It is not related to adrenal hormone replacement.

Choice B reason: Tensilon (edrophonium) is used in the diagnosis of myasthenia gravis and is not relevant for managing adrenal insufficiency or preventing Addisonian crisis.

Choice C reason: Hydrocortisone intravenously is the correct choice for preventing Addisonian crisis in a client scheduled for adrenalectomy. Hydrocortisone provides the necessary corticosteroid replacement to manage the deficiency of adrenal hormones during and after surgery.

Choice D reason: Spironolactone is a potassium-sparing diuretic used to treat conditions like heart failure and hypertension. It is not used for preventing Addisonian crisis or managing adrenal insufficiency.

A. "I can change who serves as my health care proxy at any time." B. "The health care proxy does not go into effect until I am incapable of making decisions." C. "I have to choose a family member as my health proxy." D. "My health care proxy can make decisions on my behalf if I am unable to do so."

Correct Answer is C

Explanation

Choice A reason: The statement "I can change who serves as my health care proxy at any time" is correct. A client can modify or revoke their health care proxy designation as long as they are mentally competent.

Choice B reason: The statement "The health care proxy does not go into effect until I am incapable of making decisions" is accurate. The health care proxy is activated when the client is unable to make their own medical decisions.

Choice C reason: The statement "I have to choose a family member as my health proxy" indicates a need for clarification. A client is not required to choose a family member as their health care proxy; they can select any trusted individual to act in this capacity.

Choice D reason: The statement "My health care proxy can make decisions on my behalf if I am unable to do so" is correct. The purpose of a health care proxy is to appoint someone to make medical decisions when the client is incapacitated.

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A nurse is caring for an older adult client who states, "I am afraid that I may fall while walking to the bathroom during the night." Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who is scheduled for an adrenalectomy. The nurse plans to administer which medication in the preoperative period to prevent Addisonian Crisis?

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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