A nurse is contributing to the plan of care for a client who is experiencing delirium. Which of the following interventions should the nurse recommend?
Alternate daily caregivers.
Remind the client of the day and time often.
Offer the client several choices at mealtimes.
Avoid discussing the client's fears.
The Correct Answer is B
A. Alternate daily caregivers is incorrect. Consistent caregiving is important for clients experiencing delirium to provide stability and reduce confusion. Frequent changes in caregivers can increase anxiety and disorientation.
B. Remind the client of the day and time often is correct. Frequent reminders of the day, time, and orientation help ground the client in reality and reduce confusion. This is an essential part of managing delirium by addressing disorientation and improving cognitive clarity.
C. Offer the client several choices at mealtimes is incorrect. Giving too many choices can lead to overwhelm and confusion in clients with delirium. It is better to offer simple, limited options to avoid stress or difficulty in decision-making.
D. Avoid discussing the client's fears is incorrect. Addressing a client's fears is important in the management of delirium. It is more beneficial to acknowledge and provide reassurance, which can help reduce anxiety and the psychological stress that might exacerbate delirium.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. This medication will increase the immunity of your newborn.: Vitamin K does not directly affect the immunity of a newborn. It plays a crucial role in blood clotting, not immune function.
B. This medication will decrease the risk of hemorrhage in your newborn.: Vitamin K is given to newborns to prevent bleeding or hemorrhagic disease, as newborns have low levels of vitamin K at birth, which is essential for clotting.
C. This medication will decrease the possibility of your newborn developing jaundice.: Vitamin K does not have a role in preventing jaundice, which is related to elevated bilirubin levels in the blood.
D. This medication will increase the absorption of nutrients in the intestines.: Vitamin K does not influence nutrient absorption in the intestines; it primarily supports blood clotting by helping in the synthesis of clotting factors.
Correct Answer is D
Explanation
A. "If I were you, I would contact your spiritual director.": While this may be a helpful suggestion for the client, it can come across as dismissive of the client’s personal beliefs and decision-making. The nurse should respect the client’s autonomy in making healthcare decisions.
B. "I'm sure that everything will be all right, regardless of your decision.": This statement may be dismissive of the client's concerns and the seriousness of their medical decision. It also minimizes the importance of the client’s decision, which should be respected.
C. "Making this decision is wrong.": This response is judgmental and violates the client’s autonomy. The nurse should avoid imposing personal beliefs and instead support the client’s choices.
D. "You have a right to change your mind.": This is the best response, as it acknowledges the client’s autonomy and the possibility that the client may reconsider their decision in the future. It provides a nonjudgmental and supportive statement that empowers the client.
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