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?

Avoid discussing the client's fears.

Offer the client several choices at mealtimes.

Remind the client of the day and time often.

Alternate daily caregivers.

Answer and Explanation

The Correct Answer is C

Delirium is a state of acute confusion and cognitive impairment that can cause disorientation and difficulty with time perception. Reminding the client of the day and time frequently helps provide orientation and reduce confusion. It can help ground the client in reality and improve their understanding of their current circumstances.

A. Avoiding discussing the client's fears can hinder their ability to express and address their concerns. It is important to provide a safe and supportive environment where the client can communicate their fears and feelings.

B. Offering the client several choices at mealtimes might be overwhelming and confusing for someone experiencing delirium. It is generally better to provide structure and simplicity in their meal options, reducing decision-making demands.

D. Alternating daily caregivers can disrupt the continuity of care and increase the client's confusion. Consistency in the caregiving team can help establish a therapeutic relationship and familiarity, which can aid in managing delirium.

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Correct Answer is C

Explanation

Insomnia refers to the difficulty in falling asleep or staying asleep, leading to sleep disturbances. It is a frequently reported symptom during the initial phase of nicotine withdrawal.

While weight loss can be associated with smoking cessation due to changes in metabolism, it is not a direct manifestation of nicotine withdrawal. Similarly, diarrhea is not a commonly reported symptom of nicotine withdrawal.

Diaphoresis, which refers to excessive sweating, can occur in some individuals during nicotine withdrawal, but it is not as commonly observed as insomnia. It is worth noting that different individuals may experience varying symptoms during nicotine withdrawal, and the intensity and duration of these symptoms can also differ.

A. Decreased BUN level B. Decreased hemoglobin level C. Increased weight of 0.91 kg (2 lb) D. Increased urinary output

Correct Answer is D

Explanation

Furosemide works by promoting diuresis, which helps to reduce fluid volume overload in heart failure. Increased urinary output indicates that the medication is effectively removing excess fluid from the body. This can help alleviate symptoms such as edema and fluid retention commonly associated with heart failure. Therefore, an increased urinary output is a positive response to furosemide therapy in this context.

Decreased BUN (blood urea nitrogen) levels and weight loss are also expected outcomes of diuretic therapy, further indicating the effectiveness of the medication. However, a decreased hemoglobin level is not directly related to the efficacy of furosemide and might be indicative of other factors such as anemia or bleeding, requiring further assessment and intervention.

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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?

Nursing Test Bank

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