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?

Remind the client of the day and time often.

Offer the client several choices at mealtimes.

Avoid discussing the client's fears.

Alternate daily caregivers.

Answer and Explanation

The Correct Answer is A

A. Correct.

Option A, reminding the client of the day and time often, aligns with this goal. Orienting the individual to time and place can help reduce confusion and disorientation commonly associated with delirium.
B. Incorrect. Offering the client several choices at mealtimes, might not directly address the issue of orientation and may potentially overwhelm the individual, exacerbating their confusion.

C. Incorrect. Discussing the client's fears and addressing their concerns is important for providing appropriate care and support.
D. Incorrect. Alternating daily caregivers may increase confusion for the client experiencing delirium. Consistency in care providers can be beneficial.

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Correct Answer is A

Explanation

A. Correct. This response acknowledges the client's feelings and demonstrates empathy. It opens the door for further discussion and exploration of the client's beliefs without immediately challenging them.
B. Incorrect. Directly contradicting the client's beliefs may cause resistance and increase their distress. It's important to approach the situation with sensitivity and understanding.
C. Incorrect. While asking for clarification is a valid approach, it may not be the most appropriate initial response. It's important to establish trust and rapport with the client before delving into their delusional beliefs.
D. Incorrect. Asking "why" s may put the client on the defensive and may not lead to a productive conversation about their beliefs. It's better to approach the situation with empathy and openness before exploring the client's perspective.

A. Initiate droplet precautions. B. Administer granulocyte colony-stimulating factor. C. Educate the infant's guardians about exchange transfusions. D. Monitor the infant's lymphocyte count.

Correct Answer is D

Explanation

A. Droplet precautions are not indicated for HIV; standard precautions should be followed.
B. Granulocyte colony-stimulating factor is typically used to increase white blood cell production and is not directly related to HIV care.
C. Exchange transfusions are not a routine intervention for infants with HIV.
D. Correct. Monitoring the infant's lymphocyte count is important to assess immune function and response to HIV treatment.

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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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