A nurse is planning care for an older adult client who has dementia.
Which of the following interventions should the nurse include in the plan of care? (Select all that apply.).
Allow the client to choose among a variety of activities each day.
Give the client one simple direction at a time.
Reinforce orientation to time, place, and person.
Establish eye contact when communicating with the client.
Refute the client’s delusions using logic.
Correct Answer : B,C,D
The correct answer is choice B, C, and D. The nurse should give the client one simple direction at a time, reinforce orientation to time, place, and person, and establish eye contact when communicating with the client.
These interventions can help the client with dementia to understand and follow instructions, reduce confusion and anxiety, and enhance communication.
Choice A is wrong because allowing the client to choose among a variety of activities each day can overwhelm and frustrate the client with dementia.
The nurse should provide a structured and consistent daily routine for the client.
Choice E is wrong because refuting the client’s delusions using logic can increase the client’s agitation and distrust.
The nurse should use validation therapy to acknowledge the client’s feelings and emotions without arguing or correcting the client.
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Related Questions
Correct Answer is A
Explanation
The correct answer is choice A. Implement firm but flexible boundaries in their relationship.
This is because boundaries can help the client and family to respect each other’s roles, needs and preferences, and to avoid role confusion, resentment or guilt. Boundaries can also promote independence and self-care for the client, as well as prevent caregiver burnout for the family.
Choice B is wrong because minimizing open discussion regarding the changes can lead to misunderstanding, frustration or isolation. The client and family should communicate openly and honestly about their feelings, expectations and challenges, and seek support when needed.
Choice C is wrong because authoritative communication from the adult child can create a power imbalance, undermine the client’s autonomy and dignity, or cause conflict or resistance. The client and family should use respectful and collaborative communication, and involve the client in decision-making as much as possible.
Choice D is wrong because decreasing socialization with extended relatives can reduce the client and family’s support network, increase their stress or loneliness, or limit their opportunities for meaningful activities. The client and family should maintain contact with their relatives and friends, and participate in social or recreational activities that they enjoy.
Correct Answer is D
Explanation
This is because abruptly stopping TPN can cause hypoglycemia, which is a low blood sugar level that can cause shakiness, diaphoresis, confusion, and seizures. Therefore, infusing dextrose 10% in water temporarily at the same rate as the TPN can prevent this adverse effect. Dextrose 10% in water is a hypertonic solution that contains 340 calories per liter and can maintain the client’s blood glucose level until the new TPN bag arrives.
Choice A is wrong because giving 500 mL of lactated Ringer’s solution would not provide enough calories or glucose to prevent hypoglycemia. Lactated Ringer’s solution is an isotonic solution that contains electrolytes but no calories or glucose.
Choice B is wrong because temporarily discontinuing the infusion would cause hypoglycemia, which can be life-threatening for the client.
Choice C is wrong because slowing the TPN infusion rate would also cause hypoglycemia, as the client would receive less calories and glucose than prescribed.
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