A nurse is providing discharge teaching to the family of a client who has Alzheimer's disease. Which of the following instructions should the nurse include in the teaching?

Keep a monthly calendar in the client's kitchen.

Provide distraction by keeping the television on.

Install a nightlight in the client's bedroom

Place a deadbolt lock on the client's bedroom door.

Answer and Explanation

The Correct Answer is C

A. Keep a monthly calendar in the client's kitchen: A calendar showing a full month may be difficult for a client with Alzheimer's disease to process due to impaired memory and orientation. Simpler visual aids or daily reminders are more effective in supporting cognitive function.
B. Provide distraction by keeping the television on: Leaving the television on continuously can overstimulate the client and contribute to confusion or agitation. Clients with Alzheimer's often benefit more from calm, structured environments than from constant auditory input.
C. Install a nightlight in the client's bedroom: Installing a nightlight helps maintain orientation and reduce nighttime confusion. It also lowers the risk of falls by making it easier for the client to navigate their environment if they wake during the night.
D. Place a deadbolt lock on the client's bedroom door: Locking the client in their bedroom poses serious safety concerns, especially in emergencies like a fire. It may also increase anxiety or fear. Safer wandering prevention measures include door alarms or monitoring systems.

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Correct Answer is B

Explanation

A. Insert the oral thermometer in front of the infant's tongue: Oral temperature is not recommended for infants due to the risk of injury and difficulty keeping the thermometer in place.
B. Place the tip of the thermometer under the center of the infant's axilla: The axillary route is safe and appropriate for infants. Ensuring the tip is in full contact with the skin in the center of the axilla ensures a more accurate reading.
C. Pull the pinna of the infant's ear forward before inserting the probe: For infants under 3 years, the pinna should be pulled down and back to straighten the ear canal, not forward.
D. Insert the probe 3.8 cm (1.5 in) into the infant's rectum: This depth is excessive for an infant; rectal insertion should be only about 1.3 to 2.5 cm (0.5 to 1 in) to avoid rectal trauma.

A. The client is tolerating clear liquids. B. The client is voiding at least 250 m L/hr. C. The client is maintaining bed rest D. The client is consuming 1000 calories daily.

Correct Answer is A

Explanation

A. The client is tolerating clear liquids: Following gastric banding surgery, clients typically begin with clear liquids and gradually progress to more solid foods. Tolerating clear liquids 36 hours post-op is expected and indicates appropriate recovery.
B. The client is voiding at least 250 mL/hr: A urine output of 250 mL/hr is abnormally high and could suggest overhydration or other issues. Normal expected output is around 30–50 mL/hr postoperatively.
C. The client is maintaining bed rest: Prolonged bed rest increases the risk of complications like deep vein thrombosis. Clients are generally encouraged to ambulate early unless contraindicated.
D. The client is consuming 1000 calories daily: At 36 hours post-op, the client is not expected to consume high-calorie meals. Intake is usually limited to small amounts of clear liquids to prevent nausea and stress on the surgical site.

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A nurse is providing discharge teaching to the family of a client who has Alzheimer's disease. Which of the following instructions should the nurse include in the teaching?

Nursing Test Bank

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