An older adult female client is admited to the psychiatric unit for assessment of a recent onset of dementia. The practical nurse (PN) notes that in the evening, the client becomes restless, confused, and agitated.
Which instruction should the PN provide to the unlicensed assistive personnel who is assisting in the care of the client?
Calmly offer to walk around the hallways with the client.
Make sure the room lights are dimmed to calm the client.
Leave the client alone until signs of agitation have passed.
Measure the client's vital signs at the onset of agitation.
The Correct Answer is A
Restlessness, confusion, and agitation in the evening are common symptoms of sundowning, which is a condition that affects some older adults with dementia. Offering to walk around the hallways with the client can provide a calming effect and reduce the symptoms of sundowning.
Dimming the lights may actually increase confusion and agitation, and leaving the client alone may increase feelings of isolation and fear.
Measuring the client's vital signs may not be necessary unless there are specific medical concerns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Phyto menadione injectable, also known as vitamin K1, is commonly given to newborns to prevent hemorrhagic disease of the newborn (HDN), a bleeding disorder that can occur due to vitamin K deficiency in the first few days of life. Vitamin K is important for the production of clotting factors in the liver, and newborns are at risk of vitamin K deficiency because it does not cross the placenta well and their intestinal flora is not yet established. The other options do not accurately describe the purpose of administering Phyto menadione injectable to newborns.
Correct Answer is D
Explanation
When a Rh-negative mother gives birth to a Rh-positive baby, there is a risk that the mother's immune system will develop antibodies against the Rh-positive factor. These antibodies can cross the placenta in future pregnancies and atack the Rh-positive fetus, leading to hemolytic disease of the newborn. Rho(D) immune globulin is given after delivery to prevent the formation of these antibodies. The PN should explain this to the client and encourage her to reconsider her refusal of the treatment. Answers A, B, and C are incorrect and do not provide accurate information.
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