An older adult in the middle and late stages of Alzheimer's forgets where the bathroom is and has episodes of incontinence. Which intervention should the nurse suggest to the client's family?
Label the bathroom door.
Take the older adult to the bathroom hourly.
Place the older adult in disposable adult briefs.
Limit the intake of oral fluids to 1000 mL/day.
The Correct Answer is A
A. Labeling the bathroom door can provide a visual cue to help the older adult locate the bathroom, which may reduce episodes of incontinence.
B. Taking the older adult to the bathroom hourly is a good strategy, but it may not always be feasible or effective in preventing accidents.
C. Using disposable adult briefs may be necessary at times, but it should not be the first line intervention.
D. Limiting oral fluids to 1000 mL/day may lead to dehydration and is not an appropriate intervention for addressing incontinence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Increasing aggression may be an indication for a PRN medication, but benztropine specifically targets extrapyramidal symptoms (EPS).
B. Elevated blood pressure is not a direct indication for benztropine; it is used to address EPS.
C. Complaints of dizziness may not be directly related to EPS, which is the target of benztropine.
D. Benztropine is an anticholinergic medication used to manage extrapyramidal symptoms (EPS) associated with antipsychotic medications like haloperidol.
Correct Answer is D
Explanation
A. Orienting the client to the unit While orientation is important, the client's prolonged
immobility and stupor necessitate a physical assessment first to ensure there are no underlying medical issues contributing to this state.
B. Reinforcing reality with the client The client's catatonic state may make it difficult to effectively communicate or engage in reality orientation at this point. Addressing potential physical issues is the initial priority.
C. Establishing a nonthreatening relationship Building a therapeutic relationship is crucial, but given the client's current state, assessing for physical problems takes precedence.
D. Assessing the client for physical problems The client's prolonged catatonic state requires an
immediate physical assessment to rule out any underlying medical conditions contributing to his condition.
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