An older client is admitted to the psychiatric unit for assessment of a recent onset of dementia. The practical nurse (PN) notes that in the evening this client often becomes restless, confused, and agitated. Which intervention should the PN implement?
Delay administration of nighttime medications until after visitors have left.
Administer a prescribed PRN benzodiazepine at the onset of a confused state.
Make certain that the client's assigned room is close to the nurses' station.
Ask family members about how they dealt with the client in the evening.
The Correct Answer is C
Restlessness, confusion, and agitation are common symptoms of dementia, particularly in the evening, a phenomenon known as sundowning. Therefore, the PN should implement interventions that can help to prevent or minimize these symptoms. Assigning the client to a room close to the nurses' station can help to provide constant observation and reassurance and can help to prevent the client from wandering or becoming disoriented.
A. Delaying administration of nighttime medications until after visitors have left may be appropriate, but it is not the first intervention to be implemented in this scenario.
B. Administering a prescribed PRN benzodiazepine at the onset of a confused state may be appropriate in some cases, but it should not be the first intervention to be implemented in this scenario.
D. Asking family members about how they dealt with the client in the evening may be helpful, but it is not the first intervention to be implemented in this scenario.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The action by the PN that is likely to facilitate accurate responses to personal and social history questions is to **request that the mother leave the exam room**. The personal and social history contains many areas of special sensitivity to adolescents including such issues as drug and alcohol use and sexual activity. The teen should provide the personal and social history, not the parent⁴.
Correct Answer is A
Explanation
Baclofen is a muscle relaxant that can help relieve muscle spasms and manage conditions such as cerebral palsy¹. An assessment finding that indicates the drug is effective for a child with cerebral palsy would be decreased muscular spasticity. This means that the child's muscles are less stiff and rigid, which can improve their mobility and overall quality of life.
The other choices are incorrect because they are not directly related to the therapeutic effects of baclofen. Baclofen is a muscle relaxant that is used to relieve muscle spasms and stiffness. While it may have other effects on the body, its primary therapeutic effect is to decrease muscular spasticity.
- Increased appetite is not a known effect of baclofen.
- Sufficient urinary output is important for overall health, but it is not directly related to the effectiveness of baclofen.
- Fewer temper outbursts may be an indirect result of decreased muscular spasticity and improved mobility, but it is not a direct effect of baclofen.
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