At bedtime, a female client with dementia becomes increasingly confused and agitated because she believes that someone is standing behind the privacy curtain. Which action should the practical nurse (PN) take?
Administer a PRN antianxiety agent.
Tell her no one is behind the curtain.
Transfer the client to another room.
Leave a night light on in her room.
The Correct Answer is D
A. Administer a PRN antianxiety agent. - This should be a last resort due to potential side effects.
Non-pharmacological interventions are usually preferable.
B. Tell her no one is behind the curtain. - Arguing or contradicting her belief may escalate her agitation or confusion.
C. Transfer the client to another room. - Moving her to a new environment might exacerbate her confusion and distress.
D. Leave a night light on in her room. - This is a simple, non-intrusive intervention that can help reduce visual misinterpretations and provide comfort, potentially calming her agitation without confrontation or disruption.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Cleansing the site and covering with a sterile towel is typically done by the healthcare provider performing the procedure.
B. Gathering the procedure tray and equipment ensures everything necessary for the thoracentesis is ready.
C. Placing the client in an orthopneic position may be part of the positioning during the procedure but is not the primary preparation.
D. Keeping the client NPO and encouraging voiding might be necessary for some procedures but isn't specific to thoracentesis preparation.
Correct Answer is C
Explanation
A. Write an incident report about the bruises on the infant. - These areas might not be bruises; hence, writing an incident report without accurate information could be premature.
B. Review the labor and delivery record for birth trauma. - While important, it might not directly relate to the observed bluish-black areas.
C. Record the size and location of the areas in the infant's chart. - Documenting the observations is essential for tracking changes and informing other healthcare providers.
D. Notify the pediatrician of a possible bleeding problem with the infant. - Without further assessment, assuming a bleeding problem might be premature and unnecessarily alarming.
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