The nurse is caring for an assigned group of clients. Which client does the nurse identify as being at the highest risk for the development of delirium and will be closely monitored?
A client with a blood glucose level of 110 mg/dL (6.1 mmol/L).
A client who sustained a fractured femur in a motor vehicle crash.
An adult client being prepared for a laparoscopic cholecystectomy.
An older adult client with sepsis from a urinary tract infection.
The Correct Answer is D
Choice A reason: This choice is incorrect. A blood glucose level of 110 mg/dL is within normal range and does not significantly increase the risk of delirium.
Choice B reason: While a fractured femur can be painful and stressful, it does not pose the highest risk for delirium compared to sepsis.
Choice C reason: Preparation for surgery can be a risk factor for delirium, but it is not as high a risk as sepsis in an older adult.
Choice D reason: This is the correct choice. Older adults with sepsis are at a high risk for delirium due to the systemic infection and its impact on overall health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This choice is incorrect. Requesting quiet to sleep does not necessarily support a diagnosis of a manic episode.
Choice B reason: This choice is incorrect. Feeling tired and wanting to rest is not indicative of a manic episode, which is typically characterized by increased energy and activity.
Choice C reason: This is the correct choice. The statement about the purple hat and zebra-striped pants suggests a lack of awareness of social norms and possibly grandiosity or flamboyance, which can be indicative of a manic episode.
Choice D reason: This choice is incorrect. Concern about appearance does not specifically support a diagnosis of a manic episode.
Correct Answer is B
Explanation
Choice A reason: This choice is incorrect because depressive symptoms alone do not indicate bipolar disorder, which is characterized by episodes of mania and depression.
Choice B reason: This is the correct choice. Major depressive disorder is characterized by depressive episodes without the occurrence of mania.
Choice C reason: This choice is incorrect. Depression can be a recurring disorder and is not typically a one-time incident.
Choice D reason: This choice is incorrect. Hypomania is associated with bipolar disorder, not major depressive disorder.
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