The nurse is caring for an older adult client who has an infection and a fever of 38°C (100.4°F).

The nurse should monitor the client for which of the following complications?

Dehydration

Hypothermia

Seizures

Delirium

Answer and Explanation

The Correct Answer is D

The correct answer is D.

Delirium.

The nurse should monitor the client for delirium, which is a state of acute mental confusion that can be caused by fever, infection, dehydration, or medications.

Delirium can affect the client’s cognition, attention, orientation, memory, and behavior. It can also increase the risk of falls, complications, and mortality.

Choice A is wrong because dehydration is not a complication of fever, but rather a possible cause of fever.

Dehydration occurs when the body loses more fluid than it takes in, and it can impair the body’s ability to regulate its temperature. Dehydration is more common and dangerous in older adults because they have a lower volume of water in their bodies, a weaker thirst response, and may have conditions or medications that increase fluid loss.

Choice B is wrong because hypothermia is not a complication of fever, but rather a condition of abnormally low body temperature.

Hypothermia can occur when the body loses heat faster than it can produce it, such as in cold weather or water exposure. Hypothermia can affect the brain, heart, and other organs, and can lead to death if not treated promptly.

Choice C is wrong because seizures are not a common complication of fever in older adults.

Seizures are sudden episodes of abnormal electrical activity in the brain that can cause changes in movement, sensation, behavior, or consciousness.

Seizures can have various causes, such as head injury, stroke, infection, or epilepsy.

Fever-induced seizures are more likely to occur in young children than in older adults.

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Correct Answer is ["A","B","C","E"]

Explanation

The correct answer isA, B, C and E.These interventions are consistent with the best practices for optimizing functional status in the elderly.

Some explanations for the choices are:.

• Choice A is correct because physical activity and exercise can help maintain muscle strength, joint mobility, balance and coordination, which are essential for functional independence and quality of life.

• Choice B is correct because adequate nutrition and hydration can prevent malnutrition, dehydration and electrolyte imbalance, which can impair physical and cognitive function and increase the risk of complications.

• Choice C is correct because managing chronic diseases and medications can prevent complications, adverse effects and polypharmacy, which can affect functional status and increase the need for health care services.

• Choice D is wrong because providing assistive devices and adaptive equipment is not an intervention to improve functional status, but rather to enhance mobility, safety and independence for patients who already have functional limitations.

The question asks for interventions to improve functional status, not to compensate for it.

• Choice E is correct because modifying the environment can reduce hazards, improve accessibility and facilitate self-care, which can promote functional independence and prevent injuries or falls.

The normal ranges for blood glucose and blood pressure for older adults with diabetes and hypertension are:.

• Blood glucose: 80-130 mg/dL before meals and less than 180 mg/dL after meals.

• Blood pressure: less than 140/90 mmHg or individualized based on comorbidities and risk factors.

A. Avoid drinking grapefruit juice while taking this medication. B. Brush your teeth gently with a soft-bristled toothbrush C. Wear a medical alert bracelet or necklace at all times. D. Stop taking this medication if you develop a rash or fever. E. Have your blood levels checked regularly as directed by your provider.

Correct Answer is ["B","C","E"]

Explanation

The correct answer is B, C, and E.

Phenytoin (Dilantin) is an anticonvulsant medication that is used to control seizures.

It can have several side effects, some of which are serious and require medical attention.

Here are some explanations for each choice:.

A. Avoid drinking grapefruit juice while taking this medication.

This iswrongbecause grapefruit juice does not interact with phenytoin.However, grapefruit juice can affect the levels of other medications, such as statins, calcium channel blockers, and some antidepressants.

B. Brush your teeth gently with a soft-bristled toothbrush.This isrightbecause phenytoin can causegingival hyperplasia, which is an overgrowth of the gums that can lead to bleeding, infection, and difficulty chewing.

To prevent this, patients should practice good oral hygiene, avoid alcohol and tobacco, and see a dentist regularly.

A. Avoid drinking grapefruit juice while taking this medication B.

Brush your teeth gently with a soft-bristled toothbrush C.

Wear a medical alert bracelet or necklace at all times D.

Stop taking this medication if you develop a rash or fever E.

Have your blood levels checked regularly as directed by your provider

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The nurse is caring for an older adult client who has an infection and a fever of 38°C (100.4°F). The nurse should monitor the client for which of the following complications?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is implementing interventions to improve the functional status of an older adult client who has diabetes and hypertension. Which of the following interventions should the nurse include? (Select all that apply.).

Correct Answer is ["A","B","C","E"]

Explanation

A nurse is providing discharge teaching for a patient who had a seizure disorder and is prescribed phenytoin (Dilantin). Which of the following instructions should the nurse include? (Select all that apply.).

Correct Answer is ["B","C","E"]

Explanation

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A nurse is performing a mental status examination on an older adult client who has delirium. Which of the following tools can the nurse use to assess the client’s attention span and concentration?

The nurse is caring for an older adult client who has an infection and a fever of 38°C (100.4°F).

The nurse should monitor the client for which of the following complications?