The nurse is performing a history and physical assessment for a client in the clinic with moderate dementia. The client becomes agitated when asked questions and inquires why so many questions are being asked. What are the best actions for the nurse to take to obtain the necessary data? Select all that apply.
Persistently ask the same question until answered.
Give the client ample time to answer the questions asked.
Ask simple questions instead of compound questions.
Provide simple explanations to the client as often as required.
Take frequent breaks during the interview process.
Correct Answer : B,C,D,E
Choice A reason: Persistently asking the same question can increase agitation in clients with dementia.
Choice B reason: Allowing ample time for responses can reduce pressure and agitation in clients with dementia.
Choice C reason: Simple questions are easier for clients with dementia to understand and respond to.
Choice D reason: Providing simple explanations can help clients with dementia understand the purpose of the questions.
Choice E reason: Taking frequent breaks can help prevent fatigue and agitation during the assessment process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Choice A reason: This statement is an example of rationalizing the spouse's behavior, which can perpetuate the cycle of substance abuse.
Choice B reason: Providing money for drugs, even under the guise of preventing theft, is enabling because it facilitates the continuation of the substance abuse.
Choice C reason: Suggesting rehab as a condition for coming home is not enabling; it is a step towards addressing the substance use disorder.
Choice D reason: Calling in sick on behalf of the spouse to cover for their potential job loss due to substance abuse is an enabling behavior that prevents the spouse from facing the natural consequences of their actions.
Choice E reason: Securing valuables to prevent theft due to the spouse's substance abuse is also enabling because it adjusts normal routines to accommodate the substance use, rather than confronting or addressing the issue.
Correct Answer is ["B","D","E"]
Explanation
Choice A reason: Considering a transfer might avoid the immediate issue but does not address the nurse's countertransference or promote professional growth.
Choice B reason: Requesting another nurse to take over may be appropriate to ensure the client receives unbiased care while the original nurse addresses their countertransference.
Choice C reason: Discussing personal issues with the client is not appropriate as it can blur professional boundaries and may not be therapeutic for the client.
Choice D reason: The nurse should examine their feelings and responses to prevent personal experiences from affecting professional judgment and interactions with clients.
Choice E reason: Talking about feelings and emotions with a trusted colleague can provide support and help the nurse process their feelings in a safe environment.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
