Which statement made by the nurse would be most appropriate to an elderly client who is confused, has no history of dementia and is hospitalized for an acute urinary tract infection?

"You are likely to become progressively more confused now."

"This is only a temporary situation."

"Don't worry about it; everyone is confused when they are in the hospital."

"Things may be upsetting and confusing right now, but your confusion should clear as you get better."

Answer and Explanation

The Correct Answer is D

A.   This statement may cause unnecessary distress to the client and is not necessarily true in this situation.
B.   While the confusion may be temporary, this statement may not provide enough reassurance or information.
C.   This statement may not be accurate or helpful in addressing the client's concerns about confusion.
D.   This statement provides reassurance and offers a positive outlook, indicating that the confusion is likely to improve as the client's condition gets better.

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Correct Answer is D

Explanation

A. While medication review may be necessary, the immediate concern is the client's current symptoms and potential need for urgent intervention.
B. Encouraging the client to eat more slowly does not address the urgent nature of the client's symptoms.

C. "Assessment security" is not a standard term or intervention. It does not provide specific guidance for addressing the client's symptoms.
D. Given the client's complaints of swelling and tightness, along with difficulty swallowing, further assessment is needed to determine the cause. This information should be reported to the provider promptly.

A. Orienting the client to the unit B. Reinforcing reality with the client C. Establishing a nonthreatening relationship D. Assessing the client for physical problems

Correct Answer is D

Explanation

A. Orienting the client to the unit While orientation is important, the client's prolonged
immobility and stupor necessitate a physical assessment first to ensure there are no underlying medical issues contributing to this state.

B. Reinforcing reality with the client The client's catatonic state may make it difficult to effectively communicate or engage in reality orientation at this point. Addressing potential physical issues is the initial priority.

C. Establishing a nonthreatening relationship Building a therapeutic relationship is crucial, but given the client's current state, assessing for physical problems takes precedence.

D. Assessing the client for physical problems The client's prolonged catatonic state requires an
immediate physical assessment to rule out any underlying medical conditions contributing to his condition.

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Which statement made by the nurse would be most appropriate to an elderly client who is confused, has no history of dementia and is hospitalized for an acute urinary tract infection?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse observes a client drooling during mealtime. The client complains that his tongue feels swollen, and his jaw feels tight. What is the first action by the nurse?

Correct Answer is D

Explanation

A 28-year old male admitted with catatonic schizophrenia has been mute and motionless for several days while at home prior to admission. He still appears stuporous in the hospital. Which nursing intervention would be an initial priority?

Correct Answer is D

Explanation

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