A nurse in a long-term care facility is contributing to the plan of care for a client
who has dementia and is increasing anxious and confused. Which of the following
actions should the nurse plan to implement? (SATA)
-Elevate the height of the bed.
-Assist the client with ADLs.
-Establish a toileting schedule for the client.
-Turn off the lights in the client's room at night.
-Reorient the client to the environment frequently. Ans✓✓✓ Answer:
-Assist the client with ADLs.
-Establish a toileting schedule for the client.
-Reorient the client to the environment frequently.
A nurse in an urgent care facility is caring for a client who is receiving care
following a sexual assault. Which of the following actions should the nurse plan to
take?
-Allow the client to shower upon arrival to facility.
-Discourage the client from making negative statements.
-Recommend the client take legal action.
-Reassure the client that they are in a safe place. Ans✓✓✓ Answer: Reassure the
client that they are in a safe place.
, A nurse is a subtance use disorder treatment center is discussing community
resources with a newly licensed nurse. The nurse should identify that a referral to
AI-Anon is appropriate for which of the following individuals?
-An older adult clinet who has alcohol use disorder.
-A coworker who is considering an alcohol treatment program.
-A member of Alcoholics Anonymous who recently resumed alcohol intake.
-A family member who has alcohol use disorder. Ans✓✓✓ Answer: A family
member of a client who has alcohol use disorder.
A nurse is caring for a client who appears distraught after losing all their
possessions in an apartment fire. Which of the following interventions should the
nurse implement?
-Encouragethe client to block negative feelings.
-Maintain eye contact with the client during communication.
-Adopt an optimistic attitude by telling the client that the situation will end
positively.
-Request a chaplain to help provide spiritual support for the client. Ans✓✓✓
Answer: Maintain eye contact with the client during communication.
A nurse is caring for a client who has acute heroin use disorder and will soon
experience manifestations of withdrawal. Which of the following medications
should the nurse expect to administer to the client?
-Risperidone
-Disulfriam