An older client is hospitalized with Guillain-Barré syndrome. A family member tells the nurse the client is restless and seems confused. What action by the nurse is best?
a. Assess the client's oxygen saturation.
b. Check the medication list for interactions.
c. Place the client on a bed alarm.
d. Put the client on safety precautions.
ANS: A
In the older adult, an early sign of hypoxia is often confusion and restlessness. The nurse should first assess the client's oxygen saturation. The other actions are appropriate, but only after this assessment occurs.
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