A nurse notes that an older adult is unable to process complex thoughts and has difficulty forming sentences. Which of the following actions by the nurse is priority?
A) Review medication administration record.
B) Place the client on high fall risk precaution.
C) Assess muscle strength and deep tendon reflexes.
D) Orient the client to environment.
Ans: A
Nurses need to be alert to the possibility that even a simple over-the-counter product is a common cause of mental changes in older adults. An acute confusional state can be precipitated by any medication or by medication interactions. Assessment of deep tendon reflexes will be important to assess fluid and electrolyte imbalances; review the medications first. Orienting the client and high fall risk may be needed (or not).
You might also like to view...
An elderly woman had a series of lab tests that indicate she is healthy, but she has had several colds lately and often feels fatigued (although she is not depressed). She eats lightly but has a healthful diet
Which is the best advice a nurse could give her for improving her health? A) Increase total food intake. B) Take mega-doses of vitamins. C) Exercise more. D) Have psychotherapy.
A 37-year-old male is brought to the clinic by his wife because the patient is experiencing loss of motor function and sensation
After initial neurological assessment, the health care provider suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In preparation for diagnostic studies, the nurse will inform the patient that the most commonly used study to diagnosis spinal cord compression from a tumor is what? A) An X-ray B) An ultrasound C) A computed tomography (CT) scan D) A magnetic resonance imaging (MRI) scan
A woman who is 6 weeks pregnant is concerned because she is nauseated every morning. Which measure should the nurse suggest the patient use to help relieve nausea?
A) Take two aspirin on arising. B) Delay toothbrushing until noon. C) Delay breakfast until midmorning. D) Take a teaspoon of baking soda before breakfast.
Round down 9.6723 to the tenths place
1. 9.7 2. 9.6 3. 9.67 4. 9.72