A patient diagnosed with moderate dementia consistently appears to be distorting the truth resulting in his wife asking, What should I do when he lies to me about unim-portant things? Upon what rationale should the nurse's response be based?
a. Changing the topic provides diversion.
b. Delusions should be confronted to clarify thinking.
c. Ignoring memory deficit avoids catastrophic reactions.
d. This isn't lying but rather a way to fill in the memory gaps.
Question 2
The nurse is to perform a complete assessment of a patient in her home, using the Mini-Mental State Examination (MMSE) as one component.
When the nurse arrives, the patient is seated at the table with her husband, the TV is on, and several grandchildren are visiting. The patient is quiet, but her hands are gripped tightly, and she is staring at the ceiling. The best action for the nurse to take would be which of the following?
a. Ask the husband to make an appointment to bring his wife to the clinic for test-ing.
b. Explain to the husband that accurate data will be sought, and ask him to stay with the grandchildren in another room.
c. Do not perform the test during the assessment (because it will not be valid) and rely on observations and reports from the family.
d. Explain the importance of the testing process and make an appointment for an-other day when the environment can be better controlled.
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