The nurse is assessing an elderly male in the nursing home. What ...

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The nurse is assessing an elderly male in the nursing home. What question will the nurse ask this patient to best assess his level of orientation?
 
  a. Will you please repeat these three words for me: glasses, rocket, truck?
  b. Can you tell me the date of your retirement from your workplace?
  c. What is your name and today's date? Can you tell me where you are?
  d. What did you eat for breakfast this morning?

Question 2

The nurse is caring for a male patient who states, I have been smoking two packs of cigarettes a day for 20 years and now my nurse practitioner wants me to take vitamins.
 
  Do you think I need to take vitamins? What is the most appropriate response by the nurse?
  a. Smoking is bad for your health. I believe if you stop smoking you would certainly be better off and not have to take vitamins.
  b. Smokers use vitamin C faster than do nonsmokers, and is linked to iron deficiency. You can either eat more foods containing vitamin C and iron or take dietary supplements.
  c. It is probably a good idea. With your history of tobacco use, I'm sure you are lacking in vitamins and nutrients.
  d. I really cannot answer this question. You will need to speak with your nurse practitioner to find out more about this.

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Answer to Question 1

C
To assess level of orientation, the best question is to ask the patient for his name, date, and his current location. Asking the patient to repeat a sequence of words (e.g., glasses, rocket, truck) assesses recall and recent memory. Asking a patient for the date of retirement assesses long-term memory but does not reflect the patient's orientation status to the present time and situation. Asking a patient what he ate for breakfast assesses short-term memory only.

Answer to Question 2

B
Because vitamin C is an antioxidant, smokers metabolize vitamin C faster than do nonsmokers. The more a person uses tobacco, the more vitamin C is lost, yet, the body needs more vitamin C to counteract the damage smoking causes to cells. Additionally, because vitamin C aids in absorption of iron, a low level of vitamin C is also linked to iron deficiency. If a person cannot quit smoking, vitamin C and iron supplementation may help compensate. This is the best explanation to give to the patient. It is informative and nonjudgmental. Nurses can answer these questions without having to refer the patient to the nurse practitioner. Telling a patient he would be better off not smoking may be true, but it reflects a judgmental attitude on the part of the nurse. Telling the patient that he is lacking in many vitamins is too broad and not helpful.