Author Question: A nurse is assessing a client's immediate and short-term memory. Which of the following would be ... (Read 35 times)

Alainaaa8 · **on:** Jul 19, 2018

A nurse is assessing a client's immediate and short-term memory. Which of the following would be most appropriate?

A) Questioning the client about an event that has occurred within the past several months
B) Giving the client a simple scenario and having him identify what would be the best response
C) Giving the client three words and asking him to recite them now and then again in 5 minutes
D) Asking the client to tell the nurse the date, time, and current location

Question 2

After teaching a group of nursing students about milieu therapy, the instructor determines that additional education is needed when the students identify which of the following as a key concept of milieu therapy?

A) Structure interaction
B) Open communication
C) Validation
D) De-escalation

braelync · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

Ans: C
To check immediate and short-term memory, the nurse gives the client three unrelated words to remember and asks him or her to recite them immediately and at 5-minute and 15-minute intervals. To test recent memory, the nurse may question about a holiday or world event within the past few months. Giving the client a scenario and asking him for the best response evaluates judgment. Asking the client the about date, time, and current location evaluates orientation.

Answer to Question 2

Ans: D
The key concepts of milieu therapy include containment, validation, structured interaction, and open communication. De-escalation is used to provide client safety and is an interactive process of calming and redirecting a client who demonstrates potential for violence toward himself or others.