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Q:
A priority nursing intervention for a client with bipolar mania who has difficulty sleeping is to:1. Have the night nurse talk with the client.2. Encourage long naps during the day.3. Administer PRN zolpidem tartrate (Ambien).4. Provide strenuous exercise prior to bedtime.
Q:
Your client with a mood disorder states, "My husband never calls to tell me he will be late for dinner, and then dinner is always ruined." The nurse knows that a priority teaching for this client would be:1. Cognitive theory2. Psychoanalytic Theory3. Object loss theory4. Genetic theory
Q:
When taking the admission history of a client with bipolar disorder, which information would be most significant to determine circadian rhythm dysfunction?1. Negative thought patterns2. Sleep and appetite patterns3. Psychiatric diagnosis4. Personality patterns
Q:
Which biopsychosocial theory would most support the development of depression in a client who went to live with his father at 3 months of age when his mother was sentenced to jail for 15 years?1. Object loss theory2. Gender theory3. Genetic theory4. Cognitive theory
Q:
A client describes being sad since his wife died three weeks ago. When he describes the memorial service, funeral, and his plans for the future, the nurse assesses this as:Standard Text: Select all that apply.1. A crisis.2. Bereavement.3. Delayed grief.4. Normal grief.5. Dysfunctional grieving.
Q:
What treatment approach(es) would the nurse use for a client with dysfunctional grieving?Standard Text: Select all that apply.1. Teach about maladaptive dependence on the nurse2. Talk therapies3. Antidepressants4. Cognitive therapy5. Teach anger management
Q:
A client told the nurse that even though his wife died three years ago, he continues to have dinner with his wife every Saturday night. He includes a table setting for her and he prepares their "usual" steak dinner. He also lights a candle for her each week marking the time of her death. This is evidence of:1. Dysfunctional grieving.2. Anticipatory grief.3. Normal grief.4. Bereavement.
Q:
During a nurse"client interaction, an adolescent client with a major depressive disorder stated, "I was on the swim team at school, but I don"t enjoy swimming anymore so I quit." The client is describing:1. Anhedonia.2. Aphasia.3. Anergia.4. Antagonism.
Q:
The treatment plan for a client with acute mania has been effective when the nurse charts that the client has:1. Pressured speech and wears short shorts and a low-cut blouse.2. An expansive mood and has organized a unit pool tournament.3. An irritable mood and sat for one minute to eat lunch.4. Been intrusive with peer conversations.
Q:
The major difference between bipolar disorder and major depressive disorder is that in bipolar disorder there is:1. Suicidal ideation.2. Only one week of symptoms.3. A mania component.4. No history of depressive feelings.
Q:
The nurse would expect a client who is exhibiting the vegetative signs of depression to have:1. Constipation and insomnia.2. Helplessness.3. Hopelessness.4. Suicidal ideation and a plan.
Q:
Which of the following indicates sensitivity toward a client with schizophrenia?1. Reporting a client's compliance with medication to the psychiatrist2. Providing privacy for the client to visit with his or her family3. Eating in the dining room with the clients4. Providing encouragement for a client to attend groups
Q:
Which answer choice, when placed in the blank, creates a correct statement?The nurse maintaining a ______________ attitude will be more likely to understand the experiences and difficulties of a client with schizophrenia.1. sympathetic2. enmeshed3. complementary4. nonjudgmental
Q:
The nurse manager of the inpatient psychiatric unit is talking with the staff about the interventions to promote independent actions of clients on the chronic schizophrenia unit. Which of the following responses made by the staff indicates lack of insight into the client's illness?1. "I want to learn more about the side effects of the medication."2. "I know when clients hear voices they are not real."3. "I understand that some clients are not able to put on their clothes."4. "I believe clients sometimes need to be isolated help them feel safe."
Q:
Which of the following interventions will increase the client's likelihood of complying with taking psychotropic medications?1. Give family members information about the client's medication.2. Encourage the client to take all medication at the same time.3. Give the client a pamphlet explaining the positive effects of psychotropic medication.4. Encourage the client to use measures to manage side effects.
Q:
Lower relapse rates in schizophrenia have been found to be effective with which of the following treatment approaches?Standard Text: Select all that apply.1. Psychosocial treatment only2. Recognizing schizophrenia as an acute illness3. Antipsychotic medication exclusively4. Early intervention5. The combined use of antipsychotic medication and psychosocial treatment
Q:
Which of the following psychosocial approaches for treating schizophrenia have been found to have lower relapse rates?1. Learning is often affected negatively in schizophrenia, so there is not a need to educate clients about schizophrenia and relapse.2. Setting high goals for clients serves as an incentive for clients to avoid relapse.3. Weekly individual monitoring can help to identify and intervene with clients who are at risk for relapse.4. Antipsychotic medications are effective in lowering relapse rates for all clients.
Q:
The nurse is talking with a client diagnosed with schizophrenia about the importance of careful adherence to the medication regimen. Which of the following client reasons is not commonly associated with noncompliance?1. Lack of access to pharmacies due to financial or transportation concerns2. Increased ability to trust healthcare providers who prescribe medications3. Inability to understand instructions for taking medications4. Side effects causing extreme discomfort
Q:
The nurse is providing discharge teaching and anticipatory guidance to the family of a client with schizophrenia who experiences delusions and is easily frightened. Which of the following actions are appropriate nursing interventions?Standard Text: Select all that apply.1. Provide reality orientation.2. Assure the client that the nurse does not experience delusions or hallucinations.3. Validate the client's feelings in response to altered perceptions.4. Inform the client that their delusions and hallucinations are just bad dreams.5. Keep the client physically safe.
Q:
The sister of a client with schizophrenia asks the nurse what to do when her brother "acts like he is talking to someone, but no one is there." Which of the following responses by the nurse would help the sister gain insight into her brother's experience?1. Tell your brother to go to his room to decrease the amount of stimuli he is experiencing.2. Tell your brother there is no one else in the room.3. Give your brother medication for increased anxiety.4. Ask your brother to describe what he is seeing and hearing.
Q:
Which of the following aspects of family communication patterns may be problematic?Standard Text: Select all that apply.1. Family members appear to respect individual boundaries.2. Family members appear to be enmeshed or over-involved with each other.3. Family members appear to be able to focus and discuss specific topics reasonably with each other.4. Family members allow each other to finish a sentence without interruption.5. Family members appear to use language patterns that are unusual in that they are characteristic of the client's family only.
Q:
A client admitted to the inpatient unit has a diagnosis of schizophrenia, residual type. The nursing diagnosis that has the highest priority for this client is:1. Disturbed Thought Process2. Impaired Social Interaction3. Impaired Verbal Communication4. Risk for Violence: Self-Directed or Other-Directed
Q:
A nurse is leading an inpatient group for clients with schizophrenia. Which statements address the two main categories of nursing activities?1. "We will listen to each other's best and worst experiences of the last week."2. "We will go around the room and each person will state a personal goal for today."3. "If you can increase your self-assessment skills, you"ll be able to tell when you"re getting more stressed."4. "We"re going to discuss current events."5. "Group members can help each other identify and improve their coping skills so that each has a better "tool chest" to draw from when experiencing stress."
Q:
A client is experiencing delusions and appears to be frightened. Which of the following actions are appropriate nursing interventions?Standard Text: Select all that apply.1. Validate the client's feelings in response to altered perceptions.2. Inform the client that their delusions and hallucinations are just bad dreams.3. Assure the client that the nurse does not experience delusions or hallucinations.4. Provide reality testing.5. Keep the client physically safe.
Q:
A client is pacing in the hall. The nurse overhears the client say, "Leave me alone. I am not in the Mafia." The best response from the nurse would be:1. "Remember you are safe from the Mafia here in the hospital."2. "Tell me what you are hearing right now."3. "You need to attend the next recreation group. That will help you ignore the voices."4. "You are hearing voices again, right?"
Q:
Which of the following interventions provides the most support to assist a client with schizophrenia in adapting to a new social environment?1. Accompany the client2. Encourage the client to make new friends3. Instruct the client in coping strategies4. Increase physical activity
Q:
Which of the following statements that address the typical age of onset for schizophrenia is true?1. The typical age of onset for schizophrenia is early adolescence in both males and females.2. The typical age of onset for late-onset schizophrenia is age 60.3. The typical age of onset for schizophrenia is late adolescence to mid-thirties.4. The typical age of onset for schizophrenia is late thirties to early forties.
Q:
Select the responses which are true regarding the interactional model for schizophrenia.Standard Text: Select all that apply.1. People with schizophrenia have a greater potential for vulnerability to stress.2. People with schizophrenia have a greater likelihood of relapsing if they are from families demonstrating high expressed emotion (EE).3. People with schizophrenia are less sensitive to interpersonal stressors.4. Vulnerability, stressors, and risk factors enhance and potentiate each other in people with schizophrenia.5. People with schizophrenia are less responsive to environmental stressors.
Q:
It would be inaccurate to state that the brain structure in people with schizophrenia:1. Shows changes in the frontotemporal cortical gray matter.2. Shows changes in the hippocampal area.3. Shows changes in the parietal area.4. Is different from those without schizophrenia.
Q:
A statement which accurately describe genetics and schizophrenia would be:1. One single gene is responsible for producing schizophrenia.2. There is strong evidence that environmental factors do not affect the risk of developing schizophrenia.3. 10% of first degree relatives (children, siblings, parents) are diagnosed with schizophrenia at some point in their lives.4. The chance of monozygotic (identical) twins both having schizophrenia is 100%.
Q:
Which of the following statements would not be accurate regarding the dopamine hypothesis?1. Typical antipsychotic medications cause fewer extrapyramidal side effects than traditional antipsychotic medications.2. Atypical antipsychotic medications block serotonin and dopamine.3. Numerous types of dopamine receptors have been found to exist in varied regions of the brain.4. Positive symptoms of schizophrenia respond more readily to traditional antipsychotic medications than the newer atypical medications.
Q:
A client who is diagnosed with schizophrenia, paranoid type, tells the nurse, "I will take these antipsychotic medications to help alleviate the voices. I will not take these antipsychotic medications because of the weight gain." This client is exhibiting:1. Body image disturbance.2. Decisional conflict.3. Magical thinking.4. Noncompliance.
Q:
Which of the following behaviors is characteristic of a client with disorganized schizophrenia?1. A client tells the nurse he is being "monitored" by the FBI.2. A client tells the nurse, "All is well, but the well is dry, so why bother with clock and tock, mock, lock, jock."3. A client comes to the nursing station and asks for something to "help calm my nerves."4. A client sits in the corner rocking back and forth crying because "the voices are telling me I am a lousy good-for-nothing."
Q:
A client admitted to the inpatient unit has a diagnosis of schizophrenia, residual type. The nursing diagnosis which has the highest priority for this client is:1. Disturbed Thought Process2. Impaired Social Interaction3. Risk for Violence: Self-Directed or Other-Directed4. Impaired Verbal Communication
Q:
Which of the following statements are accurate descriptions of schizoaffective disorder?1. The mood component of schizoaffective disorder is depression.2. Alterations in mood and thought process occur simultaneously in schizoaffective disorder.3. A client with schizoaffective disorder usually has hallucinations and delusions only when experiencing a manic or depressed state.4. The prognosis for schizoaffective disorder is substantially worse than for schizophrenia.
Q:
A client talks in a monotone voice and shows no emotion when speaking. The client tells the nurse, "I want to stay in bed all day. I do not enjoy watching television like I used to. I do not want to talk with other people." Which of the following symptoms of schizophrenia are illustrated in this scenario?Standard Text: Select all that apply.1. Alogia2. Flat affect3. Anhedonia4. Avolition5. Apathy
Q:
A client tells the nurse, "I refuse to take quetiapine (Seroquel) because it is manufactured by Al Qaeda. If I take it, I"ll die." This is an example of:1. A negative symptom of schizophrenia called alogia.2. A negative symptom of schizophrenia called avolition.3. A positive symptom of schizophrenia called delusion.4. A characteristic of schizophrenia called ambivalence.
Q:
A client is informed that his family refuses to allow him to return to the family's home because of recent violent behavior. The client's expression remains blank; there is no apparent reaction to this statement. The client then asks what time dinner is served. The client is exhibiting:1. Inappropriate affect.2. Blunted affect.3. Flat affect.4. Mutism.
Q:
The client tells the nurse, "The world will end tonight at midnight. Armageddon is upon us!!" Which type of delusion is this?1. Religious2. Grandiose3. Nihilistic4. Persecutory
Q:
The nurse is interacting with a client. The client states, "I am from the planet Shoz, so I am a Shozoid." The client is manifesting which type of communication?1. Echolalia2. Neologism3. Clang association4. Blocking
Q:
The nurse is learning how to reduce the stigma associated with substance abuse. Which of the following statements by the nurse would reflect that learning has taken place?1. "We"re admitting a coked-out, manic client."2. "A 34-year-old is being admitted for suicidal threats as a result of cocaine use."3. "They"ve added another druggie to my caseload."4. "We"re admitting a cocaine addict who threatened to kill herself."
Q:
A nursing student expresses a belief that it is hopeless to keep providing substance abuse treatment when the rate of relapse is so high. The staff nurse should respond with which of the following statements?1. "Sometimes a client doesn"t show much effort."2. "You are right. I don"t know why we bother."3. "It is important to maintain hope that a client can make positive change."4. "We are legally obligated to provide care."
Q:
A short-term goal that can be identified for a client completing his fourth alcohol detoxification program in one year is that the client will:1. Develop a treatment relationship with another client.2. Identify constructive outlets for stress.3. State that he sees the need for ongoing treatment.4. Use denial and rationalization in a healthier way.
Q:
For a substance-abusing client, the most appropriate nursing goal is to:1. Assume responsibility for the choice to use substances.2. Allow family to determine the plan of intervention.3. Use acceptable amounts of legal substances.4. Learn to avoid feelings of low self-esteem.
Q:
A client who presents in the psychiatric unit tells the admitting nurse that she is very depressed and is having a hard time staying clean and sober. Which of the following is true regarding mental illness in a client with identified substance abuse?1. Depression or other mental illnesses should be treated only after the client has been sober for one month.2. Depression or other mental illness is an expected outcome of substance abuse recovery.3. Depression or other untreated mental illness can contribute to relapse.4. Depression or other mental illnesses are symptoms of the substance abuse.
Q:
The nurse is working with a client who suffers from addiction. What treatment approach would be most appropriate for this client who has had multiple substance abuse treatments and has relapsed?1. 12-step self-help program2. Long-term outpatient therapy3. Lifestyle change4. One week detoxification program
Q:
A client in an alcohol rehabilitation program tells the nurse, "I"ve been such a loser all my life! I feel so ashamed for what I have put my family through! Now I am in rehab and I am not sure I can stay sober." What nursing diagnosis would be most appropriate?1. Self-Esteem Disturbance2. High Risk for Violence3. Powerlessness4. Alteration in Health Maintenance
Q:
The nurse and a client talk about Alcoholics Anonymous (AA). The client asks, "What's AA all about?" Which reply by the nurse best describes AA?1. "It's a group that learns about drinking from a group leader."2. "It's a form of group therapy led by a psychiatrist."3. "It's a group that advocates strong punishment for drunk drivers."4. "It's a self-help group where the norm is sobriety."
Q:
The nurse knows that when focusing on relapse prevention, what is most important for the client?1. Identify high-risk situations.2. Acknowledge connection to a greater power.3. View the disorder as only one facet of who the client is.4. Recognize that most relapse occurs after five years of being chemically clean.
Q:
A college student tells the nurse that he sometimes cannot recall conversations or events during times when he was drinking heavily. The nurse teaches the client that this experience is indicative of which of the following symptoms?1. Addiction2. Confabulation3. Delusion4. Blackout
Q:
A client was brought to the hospital at two a.m. She had been drinking and she fell, fracturing her femur. If the client is going to experience withdrawal symptoms, the nurse should be alert for them to peak around which time?1. 24-48 hours after drinking stops2. 72-92 hours after drinking stops3. 54-72 hours after drinking stops4. 6-12 hours after drinking stops
Q:
The nurse is teaching an alcoholic patient about the importance of proper nutrition. Which of the following nutritional recommendations is appropriate for clients with alcohol dependence?1. Restrict fluid intake to decrease renal load2. Provide a multivitamin supplementation, including thiamine and folate3. Encourage a high-protein, low-carbohydrate diet to promote lean body mass4. Increase sodium-rich foods to increase iodine levels
Q:
A client admitted for a heroin overdose receives naloxone (Narcan), which relieves his altered breathing pattern. Two hours later, he complains of muscle aches and abdominal cramps. He also displays a runny nose and is shivering. What assessment can be made?1. The client should be placed on seizure precautions.2. The client is experiencing relapse.3. The client is experiencing symptoms of narcotic withdrawal.4. The client is experiencing a side effect to the naloxone.
Q:
A client brought to the emergency room after a motor vehicle accident tells the nurse that she attended a party and drank four drinks over the last hour. Her blood alcohol level is 0.15g/dl. She states she is "buzzed." What conclusions can the nurse draw?1. The client is intoxicated.2. The client's blood alcohol level is dangerously high.3. The client has a problem with alcohol dependence.4. There is insufficient data to draw a conclusion.
Q:
The nurse is admitting a client to the unit for acute alcohol intoxication. In planning the client's care, which of the following is the priority intervention for this client?1. Check for seizure precaution equipment2. Darken the room3. Monitor vital signs frequently4. Restrain the client when restless
Q:
A nurse is meeting with a family in which the wife abuses alcohol. During the family assessment meeting, the nurse observes that the husband tends to help the wife during the assessment. The husband says, "I help her a lot. This is so difficult for her." What type of support group might be helpful for the husband?1. Alcoholics Anonymous2. Caretakers group3. Adult Children of Alcoholics4. Codependents group
Q:
Since chemical dependency is a family disease, it is important to help non-abusing family members change over-responsible behaviors such as:1. Expressing their feelings directly.2. Rejecting the client until the client is chemically clean.3. Distancing themselves from the client's problem.4. Covering up for problems the client has.
Q:
The nurse is taking the history of a psychiatric client suspected of abusing alcohol. Which assessment question is best to ask?1. When was your last drink?2. Do you drink regularly?3. Are you experiencing blackouts?4. Who are your drinking partners?
Q:
A nurse interviews a client with a diagnosis of both a psychiatric disorder and a substance use disorder. Dual diagnosis will:1. Demand that the substance use disorder be prioritized.2. Demand that the psychiatric disorder be prioritized.3. Complicate the clinical picture as both diagnoses have to be addressed.4. Have little or no impact on the plan of care.
Q:
A client's family member states, "I don"t understand the reason for the methadone treatment. Why replace heroin with methadone?" What is the best explanation for this family?1. Methadone is safe even in large doses.2. Methadone replaces a more potent drug.3. Methadone is a deterrent to the use of drugs.4. Methadone blocks the craving for and the action of opiates.
Q:
A client who abuses alcohol has been placed on naltrexone (Trexan). What information should be included in the client education about the effects of this medication?1. The client may discontinue its use in alcohol abuse treatment.2. If alcohol is ingested, the client may experience a lethal reaction.3. The client needs to avoid use of over-the-counter products that contain alcohol.4. If alcohol is ingested, the client will feel less "high."
Q:
A preceptor nurse is discussing the substance abuse program with a new graduate nurse. The new graduate nurse asks the preceptor what is the most important initial outcome for clients in substance abuse programs. Which of the following is the best answer from the preceptor?1. Make a moral inventory of self2. Make amends for people they have hurt3. Overcome denial4. Learn problem-solving
Q:
A community nurse who is preparing education on opioid usage in the community should focus the education on:1. Teaching seizure precautions.2. Effects of opioids on long-term vision problems.3. Dangers of overdose.4. Recognition of signs of withdrawal.
Q:
Ten hours after admission to the ICU following an auto accident, a client begins to exhibit mild tachycardia, irritability, and tremors. Three hours later the client has a grand mal seizure. The staff suspect that the client has:1. Wernicke's encephalopathy.2. Korsakoff's syndrome.3. Undetected internal bleeding.4. Alcohol withdrawal syndrome.
Q:
A teen is brought to the emergency room by a parent. The assessment reveals that the client has been acting strangely for the past three hours and is hypervigilant, grandiose, and irritable. Vital signs indicate hypertension, tachycardia, and some arrhythmias. The teen may have ingested:1. Alcohol.2. Crack.3. Cocaine.4. Amphetamines.
Q:
The nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following diagnoses receives priority for a client in alcohol withdrawal?1. Risk for Injury2. Ineffective Coping3. Disturbed Sensory Perception4. Disturbed Thought Processes
Q:
When doing the morning medication count for the past two weeks, the nurse noticed several drugs that had been "wasted" or "re-ordered." Which of the following is the most appropriate intervention when suspecting drug diversion?1. Set up a "sting" operation2. Obtain definitive evidence3. Stay out of the situation4. Document findings
Q:
A nurse manager in a women's clinic is meeting with the staff to discuss assessment of substance abuse among pregnant clients. What would the group typically assess as the most frequently abused substance by pregnant women?1. Caffeine2. Tobacco3. Alcohol4. Cocaine
Q:
The nurse instructs the client about addiction. The nurse determines that the client understands the instructions given when the client says:1. "Addiction is a biopsychosocial problem."2. "Addiction is an emotional attachment."3. "Addiction is a behavioral habit."4. "Addiction is a moral disease."
Q:
The nurse educator is discussing the family systems explanation for substance abuse with the nursing students. Which of the following is included in the family systems explanation of substance abuse?1. Addiction can be managed through pharmacologic intervention.2. Addiction shifts the family focus.3. Addiction is a disease.4. Addiction is due to genetic causes.
Q:
Which questions would assist the nurse in developing self-awareness when working with clients who have cognitive disorders?Standard Text: Select all that apply.1. How do the clients with cognitive disorders feel about working with me?2. How do I feel about working with clients with cognitive disorders?3. What do the clients like about working with me?4. How can I help the client who is confused?5. What frustrates me about working with them?
Q:
A nursing student expresses a belief that it is normal for older adults to experience forgetfulness and depression. With which of the following statements should the staff nurse respond?1. "Impairments in memory and a depressed mood are pathologic changes that require professional intervention."2. "Memory impairments are normal in older adults, but a depressed mood is not."3. "You are right. Once you pass 50, your memory is in decline."4. "Memory impairments are not normal, but a depressed mood is fairly common in older adults."
Q:
An 84-year-old woman with a diagnosis of dementia lives with her daughter and son-in-law. The client's daughter tearfully tells the nursing student that she does not know what's wrong with her mother, who has begun accusing them of stealing her lingerie and keeping her prisoner. Based on the above, the nursing student identifies the following nursing diagnosis for the client:1. Disturbed Thought Processes.2. Defensive Coping.3. Powerlessness.4. Ineffective Coping.
Q:
A client's daughter provides all the day-to-day care for her mother who has a diagnosis of dementia. The daughter is experiencing symptoms of insomnia, stomach pains, and frequent headaches. These symptoms may indicate that the daughter is in need of:1. A nursing home placement for her mother.2. Electroconvulsive treatment for depression.3. A thorough mental status examination.4. Supportive counseling and information about respite care.
Q:
A nurse is working with a family who is caring for their mother at home. They complain that the strain of caring for her 24 hours a day is exhausting them. What is the nurse's best suggestion?1. They place their mother in a nursing home2. They hire a housekeeper3. They obtain respite care to give them a break4. They go into family therapy
Q:
When a client with memory loss is in need of orienting cues, the most appropriate response for maintaining dignity and self-esteem would be:1. "What an unusually warm and sunny day for the 12th of November."2. "I"m sure you remember to look at your calendar every day. What is today's date?"3. "What is today's date? I have such a hard time keeping track."4. "You remember that yesterday was Veteran's Day, don"t you? Of course that would make today November 12th."
Q:
A 72-year-old client has Alzheimer's dementia. Her husband of 50 years is no longer able to care safely for her at home and has her placed in a long-term care facility. When her husband visits, she smiles and talks about their many travels around the world. Intrigued, the nurse asks the husband to describe his travels. The husband laughs and says, "We've never been out of the states." The client's tales are an example of:1. Delirium.2. Apraxia.3. Aphasia.4. Confabulation.
Q:
Which of the following medications might be given to a client with Alzheimer's disease to delay the rate of cognitive decline?1. Donepezil (Aricept)2. Quetiapine (Seroquel)3. Valproic acid (Depakote)4. Escitalopram (Lexapro)
Q:
Which of the following statements would be most important for staff to consider when planning delirium management for a client?1. Provide education for family members as needed2. Decrease all stimulation in the client's room3. Ask the family to involve the client in all conversations and interactions4. Sensory deprivation and overstimulation can worsen symptoms
Q:
In a supervision session, several of the nurses discuss methods for preventing agitated and angry outbursts in clients diagnosed with dementia. One nurse appropriately suggests:1. Ignoring the behavior.2. Distraction or a quieter environment at the first sign of agitation.3. Attempting a rational discussion of the issue with the client.4. Distraction and engagement in high-energy activities.