Question

an older female client with advanced dementia is admitted to the hospital with a fractured hip. the client repeatedly tells the staff, \take me home. i want my mommy.\ which response is best for the nurse to provide?

orient the client to the time, place, and person.
tell the client that the nurse is there and will help her.
remind the client that her mother is no longer living.
explain the seriousness of her injury and need for hospitalization.

Explanation:

Analyze the client's condition and behavior

The client has advanced dementia, is hospitalized with a fractured hip, and is expressing distress by asking for her mother ("Take me home. I want my mommy.").

Evaluate the clinical interventions

• Orienting the client to reality or reminding her that her mother is deceased will likely increase anxiety, agitation, and distress because her cognitive impairment prevents her from processing reality correctly.
• Explaining the medical seriousness of her injury is ineffective due to her advanced cognitive decline.
• Providing a calm, supportive, and reassuring presence ("Tell the client that the nurse is there and will help her") addresses the underlying emotional need for safety and security without challenging her reality.

Determine the best response

The response that focuses on safety, reassurance, and emotional validation is the most therapeutic intervention for a client with advanced dementia.

Answer:

• Orient the client to the time, place, and person.
• Tell the client that the nurse is there and will help her. (Correct answer)
• Remind the client that her mother is no longer living.
• Explain the seriousness of her injury and need for hospitalization.