RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016
Mental Health Nursing
Medium
Best nursing intervention for a delusion patient with confusion at night time is to?
Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016
Explanation
- Patients with confusion at night (sundowning) often misinterpret their environment due to poor lighting.
- Shadows can create illusions (e.g., seeing a coat rack as a person), which can trigger fear and worsen delusions.
- An indirect light source, like a nightlight, provides enough illumination for the patient to orient themselves to the room, reducing the risk of misinterpretation without being overly stimulating.
- This intervention directly addresses the perceptual disturbances that contribute to nocturnal confusion and agitation, making it the safest and most effective environmental modification among the choices.
Why Other Options Were Wrong
- Option A: Placing a patient near the nursing station is a strategy for safety and close observation, but the high levels of noise, light, and staff activity can cause sensory overload, disrupt the sleep-wake cycle, and worsen confusion and agitation.
- Option C: A television provides both visual and auditory stimuli that a confused and delusional patient can easily misinterpret. They may believe the events on TV are happening in the room or that the characters are real, which can fuel paranoia and delusions.
- Option D: While soft music can be calming for some, a patient with delusions may misinterpret the music or lyrics as containing personal messages or commands (ideas of reference), which can increase anxiety and agitation.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Management of sundowning and nocturnal confusion in patients with delusions to guide bedside assessment, documentation, and the next nursing action.
- Effectively managing sundowning is crucial for patient safety, as confusion increases the risk of falls, agitation, and attempts to leave the facility.
- Non-pharmacological interventions, like environmental modifications, are always the first-line approach to manage behavioral symptoms in dementia and delirium, minimizing the need for chemical or physical restraints.
- What if the patient is also trying to get out of bed despite the indirect light? In that case, the priority shifts to immediate safety. The nurse would add interventions like a bed alarm, ensuring the bed is in the lowest position, and placing a floor mat, while considering moving the patient closer to the nursing station as a necessary trade-off for fall prevention.
How to Approach the Question
- First, identify the core problem in the question: a patient with delusions is experiencing increased confusion at night. This is a classic presentation of 'sundowning'.
- Next, recall the principles of managing sundowning. The goal is to create a safe, calm, and orienting environment while minimizing stimuli that could be misinterpreted.
- Evaluate each option against these principles.
- Option A (Nursing station): This increases observation but also sensory stimulation (noise, light, activity), which is counterproductive for confusion. Eliminate it as not the 'best' option.
- Options C (TV) and D (Music): These introduce auditory and/or visual stimuli that a delusional mind can easily misinterpret, worsening the problem. Eliminate these.
- Option B (Indirect light): This directly addresses a major cause of nocturnal confusion—misinterpreting shadows. It improves orientation without being overstimulating. This aligns perfectly with the management principles.
Concept Tested & Keywords
- Concept Tested: Management of sundowning and nocturnal confusion in patients with delusions.
- Stem keywords: nursing intervention, delusion patient, confusion at night
- Lead-in keywords: Best
- Clinical cues: The combination of 'delusion' and 'confusion at night' points towards sundowning syndrome, a common issue in patients with dementia or delirium.
Question ID
QnRZHwzn2kisABimxOoy1b
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 13840-13842
E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 157-159
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 127-129
Practise the full RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Organic Brain Disorders Questions
- A patient admitted in a ward with the diagnosis of delirium. In first 24 to 48 hours what nurse plan according to priority:
- What is the most common cause of delirium in older adults?
- The most important component of nursing care plan for a client with organic brain deterioration would be?
- Which of the following is expected in a patient who is diagnosed with an organic mental disorder?
- An example of acute organic mental disorder?
- What is "sun drowning"?
- Imaginary filling of memory gaps is known as?
- Impairment in consciousness and cognition for a short time is?
- A 75-year-old patient has dementia of the Alzheimer's type and confabulates. A nurse should understand that this patient?
- A 54-year-old male patient admitted with memory impairment. His Mini-Mental State Examination (MMSE) score ranges from 10 - 18 points, which indicate…
More RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016 Questions
- Tissue injury followed by acute inflammation and marked neutrophil reaction leads to?
- Illusion is the
- The tendency to group together objects that are the same size, shape and color is known as?
- Deceased perceptual response to a repeated stimulus is known as?
- The information surrounding a stimulus is?
- The unconscious contains?
- One difference between human beings and animals is the?
- Social structure of a society is a network of?
- Gerontology is the study of?
- A disease condition characterized by excessive mucus collection with collapse of alveoli is?