A Confused Patient Is Restless and Continues to Try to Remove

question 24

Multiple Choice

A confused patient is restless and continues to try to remove his oxygen and urinary catheter.What are the priority nursing diagnosis and intervention to implement for this patient?

• A)Risk for injury: Prevent harm to patient;use restraints if alternative strategies fail.
• B)Deficient knowledge: Explain the purpose of oxygen therapy and the urinary catheter.
• C)Disturbed body image: Encourage patient to express concerns about body.
• D)Caregiver role strain: Identify resources to assist with care.