💊 NCLEX-RN Exam Prep

A nurse is caring for an older adult client with advanced Alzheimer's disease who is exhibiting restlessness and repeatedly pointing to their abdomen but is unable to verbalize their needs. What is the most appropriate initial nursing action?

A Ask the client, "Are you having pain in your stomach?"
B Assess for non-verbal cues such as facial grimacing, guarding, or rigidity.
C Offer the client a snack or a drink of water.
D Document the client's non-verbal communication and re-evaluate later.

✓ Correct Answer: Option B

Inability to verbalize requires the nurse to prioritize non-verbal assessment for potential discomfort, such as pain. Observing body language provides crucial information before direct questioning or offering interventions.

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