A home health nurse is admitting a client who is prescribed peritoneal dialysis. Which of the following actions should the nurse take first?

Confirm schedule for delivery of supplies.

Coordinate interdisciplinary health care services.

Demonstrate how to perform the procedure.

Clarity the clients actual and perceived health needs

Answer and Explanation

The Correct Answer is D

A. Confirm schedule for delivery of supplies: Ensuring supplies are delivered is important for continuity of care, but it does not address the client’s immediate needs or understanding of peritoneal dialysis. This can be arranged after assessing needs.

B. Coordinate interdisciplinary health care services: Collaboration with other healthcare providers is essential for comprehensive care, but initiating coordination should follow a thorough assessment of the client’s specific needs and goals.

C. Demonstrate how to perform the procedure: Teaching the procedure is a critical step, but effective teaching requires understanding the client’s current knowledge, abilities, and perceived needs first. Without this assessment, instruction may not be individualized or effective.

D. Clarify the client’s actual and perceived health needs: Assessing both objective and perceived needs establishes a foundation for individualized care planning, teaching, and coordination. This is the first action because it informs all subsequent interventions and ensures the client’s priorities are addressed.

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Correct Answer is ["C","F"]

Explanation

A. Bedtime: The client’s bedtime of 2330 has remained unchanged despite the shift in work hours, providing some stability to the circadian rhythm. A consistent bedtime typically supports sleep regulation rather than disrupting it. Although the new routine may affect sleep pressure, the bedtime is not the primary contributor to the new difficulties falling asleep.

B. Use of chronic devices: The client turns off their phone at 2230, limiting blue-light exposure well before bedtime. There is no indication of prolonged screen use or other electronic stimulation that would interfere with melatonin release. With the device turned off an hour before bed, this factor is unlikely to be influencing the client’s disrupted sleep.

C. Evening meal: The client now eats dinner late in the evening after a 1200–2000 work shift, placing the meal close to their 2330 bedtime. Eating late can increase gastrointestinal activity and delay the body’s transition into restful sleep, contributing to both difficulty falling asleep and nighttime awakenings.

D. Medication: The client’s medications ethinyl estradiol/desogestrel and ferrous sulphate have remained consistent for months without changes in timing or dosage. These medications are not known to disrupt sleep when taken as prescribed and do not coincide with the recent onset of nighttime symptoms.

E. Caffeine use: Although the client now drinks 2 to 3 cups of coffee, it is consumed early in the morning and remains outside the usual window in which caffeine impacts nighttime sleep. Morning intake allows adequate time for caffeine metabolism before bedtime. The timing makes it a less significant factor in the client’s difficulties initiating and maintaining sleep.

F. Exercise schedule: The client exercises immediately after a shift that ends at 2000, pushing vigorous activity close to bedtime. Late-evening exercise can increase sympathetic activity and core body temperature, which can interfere with the body’s ability to relax and initiate sleep.

A. Apple juice B. Oatmeal C. Broth D. Toast

Correct Answer is B

Explanation

A. Apple juice: Thin liquids like apple juice can be difficult for clients with dysphagia to control, increasing the risk of aspiration. These should generally be thickened or avoided based on the client’s swallowing ability.

B. Oatmeal: Soft, pureed, or thick foods like oatmeal are easier to swallow and reduce the risk of aspiration. Oatmeal has a cohesive texture that allows safer swallowing for clients with dysphagia.

C. Broth: Clear liquids such as broth are thin and can easily enter the airway, increasing the risk of choking or aspiration in clients with swallowing difficulties.

D. Toast: Dry, hard foods like toast can be difficult to chew and form into a cohesive bolus, making swallowing unsafe for clients with dysphagia.

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A home health nurse is admitting a client who is prescribed peritoneal dialysis. Which of the following actions should the nurse take first?

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