A nurse in an acute care facility is assisting with the development of an in-service about reducing environmental stressors to improve clients' sleep. Which of the following instructions should the nurse include?
Conduct change-of-shift report near the clients' rooms.
Turn on overhead lights briefly when checking IV lines.
Open curtains between clients in semiprivate rooms.
Wear shoes with rubber soles.
The Correct Answer is D
Wearing shoes with rubber soles can minimize noise and provide a quieter environment for the clients. It helps reduce disruptions caused by footsteps, especially during nighttime when clients are trying to sleep.
Conducting change-of-shift report near the clients' rooms can lead to increased noise levels and disturb clients' sleep. It is best to conduct report in a designated area away from patient rooms to minimize disruptions.
Overhead lights should be avoided during nighttime or sleep hours as they are bright and can disrupt a client's sleep. Instead, nurses should use a low-intensity light or a flashlight to check IV lines or attend to other needs. This helps minimize disruptions to the client's rest.
Opening curtains between clients in semiprivate rooms can compromise privacy and contribute to increased noise levels. It is important to provide privacy for clients, especially during their rest periods.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Fidelity, also known as loyalty or faithfulness, refers to the nurse's commitment to keeping promises and fulfilling their responsibilities to the client. By promising to walk with the client in the outdoor courtyard each day, the nurse is demonstrating fidelity by maintaining their commitment to the client's well-being and providing the support needed to alleviate anxiety.
Autonomy refers to the client's right to make decisions about their own care and treatment. While the nurse's promise supports the client's autonomy by accommodating their preference for exercising in the courtyard, it is not the principle being demonstrated by the nurse.
Justice refers to fairness and equality in healthcare, ensuring equitable treatment and distribution of resources. While justice is an important ethical principle, it is not directly applicable in this situation.
Nonmaleficence is the principle of doing no harm and taking actions to prevent harm to the client. While the nurse's promise of walking with the client aligns with the goal of reducing anxiety, it is not specifically related to preventing harm.
Correct Answer is C
Explanation
A.This is incorrect because suction should not be applied during the insertion of the catheter. Suctioning should only be applied while withdrawing the catheter to avoid causing trauma to the mucosa.
B. Suctioning should generally be performed for no longer than 10 seconds at a time to minimize the risk of complications such as hypoxia.
C.This response is correct because waiting approximately 1 minute between suctioning attempts allows the client time to recover and reoxygenate. This interval helps prevent hypoxia and mucosal damage, which are important considerations during the suctioning process.
D.In adults insert catheter approximately 16 cm (6.5 inches); in older children, 8– 12 cm (3–5 inches); in infants and young children, 4–7.5 cm (1.5–3 inches). Rule of thumb is to insert catheter distance from tip of nose (or mouth) to angle of mandible.
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