An older male client who has recently been admitted to the hospital tells the practical nurse (PN) that he is unable to fall asleep, but states he does not want to take a prescribed sleeping pill because he will feel too sleepy the next day. Which action should the PN implement to help the client sleep?

Offer blankets and thick socks for increased warmth and comfort.

Administer a prescribed as needed (PRN) analgesic with a sedating effect.

Explain that the effect of the medication will wear off by morning.

Encourage regular exercise before going to bed at night.

Answer and Explanation

The Correct Answer is A

A. Offer blankets and thick socks for increased warmth and comfort: Providing warmth promotes relaxation and comfort, which can naturally enhance sleep onset in older adults. Maintaining an optimal sleep environment is an effective nonpharmacologic intervention for insomnia without causing morning drowsiness.

B. Administer a prescribed as needed (PRN) analgesic with a sedating effect: Giving medication for sedation without a clear indication of pain or discomfort is inappropriate. Analgesics should only be administered to relieve pain, not as a substitute for a sleeping aid.

C. Explain that the effect of the medication will wear off by morning: Attempting to persuade the client to take the sleeping pill disregards his expressed preference and autonomy. Nonpharmacologic sleep promotion strategies should be prioritized to respect his wishes.

D. Encourage regular exercise before going to bed at night: Engaging in exercise immediately before bedtime can stimulate the body and increase alertness, making it more difficult to fall asleep. Exercise is beneficial earlier in the day but not recommended right before rest.

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Correct Answer is A

Explanation

A. Frame of mind: Assessing the client’s current mental and emotional state is the top priority because discontinuation of divalproex sodium can lead to recurrence of manic or depressive episodes. Evaluating mood stability, presence of suicidal or manic thoughts, and overall mental status helps determine immediate safety needs and guides further intervention.

B. Speech pattern: While pressured or rapid speech may indicate mania, it is a secondary observation that supports mood assessment rather than the initial focus. The PN must first establish the client’s overall psychological state before analyzing communication details.

C. Hyperactivity: Increased activity and restlessness can occur in mania, but this symptom should be assessed in the broader context of the client’s mood and thought processes, making it less urgent than assessing overall frame of mind.

D. Headache pain: Headache is not typically associated with medication discontinuation in bipolar disorder. Although physical discomfort should be noted, it does not provide critical information about the client’s psychiatric stability or immediate risk level.

A. Prepare to assist in applying a new cast to reduce pressure points. B. Explain that this is an expected part of the bone healing process. C. Report the client's concern to the healthcare provider. D. Teach the client strategies to prevent further calluses

Correct Answer is B

Explanation

A. Prepare to assist in applying a new cast to reduce pressure points: Recasting is unnecessary unless there is malalignment, skin compromise, or complications. Formation of a callus is a normal healing process and does not require a new cast.

B. Explain that this is an expected part of the bone healing process: A callus is new bone that forms around a fracture as part of natural healing. Educating the client helps reduce anxiety and reinforces understanding of normal fracture recovery milestones.

C. Report the client's concern to the healthcare provider: While documentation of client concerns is appropriate, reassurance and education about normal healing is the priority in this situation. There is no complication requiring provider intervention.

D. Teach the client strategies to prevent further calluses: Callus formation at the fracture site is a desired outcome of bone healing, not a preventable problem. Interventions to prevent calluses are unnecessary and would be misleading.

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Naxlex Comprehensive Predictor Exams

A male client with bipolar disorder reports to the practical nurse (PN) that he has not taken his prescribed medication, divalproex sodium, for the last 6 months. Assessment of which parameter is most important for the PN to obtain?

Correct Answer is A

Explanation

Two weeks after cast application, a client with a fractured right arm returns to the clinic for evaluation. The client seems upset and tells the practical nurse (PN) that the healthcare provider said a callus has formed on the bone. Which action should the PN take?

Correct Answer is B

Explanation

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Which intervention should the practical nurse (PN) reinforce for a client with pruritis?

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