During the interview of a client, the client states, "I have trouble falling asleep." Which action would be appropriate for a nurse to do next?

Report the finding so a sleep medication can be prescribed.

Clarify what the client means by trouble falling asleep.

Ask the client what they do before going to bed.

Question the client about their use of caffeine.

Answer and Explanation

The Correct Answer is B

A. Report the finding so a sleep medication can be prescribed. While this might eventually be necessary, it's premature to suggest medication without further assessing the problem. Other interventions could be tried first.

B. Clarify what the client means by trouble falling asleep. Clarifying the client's statement is essential to understand the specific nature of the sleep problem, such as how long it takes to fall asleep, how often it occurs, and whether there are any contributing factors. This is a critical step in assessment before any further action.

C. Ask the client what they do before going to bed. This is a good follow-up question, but it should come after clarification of what the client means by trouble falling asleep. Understanding pre-bedtime routines is important but secondary to defining the issue.

D. Question the client about their use of caffeine. While this is a relevant question that could affect sleep patterns, it should follow after understanding the client's specific sleep issues.

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Correct Answer is C

Explanation

A. Emaciation: Emaciation refers to extreme weight loss and muscle wasting due to severe malnutrition, not just loss of appetite.

B. Cachexia: Cachexia is a complex syndrome associated with chronic illness, characterized by severe weight loss, muscle atrophy, and fatigue. While it may include loss of appetite, it’s not the best term for simple loss of appetite.

C. Anorexia: Anorexia is the correct medical term for loss of appetite. It can be related to various conditions, including prolonged illness.

D. Nausea: Nausea is a sensation of discomfort in the stomach with an urge to vomit, not loss of appetite.

A. "Do you go by he, she, or they?" B. "What pronouns do you go by?"" C. "What led to this hospital admission?" D. "What brings you in today?"

Correct Answer is B

Explanation

A. "Do you go by he, she, or they?" This question is direct and acknowledges the importance of pronouns, but it might be better phrased to be more open-ended and respectful.

B. "What pronouns do you go by?" This is the most respectful and open-ended approach, allowing the client to express their preferred pronouns without making assumptions. It demonstrates a clear understanding of the importance of gender identity and respects the client's autonomy.

C. "What led to this hospital admission?" While this question is relevant to the client’s care, it does not address the client's gender identity directly, which is crucial in this context.

D. "What brings you in today?" Similar to option C, this question focuses on the reason for the hospital visit but does not address the client's gender identity, missing an opportunity to show respect for their identity.

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During the interview of a client, the client states, "I have trouble falling asleep." Which action would be appropriate for a nurse to do next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client visits a health care facility reporting loss of appetite following a prolonged illness. How should the nurse document the client's condition?

Correct Answer is C

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An adult client was born as a female gender but has a male gender identity. Which statement by the nurse demonstrates a therapeutic approach of respecting the client's gender identity?

Correct Answer is B

Explanation

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