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Exhibits

Which other recommendation(s) could the nurse give to help the client have better sleep? Select all that apply.

Avoid naps

Eat a heavy meal before bed

Watch television in bed to fall asleep

Exercise in the evening

Try to go to bed and awaken at the same time every day

Avoid alcohol in the evening

Take an analgesic before bed

Answer and Explanation

Correct Answer : A,E,F

A. Avoid naps – Napping during the day, especially late in the afternoon or evening, can interfere with the ability to fall asleep at night. It is generally recommended to avoid naps if experiencing insomnia.

B. Eat a heavy meal before bed – Eating a heavy meal before bed can cause discomfort and indigestion, making it harder to sleep. It is better to have a light snack if needed.

C. Watch television in bed to fall asleep – Engaging in stimulating activities like watching television in bed can make it harder to relax and fall asleep. It is recommended to reserve the bed for sleep and intimacy only to associate it with rest.

D. Exercise in the evening – Exercise increases alertness and can elevate body temperature, making it more difficult to fall asleep if done too close to bedtime. Exercise should be completed earlier in the day for better sleep quality.

E. Try to go to bed and awaken at the same time every day – Consistency in sleep-wake times helps regulate the body's internal clock, improving sleep quality and promoting better sleep hygiene.

F. Avoid alcohol in the evening – Alcohol can initially make someone feel sleepy but disrupts the later stages of sleep, leading to poor sleep quality. Avoiding alcohol, especially close to bedtime, is important for better rest.

G. Take an analgesic before bed – Unless there is a specific medical reason, taking an analgesic (such as pain medication) before bed is not recommended unless prescribed by a healthcare provider.

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Correct Answer is B

Explanation

A. Provide a box of tissues for the client to use when coughing is a helpful action for promoting hygiene and comfort. However, this does not address the potential risk of infection transmission to staff and others in the room.

B. Obtain face masks for staff to wear upon entering the room is the most appropriate action. The client is coughing, and non-productive coughing can still release droplets that may carry infectious agents. Wearing face masks helps protect staff and other individuals from potential exposure to airborne pathogens.

C. Assist the client in changing into a fresh hospital gown is a considerate action but does not directly address the immediate concern of infection control. The priority here is preventing the spread of potential infectious particles.

D. Teach the client to cover the mouth with hands when coughing is incorrect. The client should cover their cough with their elbow or a tissue, not with their hands, to prevent spreading germs. Teaching this technique is important but does not address the immediate need for protective measures for staff.

A. Report any change in urine color. B. Keep mucous membranes moist. C. Record the client's daily weight. D. Maintain in high Fowler's position.

Correct Answer is B

Explanation

A. Report any change in urine color is not a primary intervention in palliative care for this client. While monitoring urine output is important in assessing hydration status, it does not directly address the client's comfort, which is a key goal in palliative care.

B. Keep mucous membranes moist is a critical intervention for this client. Mouth breathing and the refusal of fluids can lead to dry mucous membranes, causing discomfort. Regular oral care using swabs or rinses can alleviate dryness, improving the client's comfort and quality of life.

C. Record the client's daily weight is unnecessary in this situation. Monitoring weight is typically relevant for clients whose fluid balance or nutritional status is being managed, which is not a focus in palliative care for a terminally ill client.

D. Maintain in high Fowler's position is not the priority in this scenario. While positioning may be adjusted to support breathing, the focus should remain on comfort, such as alleviating the dryness associated with mouth breathing.

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Exhibits Which other recommendation(s) could the nurse give to help the client have better sleep? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When entering a client's room, the nurse observes the client holding up an arm and coughing non-productively into the upper sleeve. Which action should the nurse take?

Correct Answer is B

Explanation

The palliative care nurse receives a consult for a terminally ill client in the intensive care unit (ICU). The client is weak, mouth breathing, and refusing anything to eat or drink. Which intervention should the nurse include in the plan of care?

Correct Answer is B

Explanation

Which action should the nurse implement when inserting an indwelling catheter for an uncircumcised male client?

A client is being admitted to the unit with a varicella zoster virus infection. Which room should the charge nurse assign to the client?

The nurse observes the unlicensed assistive personnel (UAP) securing a client's wrist restraints to the bedside rails. Which action is most important for the nurse to implement?

In planning the turning schedule for a bedfast client, it is most important for the nurse to consider which assessment finding?

The nurse enters a client's room to perform a physical assessment and finds the client crying. Which response is best for the nurse to provide?

A client with a sprained ankle is seen at the clinic and is given a pair of crutches. When the client stands with the aid of the crutches, the nurse notes a space of three finger-widths between the top of the crutch and the client's axilla. Which action should the nurse take?

The nurse educators on a cardiovascular unit of a health care facility are creating a social media project that addresses improving outcomes for clients with heart failure. Which action should the nurses implement to protect client privacy?

Exhibits

Which other recommendation(s) could the nurse give to help the client have better sleep? Select all that apply.