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History and Physical

The client is a 36-year-old female who is in the clinic today for insomnia. She reports that she started having trouble sleeping 2 years ago after her father's death. She has no medical problems and has never had surgery. She takes an oral contraceptive and a multivitamin daily. She does not smoke but drinks 1 to 2 glasses of wine every evening.

What other recommendations could the nurse give to help the patient have better sleep? Select all that apply.

Exercise in the evening

Watch television in bed to fall asleep

Take an analgesic before bed

Avoid alcohol in the evening

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

Avoid naps

Eat a heavy meal before bed.

Answer and Explanation

Correct Answer : D,E,F

A. Exercise in the evening – Evening exercise can be stimulating and interfere with sleep. Morning or early afternoon exercise is preferable.

B. Watch television in bed to fall asleep – Screen exposure can suppress melatonin production and disrupt sleep.

C. Take an analgesic before bed – Unless pain is the reason for insomnia, this is not recommended.

D. Avoid alcohol in the evening – Alcohol can disrupt sleep patterns and prevent deep, restful sleep.

E. Try to go to bed and awaken at the same time every day – Maintaining a consistent sleep schedule improves sleep quality by regulating the body's circadian rhythm.

F. Avoid naps – Napping during the day, especially long naps, can make it harder to fall asleep at night.

G. Eat a heavy meal before bed – A heavy meal can cause discomfort and disrupt sleep.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is ["A","C","D"]

Explanation

A. Distractions can contribute to medication errors, so minimizing interruptions is essential.

B. Documentation is important but would not have prevented the error.

C. The nurse should always verify doses that seem unusually high or low.

D. Confirming client identity ensures the right client receives the right medication.

E. Educating clients is important, but a 2-year-old cannot actively participate in verifying medication administration.

A. Offer to warm the prune juice. B. Advance to a regular diet. C. Restrict oral fluid intake. D. Initiate bowel training protocol.

Correct Answer is A

Explanation

A. Warm fluids help stimulate peristalsis, promoting bowel movement in clients with constipation.

B. A diet change should be based on provider orders and the client’s condition, not just constipation.

C. Fluids should be encouraged, not restricted, as dehydration worsens constipation.

D. While bowel training may be beneficial, it is not the first action—encouraging natural relief through prune juice is a simpler intervention.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","C","D"]

Explanation

A client on a mechanical soft diet is experiencing constipation and asks the nurse for a glass of prune juice. After auscultating decreased bowel sounds, which action should the nurse implement?

Correct Answer is A

Explanation

The nurse attaches a pulse oximeter to a client's finger and obtains an oxygen saturation reading of 91%. Which assessment finding most likely contributes to this reading?

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?

While measuring vital signs, the nurse observes that a client is using accessory neck muscles during respirations. Which follow-up action should the nurse take first?

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

While changing the dressing of a client who is immobile, the nurse notices the boundary of the wound has increased. Given there is a positive methicillin-resistant Staphylococcus aureus (MRSA) laboratory result, which action is the most important for the nurse to take?

The electronic medication system alerts the nurse that the medication dose scanned for the client is two times higher than the dose prescribed. Which action should the nurse implement?

The healthcare provider prescribes streptomycin 200 mg intramusculary every 12 hours. The vial is labeled, "Streptomycin I gram/2.5 mL". How many milliliters should the nurse administer? (Enter numerical value only. (If rounding is required, round to the nearest tenth.)

A client's spouse has just learned of the client's terminal illness. The spouse is sitting in the corner of the client’s room crying, and says to the nurse, "l feel as if I'm already so alone." Which action should the nurse take first?