The nurse is caring for a patient who becomes agitated when visitors stay for extended periods or the hospital unit becomes noisy. The nurse identifies this as sensory overload. Which interventions will be of benefit to the patient? (Select all that apply.)
Turn on the television to drown out noise from other patients.
Institute a unit-wide quiet time at 10:00 p.m. each night.
Reduce the number of visitors to the patient’s room.
Provide a dedicated period of rest time each afternoon.
Coordinate therapies and tests with other departments and providers.
Correct Answer : B,C,D,E
Choice A reason: This is incorrect. Turning on the television to drown out noise from other patients can worsen the sensory overload by adding more auditory stimulation. The patient may prefer a quiet and calm environment.
Choice B reason: This is correct. Instituting a unit-wide quiet time at 10:00 p.m. each night can benefit the patient by reducing the noise level and promoting rest and relaxation. The patient may sleep better and feel less agitated.
Choice C reason: This is correct. Reducing the number of visitors to the patient’s room can benefit the patient by minimizing the social and emotional demands and allowing the patient to have some privacy and personal space. The patient may feel less overwhelmed and more comfortable.
Choice D reason: This is correct. Providing a dedicated period of rest time each afternoon can benefit the patient by giving the patient a break from the sensory input and activities of the day. The patient may use this time to meditate, listen to soothing music, or do other calming activities.
Choice E reason: This is correct. Coordinating therapies and tests with other departments and providers can benefit the patient by avoiding unnecessary duplication or interruption of services and ensuring a smooth and consistent care plan. The patient may feel less stressed and more confident.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This is an incorrect choice because calling the operator to activate the fire alarm is not the nurse’s first response when a patient smokes in the hospital bathroom and starts a fire. Calling the operator to activate the fire alarm is an important action to alert the fire department and the other staff and patients, but it is not the most urgent or priority action. The nurse should first ensure the safety of the patient and themselves before calling for help.
Choice B reason: This is an incorrect choice because closing the door to contain the fire is not the nurse’s first response when a patient smokes in the hospital bathroom and starts a fire. Closing the door to contain the fire is a helpful action to prevent the fire from spreading to other areas, but it is not the most urgent or priority action. The nurse should first ensure the safety of the patient and themselves before containing the fire.
Choice C reason: This is an incorrect choice because utilizing a fire extinguisher to put out the fire is not the nurse’s first response when a patient smokes in the hospital bathroom and starts a fire. Utilizing a fire extinguisher to put out the fire is a possible action to control the fire, but it is not the most urgent or priority action. The nurse should first ensure the safety of the patient and themselves before attempting to extinguish the fire.
Choice D reason: This is the correct choice because removing the patient to a safe area is the nurse’s first response when a patient smokes in the hospital bathroom and starts a fire. Removing the patient to a safe area is the most urgent and priority action to protect the patient from the fire, smoke, and heat. The nurse should first assess the patient for any injuries or burns, and then move the patient to a safe and clear location away from the fire.
Correct Answer is C
Explanation
Choice A reason: This is incorrect. Neuropathy due to uncontrolled diabetes is not an example of nociceptive pain. Neuropathy is a type of neuropathic pain, which is pain that is caused by damage or dysfunction of the nervous system. It can cause sensations of numbness, tingling, burning, or shooting pain in the affected area. It is not related to tissue injury or inflammation.
Choice B reason: This is incorrect. Phantom pain after amputation of a limb is not an example of nociceptive pain. Phantom pain is a type of neuropathic pain, which is pain that is felt in a body part that is no longer present. It can be triggered by memories, emotions, or stimuli. It is not related to tissue injury or inflammation.
Choice C reason: This is correct. Pain from rheumatoid arthritis joint damage is an example of nociceptive pain. Nociceptive pain is pain that is caused by tissue injury or inflammation. It can be triggered by mechanical, thermal, or chemical stimuli. It can cause sensations of aching, throbbing, or stabbing pain in the affected area.
Choice D reason: This is incorrect. Chronic nerve pain after shingles infection is not an example of nociceptive pain. Chronic nerve pain is a type of neuropathic pain, which is pain that is caused by damage or dysfunction of the nervous system. It can be caused by a viral infection, such as shingles, that affects the nerve fibers. It can cause sensations of burning, itching, or electric pain in the affected area. It is not related to tissue injury or inflammation.
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