The nurse is completing an assessment on an older-adult patient who is having difficulty falling asleep. Which condition will the nurse further assess for in this patient?

Depression

Muscle fatigue

Hypertension

Hypothyroidism

Answer and Explanation

The Correct Answer is A

Choice A reason: Depression is strongly linked to insomnia in older adults, causing difficulty falling asleep due to rumination, low mood, or altered sleep architecture. Assessing for depression is critical, as it may underlie the sleep disturbance, requiring targeted interventions like therapy or antidepressants to improve sleep and mental health.

Choice B reason: Muscle fatigue may cause physical discomfort but is not a primary cause of difficulty falling asleep. It is more likely to affect sleep quality than initiation. Depression is a more common and significant contributor to insomnia in older adults, making this an incorrect choice.

Choice C reason: Hypertension can be associated with sleep apnea but is not directly linked to difficulty falling asleep. It may result from poor sleep but is less likely the cause. Depression is a more prevalent cause of insomnia, making this a less relevant condition to assess.

Choice D reason: Hypothyroidism can cause fatigue and sleepiness, not difficulty falling asleep. It is less commonly associated with insomnia compared to depression, which significantly disrupts sleep onset in older adults. This condition is less relevant to the patient’s presentation, making it incorrect.

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Correct Answer is B

Explanation

Choice A reason: Family relocation can cause stress or adjustment issues but is not a primary driver of developmental problems. It may temporarily affect social or academic progress, but its impact is less consistent than prolonged poverty, which has broader, long-term effects on development, making this an incorrect choice.

Choice B reason: Prolonged poverty is strongly linked to developmental problems, as it limits access to nutrition, healthcare, and education, impacting cognitive, physical, and emotional growth. Chronic socioeconomic stress can lead to developmental delays or behavioral issues, making this a critical sociocultural finding for the nurse to assess.

Choice C reason: Childhood obesity may indicate health issues like poor diet or inactivity, but its link to developmental problems is less direct than poverty. It can affect self-esteem or physical mobility but is not a primary sociocultural driver of broad developmental delays, making this a less critical finding.

Choice D reason: Loss of stamina is a vague symptom, often age-related or due to medical conditions, not a sociocultural factor. It does not directly indicate developmental problems, especially Dalin children, where poverty has a stronger impact on growth and milestones, making this an incorrect choice.

A. Caring touch B. Therapeutic touch C. Task-oriented touch D. Protective touch

Correct Answer is D

Explanation

Choice A reason: Caring touch involves physical contact to convey empathy, like holding a hand. The nurse leaves the room without touching the patient or family, overwhelmed by grief. This action does not involve physical contact or comfort, making it unrelated to caring touch in this scenario.

Choice B reason: Therapeutic touch is a healing technique using energy fields, not applicable here. The nurse’s departure due to emotional overwhelm does not involve physical or energetic interaction with the family or patient, focusing instead on self-preservation, making this an incorrect type of touch.

Choice C reason: Task-oriented touch involves physical contact for procedures, like taking a pulse. The nurse’s action of leaving the room is not task-related or physical. It reflects an emotional response to grief, not a clinical task, making this an incorrect description of the nurse’s behavior.

Choice D reason: Protective touch describes actions to shield oneself or others from emotional distress, like withdrawing from overwhelming situations. The nurse, overwhelmed by the family’s grief, leaves the room to cope, demonstrating protective touch by prioritizing emotional self-preservation, making this the correct description.

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The nurse is completing an assessment on an older-adult patient who is having difficulty falling asleep. Which condition will the nurse further assess for in this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which sociocultural finding in the history of a patient will alert the nurse to a possible developmental problem?

Correct Answer is B

Explanation

Correct Answer is D

Explanation

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