The nurse is discharging a patient with chronic obstructive pulmonary disease (COPD) who was prescribed a short course of prednisone. The patient tells the nurse that one of the side effects may be insomnia and that they already have a hard time sleeping. What can I do to help with that? Which recommendations will the nurse provide? (Select All That Apply)

Avoid alcoholic beverages late in the evening

Take the medication in the evening

Do a vigorous exercise routine right before bed

Maintain the same consistent sleep schedule

Read or do another quiet, noncomputer activity before bed

Answer and Explanation

Correct Answer : A,D,E

Choice A reason: Avoiding alcoholic beverages late in the evening can help improve sleep quality. Alcohol can disrupt the sleep cycle and lead to fragmented sleep. For someone experiencing insomnia, avoiding alcohol close to bedtime can prevent further sleep disturbances and help maintain a more restful sleep.

Choice B reason: Taking the medication in the evening is not recommended for patients experiencing insomnia as a side effect of prednisone. Prednisone is a corticosteroid that can increase alertness and cause difficulty sleeping. It is typically recommended to take the medication in the morning to align with the body's natural cortisol production and minimize sleep disturbances.

Choice C reason: Doing a vigorous exercise routine right before bed is not advisable. While regular exercise can promote better sleep, vigorous physical activity close to bedtime can stimulate the body and make it harder to fall asleep. It is better to exercise earlier in the day and engage in relaxing activities before bed to prepare the body for sleep.

Choice D reason: Maintaining the same consistent sleep schedule is crucial for managing insomnia. Going to bed and waking up at the same time every day helps regulate the body's internal clock and improve sleep quality. Consistency in sleep routines can make it easier to fall asleep and wake up refreshed.

Choice E reason: Reading or doing another quiet, noncomputer activity before bed is a good recommendation for improving sleep. Engaging in calming activities such as reading a book, listening to soothing music, or practicing relaxation exercises can help prepare the mind and body for sleep. Avoiding screens and bright lights before bed is important as they can interfere with the production of melatonin, a hormone that regulates sleep.

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Correct Answer is C

Explanation

Choice A reason: Encouraging the patient to rest in bed for most of the day may lead to further deconditioning and muscle weakness. While rest is important, balancing activity and rest is more beneficial for managing fatigue in chronic anemia.

Choice B reason: Administering a high-protein diet including caffeinated beverages to increase energy levels is not recommended. While a high-protein diet can support energy and muscle strength, caffeine may cause jitteriness and disrupt sleep, which can exacerbate fatigue.

Choice C reason: Assisting the patient with ADLs and encouraging frequent rest periods is appropriate for managing fatigue, weakness, and activity intolerance in chronic anemia. This approach helps the patient conserve energy while maintaining some level of activity to prevent deconditioning.

Choice D reason: Providing supplemental oxygen via face mask during vigorous exercises is not appropriate. Patients with chronic anemia should avoid vigorous exercises that could exacerbate fatigue and weakness. The focus should be on moderate, manageable activities with adequate rest.

A. The patient newly diagnosed with heart failure whose pulse oximetry is 94% on 2L oxygen. B. A patient scheduled for echocardiogram who has altered level of consciousness and restlessness. C. The patient who has dyspnea on exertion but wants to be discharged against medical advice. D. The patient whose ejection fraction (EF) is 50% and has 2+ bilateral lower extremity edema.

Correct Answer is B

Explanation

Choice A reason: The patient with heart failure whose pulse oximetry is 94% on 2L oxygen is stable at the moment. While they require monitoring, they do not take immediate priority over the patient with altered consciousness.

Choice B reason: Altered level of consciousness and restlessness are critical symptoms that require immediate assessment. These could indicate a life-threatening condition such as hypoxia, electrolyte imbalance, or stroke, necessitating prompt evaluation and intervention.

Choice C reason: The patient with dyspnea on exertion who wants to be discharged against medical advice is important, but altered consciousness takes precedence due to its potential severity.

Choice D reason: The patient with an ejection fraction of 50% and 2+ bilateral lower extremity edema is stable and does not require immediate intervention compared to the patient with altered consciousness.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient admitted to the hospital with chronic anemia. The patient reports persistent fatigue, weakness, and activity intolerance. Which intervention will the nurse implement for these manifestations?

Correct Answer is C

Explanation

The nurse has received SBAR report for their four assigned patients on a cardiac unit. Which patient will the nurse prioritize to assess first?

Correct Answer is B

Explanation

The nurse is assessing a patient with chronic obstructive pulmonary disease (COPD) who is reporting dyspnea. The nurse auscultates the patient's chest and hears wheezing throughout the lung fields. What does this finding indicate to the nurse about this patient?

The nurse is teaching a patient with a new diagnosis of multiple sclerosis (MS) about self-care with this condition. What patient statement indicates to the nurse that the patient requires further teaching?

The nurse is caring for a patient with diabetes who is exhibiting signs and symptoms of peripheral neuropathy. What will the nurse identify as a risk for this patient?

The nurse assesses a patient 20 minutes after initiating a blood transfusion. The patient has itching and chills. The nurse immediately turns off the transfusion and disconnects the tubing at the catheter hub. What intervention will the nurse prioritize to implement first for this patient?

The nurse is caring for a patient with diabetic ketoacidosis (DKA). What clinical manifestations will the nurse anticipate the patient to present? (Select All That Apply)