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 A

Explanation

Choice A reason: The ABG results of pH 7.21, PaCO2 36, HCO3 14 indicate metabolic acidosis, which is common in patients with end-stage kidney disease (ESKD). In ESKD, the kidneys lose their ability to excrete acid and maintain bicarbonate levels, leading to an accumulation of acid in the blood. This condition results in a low pH (acidic), normal PaCO2 (as the respiratory system attempts to compensate), and low HCO3 (bicarbonate).

Choice B reason: The ABG results of pH 7.50, PaCO2 29, HCO3 22 indicate respiratory alkalosis, which is not typically associated with ESKD. Respiratory alkalosis occurs when there is excessive exhalation of carbon dioxide, leading to a higher pH (alkaline). This condition is more likely to be seen in situations such as hyperventilation, anxiety, or certain lung diseases.

Choice C reason: The ABG results of pH 7.47, PaCO2 45, HCO3 33 indicate metabolic alkalosis, which is not typically associated with ESKD. Metabolic alkalosis occurs when there is an excess of bicarbonate or a loss of acid. This condition can result from factors such as vomiting, diuretic use, or excessive antacid consumption. It is not a common finding in patients with ESKD.

Choice D reason: The ABG results of pH 7.31, PaCO2 48, HCO3 24 indicate respiratory acidosis, which is not typically associated with ESKD. Respiratory acidosis occurs when there is an accumulation of carbon dioxide due to impaired respiratory function. This condition is more likely to be seen in chronic obstructive pulmonary disease (COPD) or other respiratory disorders. It is not a common finding in patients with ESKD.

A. "I can eat any foods I want before dialysis as long as I don't drink too much fluid." B. "I need to report any unusual changes in my access site, like redness or swelling." C. "I will need to check my blood pressure regularly to monitor for changes during dialysis." D. "I should contact my healthcare provider if I notice swelling in my hands, feet, or ankles." E. "I understand that hemodialysis will permanently cure my kidney disease."

Correct Answer is ["A","E"]

Explanation

Choice A reason: Eating any foods before dialysis as long as fluid intake is limited is incorrect. Patients undergoing hemodialysis need to follow specific dietary restrictions to manage electrolyte balance and prevent complications. A renal diet typically limits potassium, phosphorus, and sodium intake, in addition to fluid restrictions.

Choice B reason: Reporting any unusual changes in the access site, like redness or swelling, is correct. Changes at the access site can indicate infection or other complications and require immediate attention.

Choice C reason: Checking blood pressure regularly to monitor for changes during dialysis is correct. Blood pressure monitoring is essential during dialysis to detect hypotension or hypertension and adjust treatment accordingly.

Choice D reason: Contacting the healthcare provider if swelling in hands, feet, or ankles is noticed is correct. Swelling can indicate fluid overload or other complications that need to be addressed.

Choice E reason: Understanding that hemodialysis will permanently cure kidney disease is incorrect. Hemodialysis is a treatment that replaces kidney function but does not cure kidney disease. It manages symptoms and removes waste products from the blood.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with end-stage kidney disease (ESKD). Which arterial blood gas results (ABG) will the nurse correlate with the patient's condition?

Correct Answer is A

Explanation

The nurse is teaching a patient who is scheduled for hemodialysis about the process and potential complications. Which of the following statements by the patient indicates to the nurse the need for further teaching? (Select All That Apply)

Correct Answer is ["A","E"]

Explanation

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)

The nurse is teaching the patient about the medication albuterol for the treatment of chronic obstructive pulmonary disease (COPD). Which medication adverse effect will the nurse teach the patient to monitor for and report?

The nurse is observing a patient using a metered-dose inhaler (MDI) to aid in the management of chronic obstructive pulmonary disease (COPD). Which of the following actions, performed by the patient, indicate that further instruction is needed?

The nurse is caring for a patient diagnosed with rheumatoid arthritis (R

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 administering intravenous (IV) fluids to a patient undergoing hemodialysis. Which action is most important for the nurse to take to ensure patient safety during the procedure?

The nurse is caring for a patient with metabolic acidosis. Which laboratory findings will the nurse expect to support this diagnosis? (Select All That Apply)