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 B

Explanation

Choice A reason: Lethargy and hypoxia are not typically associated with respiratory alkalosis. Respiratory alkalosis occurs when there is excessive exhalation of carbon dioxide, leading to a decrease in blood CO2 levels and an increase in pH. Lethargy and hypoxia are more often related to respiratory acidosis, where CO2 accumulates due to hypoventilation.

Choice B reason: Light-headedness and muscle spasms are common clinical manifestations of respiratory alkalosis. The decrease in carbon dioxide (CO2) levels leads to cerebral vasoconstriction, resulting in light-headedness or dizziness. Additionally, respiratory alkalosis can cause a shift of calcium in the blood, leading to muscle spasms, tingling, and even tetany.

Choice C reason: Hypotension and respiratory depression are not typical findings in respiratory alkalosis. Hypotension can be a symptom of various conditions but is not directly associated with respiratory alkalosis. Respiratory depression is related to hypoventilation and respiratory acidosis, not hyperventilation.

Choice D reason: Muscle twitching and hyperkalaemia are not manifestations of respiratory alkalosis. Hyperkalaemia is more commonly seen in metabolic acidosis and not in respiratory alkalosis. Muscle twitching can occur in various conditions, but respiratory alkalosis typically causes muscle spasms and tetany due to calcium shifts.

A. Administer intravenous normal saline 300 mL/hour B. Administer regular insulin 20 units subcutaneously C. Start bicarbonate infusion intravenously D. Administer potassium chloride 40 mEq orally

Correct Answer is A

Explanation

Choice A reason: Administering intravenous normal saline at 300 mL/hour is the appropriate initial intervention for a patient presenting with a hyperglycemic emergency. Fluid replacement is crucial to correct dehydration and improve circulatory volume, which will help improve renal perfusion and facilitate the excretion of excess glucose and ketones.

Choice B reason: Administering regular insulin 20 units subcutaneously is not the immediate priority. Intravenous insulin is preferred in a hyperglycemic emergency to ensure rapid and effective lowering of blood glucose levels.

Choice C reason: Starting a bicarbonate infusion intravenously is not indicated unless there is severe acidosis (pH < 7.0) or the patient is in shock. The pH of 7.20, while low, can typically be corrected with fluid and insulin therapy.

Choice D reason: Administering potassium chloride 40 mEq orally is not necessary at this point. The potassium level of 3.6 mEq/L is within the normal range, and potassium should be monitored and replaced as needed during ongoing treatment, especially when insulin therapy is initiated.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with respiratory alkalosis. Which clinical manifestations will the nurse expect to find?

Correct Answer is B

Explanation

The nurse is caring for a patient with diabetes who presents with a hyperglycemic emergency. The patient's lab values are in the chart below. Which healthcare provider's (HCP) order will the nurse implement?

Correct Answer is A

Explanation

The nurse is in the G unit is assessing a patient after receiving the change of shift SBAR report. What assessment findings will the nurse report immediately to the provider?

The nurse is caring for a patient with hyperosmolar hyperglycemic syndrome. The patient is receiving intravenous fluids of normal saline with 20 mEq of potassium chloride and a continuous insulin infusion. Which finding will indicate to the nurse that the treatment is effective?

The nurse is monitoring a patient who is receiving a blood transfusion. The nurse identifies that the blood transfusion started over four hours ago. What intervention will the nurse implement next?

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