Which bedtime action by the nurse may make it more difficult for the patient to fall asleep?
Providing a warm cup of hot chocolate
Giving the patient a gentle backrub
Encouraging the patient to use the bathroom
Giving the patient an extra blanket when cold
The Correct Answer is A
Choice A reason: This is the correct choice because providing a warm cup of hot chocolate may make it more difficult for the patient to fall asleep. Hot chocolate contains caffeine and sugar, which are stimulants that can interfere with the sleep cycle and cause insomnia. The nurse should avoid giving the patient any beverages or foods that contain caffeine or sugar before bedtime.
Choice B reason: This is an incorrect choice because giving the patient a gentle backrub may make it easier for the patient to fall asleep. A backrub is a relaxation technique that can reduce muscle tension, pain, and anxiety, and promote comfort and sleep. The nurse should offer the patient a backrub or other soothing interventions before bedtime.
Choice C reason: This is an incorrect choice because encouraging the patient to use the bathroom may make it easier for the patient to fall asleep. Using the bathroom before bed can prevent nocturia, which is the need to urinate at night, and allow the patient to have uninterrupted sleep. The nurse should assist the patient to use the bathroom or provide a urinal or bedpan if needed.
Choice D reason: This is an incorrect choice because giving the patient an extra blanket when cold may make it easier for the patient to fall asleep. Maintaining a comfortable temperature is important for sleep quality and quantity. The nurse should adjust the room temperature and provide extra blankets or fans as requested by the patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This is an incorrect choice because the patient’s core temperature has not dropped too low. The normal body temperature range is 97.7°F to 99.5°F¹. The patient’s temperature is still within this range, although it has decreased from a feverish level.
Choice B reason: This is the correct choice because vasodilation is the process of widening the blood vessels to increase blood flow and heat loss². This is a natural response of the body to lower the temperature when it is too high. Vasodilation can cause the skin to appear flushed and feel warm to the touch³.
Choice C reason: This is an incorrect choice because the patient is not exhausted from shivering. Shivering is another mechanism of the body to increase the temperature when it is too low². Shivering involves involuntary muscle contractions that generate heat³. The patient’s temperature is not too low, so shivering is not likely to occur.
Choice D reason: This is an incorrect choice because the patient’s infection has not spread to the bloodstream. A bloodstream infection, or sepsis, is a serious condition that can cause a high fever, not a low one. Sepsis can also cause other symptoms, such as chills, rapid breathing, and confusion. The patient’s temperature has dropped, not increased, and there is no evidence of sepsis.
Correct Answer is C
Explanation
Choice A reason: This is an incorrect choice because professional shared governance is not a patient care action, but an organizational model that empowers nurses and other health care professionals to participate in decision making and policy development within their practice settings¹.
Choice B reason: This is an incorrect choice because nursing care delivery model is not a patient care action, but a framework that defines how nursing care is organized, coordinated, and delivered to the patients. Examples of nursing care delivery models include primary nursing, team nursing, and case management².
Choice C reason: This is the correct choice because interprofessional communication is a patient care action that involves exchanging information, ideas, and feedback among health care professionals from different disciplines who work together to provide comprehensive care for the patients. Interprofessional communication enhances collaboration, quality, and safety of care³.
Choice D reason: This is an incorrect choice because continuing staff education is not a patient care action, but a professional development activity that involves updating and enhancing the knowledge and skills of the health care staff through formal or informal learning opportunities. Continuing staff education improves the competence and performance of the staff.
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