HESI
How many hours of sleep would a nurse recommend for an 11yr old
9
An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. Which response by the nurse is appropriate when the client reports pain and requests medication
Acknowledging that the pain is real and administering medication to relieve it
When would analgesics be administered after an abdominal cholecystectomy is performed
As prescribed by the health care provider
Which lifestyle factor does the nurse recall that can affect sleep
Change in evening meal time
Which statement by the nurse indicates a need for better understanding of the difference between the two stages of NREM and REM
Dreams occur during NREM sleep but not during REM sleep
Which would the nurse incorporate into the plan of care for the older adult experiencing chronic pain
Exercise
Which sleep promotion technique would the nurse advise for a client who complains about being unable to sleep well at night and then feeling sleepy throughout the next day
Exercise daily
Which activity would the nurse recommend to a client who expresses concern about insomnia and asks "what can I do to get better sleep"
Follow the same bedtime ritual each night Perform deep breathing exercises
Which discharge teaching is anticipated when the client reports frequent awakening at night, snoring, and excessive daytime sleepiness
Get fitted for an oral appliance that will bring the mandible and tongue forward
Which physiological finding would the nurse determine the client is experiencing from sleep deprivation
Hand tremors Cardiac dysrhythmias
Which response would be the nurses primary consideration when responding to the client in hospice who has severe pain and asks for another dose of oxycodone
Help reduce the clients pain immediately
Which statement about sleep patterns in older adults is correct
Inadequate sleep in older adults may lead to memory and personality changes.
Which sleep disorder is being experienced when the client reports overwhelming irresistible attacks of sleep
Narcolepsy
Which technique is not used to manage mild sleep apnea
polysomnography
Which action would the nurse take first for post surgical client who is still intubated but becoming restless with an increased pulse rate and blood pressure when it has been 4 hours since the last dose of pain medication
Administer the prescribed pain medication
Which action would the nurse perform first when a home hospice client reports unrelenting pain 1 hour after administration of the maximum dose of a narcotic analgesic
Ask the client to rate the pain according to a pain scale
Which nursing consideration would be made when determining the plan of care for the client who has severe back pain?
Ask the client what the clients tolerable level of pain is Administer the pain meds regularly around the clock
Which is the most reliable indicator of a 2yr olds pain
Changes in behavior
Which alternative and complementary therapy does the nurse recognize as not being typically used to promote sleep
Chiropractic therapy
Which question would the nurse ask to determine the clients potential for injury because of sleep deprivation
Do you operate heavy machinery Does sleepiness affect your performance at work
Which instruction would the nurse provide to the client to promote sleep
Include meat in your diet Drink milk before going to sleep Perform moderate exercise 2 hours before bedtime
A client tells a nurse "I have been having trouble sleeping and feel wide awake as soon as I get into bed" which strategy should the nurse teach the client to promote sleep
Leave the bedroom when unable to sleep Exercise in the afternoon rather than in the evening Count backwards from 100 when the clients mind is racing
The client rates pain as an 8 out of 10 before receiving an analgesic and as a 7 after being medicated. Which conclusion would the nurse make regarding the clients response to the pain medication
Medication is not adequately effective
Which action would the nurse take when caring for an Asian client who had laparoscopic cholecystectomy 6 hours ago and denies having pain
Monitoring for nonverbal cues of pain
Which sleep disorder does the nurse conclude that the client is experiencing when the client reports overwhelming, frequent, and uncontrollable urges to sleep
Narcolepsy
Which finding would the nurse include in the pain assessment of a client with chronic pain in the knee
Pain history including location, intensity, and quality of pain Pain pattern including precipitating and alleviating factors
When interpreting findings from a pain assessment which does a nurse consider the most significant influence on many clients perception of pain
Past experience and cultural values
Which involuntary physiological response would a nurse monitor for in a client experiencing pain
Perspiring
Which method qualifies as an alternative therapy for pain
Prayer Hypnosis Aromatherapy Guided imagery
Which statement about REM sleep requires correction
REM sleep is the deepest stage of sleep
Which nursing intervention would the nurse implement to promote sleep for a client in a health care setting
Reduce lighting Provide activities during the day
Which statement describes phantom limb pain
Sensation of pain that feels like it's coming from the amputated body part
Which sleep hygiene strategy is aimed at obtaining a restful nights sleep
Set a consistent time to go to bed and wake up Maintain a cool temp in the bedroom Avoid excessive alcohol in the evening and before bed Do not eat, read, work, or watch tv in bed Get out of bed and engage in other activities if unable to fall asleep
After surgery a 12yr old child is receiving morphine for pain control by way of patient controlled analgesia infusion. A bolus of morphine can be delivered every 6 minutes. Which statement by the parents indicates instructions about the PCA pump have been understood
She needs to press the PCA button whenever she needs pain medication
Which statement about sleep is correct
Sleep is associated with healing It is a state of rest that occurs for a sustained period of time Sleep restores a persons energy and feeling of well being
Which statement made by the nurse demonstrates a need for further understanding about the different stages of NREM sleep
Stage 2 is the initial stage of deep sleep, whereas stage 4 is the deepest stage of sleep
Which pain assessment method would the nurse use for an adult client with Down syndrome and limitations in mental functioning
Using the wong baker faces pain rating scale
A surgical client continues to report pain in the lower abdomen after receiving pain medication. Which intervention would the nurse choose to directly address the need to improve pain management
Utilize distraction technique Notify health care provider of ineffective pain relief from medication
When leaving for a lunch break the primary nurse shares that the client is prescribed morphine PRN. Which action would the covering nurse take first when the client complains of a pain level of 8 on a scale of 1-10
Verify the pain medication prescription in the clinical record
In discharge planning for a client in a long leg cast for a fractured bone, when would the nurse advise the client to take the prescribed as needed oxycodone and acetaminophen
When the discomfort begins