Module 3- COMFORT

9) A concerned parent brings in her son, who is 13 years old, to see you. They both report that he doesn't go to sleep until late at night and then wakes up late in the morning. She doesn't know what to do. How might you respond? A) Inform her that adolescents experience changes in the body's internal clock associated with puberty. B) Recommend a polysomnography (PSG). C) Tell her to avoid giving her son any herbal preparations such as melatonin. D) Inform them that the son's sleep habits, such as bringing electronic devices to bed, have no effect on his sleep pattern.

A

8) The nurse is designing a teaching plan for community members on ways to prevent chronic pain. Which information should the nurse include in this teaching plan? Select all that apply. A) Eating a healthy diet B) Obtaining adequate sleep C) Avoiding illicit drug use D) Limiting smoking before going to sleep E) Avoiding repetitive movements

A, B, C, E

5) A client with clinical depression asks the nurse for suggestions on how to improve the quality of sleep. After reviewing the client's history, which suggestion should the nurse make to this client? Select all that apply. A) Avoid the use of alcohol late in the evening. B) Consume a cup of tea before bed to relax. C) Adjust the temperature in the room to a comfortable level. D) Change the time of aerobic exercise to 1 hour prior to sleep. E) Avoid smoking before bedtime.

ACE

8) The nurse is assessing a client's sleep patterns. Which behavior assessment should the nurse use to make this assessment? A) Videotaping client movement during sleep B) Observing client alertness during sedentary, repetitive activities C) Noting the ability of the to fall asleep within 1 hour D) Noting the client's final awakening at the habitual sleeping time

B

8) A client has been prescribed iron supplements to treat fatigue and a hemoglobin level of 9. What additional information should the nurse suggest to the client to help reduce feelings of fatigue associated with a low red blood cell count? Select all that apply. A) Increasing intake of ice cream B) Drinking a glass of orange juice each day C) Increasing intake of red meat D) Increasing intake of wax beans E) Increasing intake of green, leafy vegetables

B, C, E

10) A 55-year-old client diagnosed with sleep apnea has been prescribed a CPAP machine as treatment. The nurse is instructing the client on how to use the machine. What instruction should the nurse include? A) Any size mask will work. B) Straps can be loose, if that feels more comfortable. C) Use relaxation exercises to reduce uncomfortable feelings from the mask. D) Do not use a humidifier at the same time.

C

6) A resident in an assisted-living facility is restless most nights and sits in the lounge area reading. When questioned, the resident reports suffering from insomnia. What should the nurse expect as an outcome if the resident continues with this pattern of sleep? A) Safety issues with an unsupervised resident in the lounge area B) Onset of cardiac dysfunction C) Onset of new underdiagnosed health problems D) The ability to function during the day may be hindered by these episodes.

D

2) The nurse provides an in-service to peers regarding situations that can affect the comfort level of the clients on the unit. Which client statement indicates that the client's sense of well-being is negatively impacted? A) "I feel like I have no energy today." B) "I don't feel any physical pain today." C) "I was able to sleep uninterrupted last night." D) "I am so glad that playing cards takes my mind off my worries."

a

4) An older client recovering from prostate surgery is waking up frequently during the night. Which client statement supports the nursing diagnosis Disturbed Sleep Pattern for this client? A) "The pain in my hips is unbearable at times." B) "I walk for half an hour after I eat breakfast." C) "I take my Zoloft as soon as I get up in the morning." D) "I have one cup of regular coffee in the morning."

a

5) A child with injuries from a motor vehicle crash is crying, moaning, and thrashing about on the bed. The child's assessment reveals guarding of the abdomen. The nurse suspects that the child is in severe pain and anticipates which diagnostic test will be ordered for this client? A) Barium enema B) Electrolyte panel C) PET scan D) X-rays of the limbs

a

5) During a home visit, the nurse learns that a new mother is fatigued because the baby is not sleeping well. Which suggestion should the nurse make to help decrease this client's fatigue? A) Advise the client to alternate night feedings with the baby's father to allow each parent to rest. B) Suggest that the client ask the neighbors to babysit one night a week. C) Ask the physician for medication to restore energy. D) Increase exercise time each week to promote energy

a

6) A female client has returned to the unit following a hysterectomy. The nurse knows that which intervention will provide the most pain relief for the client? A) Offer pain relief before the client complains of pain. B) Assess the pain level every 4 hours around the clock. C) Wait until the client can describe the pain specifically. D) Allow the client to "sleep off" the anesthesia, and then offer pain medication

a

6) An 18-month-old toddler scheduled for routine vaccinations begins to cry when placed on the examination table. The parent attempts to comfort the toddler, but nothing is effective. What should the nurse do? A) Allow the toddler to sit on the parent's lap and begin the assessment. B) Allow the toddler to stand on the floor until the crying stops. C) Ask another nurse in the office to hold the toddler, since the parent is not able to control the toddler's behavior. D) Instruct the parent to hold the toddler down tightly to complete the examination.

a

7) The nurse is caring for a client who is experiencing chronic fatigue related to medication being taken for seasonal allergies. What should the nurse anticipate being prescribed to help this client? A) A medication change to treat seasonal allergies B) Physical therapy to promote exercise C) Strategies to keep the client awake during the day D) Sleep medication to increase rest time

a

2) A participant in a seminar given by the nurse asks for information about lifestyle situations that might contribute to chronic fatigue. What should the nurse identify in response to this request? Select all that apply. A) Synthroid use B) Chronic back pain C) Marijuana use D) Vigorous exercise three times a week E) Swimming after a meal

a, b, c

2) The nurse is caring for a client recently diagnosed with schizophrenia. For what sleep issues is this client at risk because of this diagnosis? Select all that apply. A) Circadian cycle disruption B) Great difficulty getting to sleep C) REM rebound D) High nighttime levels of melatonin E) Reduced REM sleep

a, b, e

5) The nurse is creating a pain management plan using the three-step approach for a client with intractable pain. Which interventions should the nurse include in this plan? Select all that apply. A) Administer a nonopioid analgesic first. B) Administer an opioid analgesic first. C) Administer a nonopioid with an opioid second. D) Administer an opioid analgesic last. E) Administer analgesics upon client request.

a, c, d

1) The nurse is preparing to assess pain level for several clients. What will the nurse assess, in addition to the client's physical experience of pain? Select all that apply. A) Religion B) Friendship C) Environment D) Psychospirituality E) Social interaction

c, d, e

10) A 46-year-old female client has been diagnosed with chronic fatigue syndrome. Which of the following symptoms would not be associated with this condition? A) Feeling unrefreshed after adequate sleep B) Joint pain with swelling C) Mild fever D) Confusion

b

4) A 21-year-old male client has come to the clinic with complaints of not being able to study effectively. The nurse plans the care based on a nursing diagnosis of Fatigue. Which client statement validates this nursing diagnosis? A) "I sleep for 9 hours a night." B) "I have hay fever." C) "I drink one beer when I go out with friends." D) "I work out in the gym two days a week."

b

4) A 3-year-old client being prepared for a lumbar puncture begins to cry when carried into the treatment room by the mother. Which nursing diagnosis is most appropriate for the client at this time? A) Knowledge Deficient of the procedure B) Anxiety related to anticipated painful procedure C) Fear related to the unfamiliar environment D) Ineffective Coping related to an invasive procedure

b

4) The nurse is caring for a 1-year-old child in the postoperative period. Which pain assessment tool should the nurse use when assessing pain in this child? A) Faces Pain Rating Scale B) FLACC Behavioral Pain Assessment Scale C) Oucher Scale D) Poker Chip Tool

b

7) The nurse is caring for a postoperative client on a medical-surgical unit. An analgesic is ordered to be given every 3-4 hours. What can occur if the nurse delays providing the client with the medication? A) Increase in the client's pain tolerance B) Increase in the chance of breakthrough pain C) Decrease in the chance of withdrawal symptoms D) Decrease in the chance of addiction

b

7) The nurse is reviewing the admission orders for an 86-year-old client who is being admitted for a hysterectomy. The client, who has been diagnosed as having uterine cancer, has chronic pain caused by arthritis. The physician has ordered long-acting oral narcotic medication to be administered every 4 hours. What should the nurse do when providing the medication to the client? A) Administer the medication when the client requests. B) Administer the medication around the clock. C) Consult the physician to order intravenous pain medication. D) Administer the medication sparingly to avoid narcotic addiction.

b

9) A client, who has multiple sclerosis, is complaining of fatigue. What should the nurse recommend? A) Advise the client to begin a high-intensity exercise program. B) Tell the client to begin a mild-to-moderate exercise program, with the approval of her physician. C) Suggest that the client restrict her activity as much as possible. D) Tell the client that she will have to adjust to fatigue and that, with MS, nothing will help.

b

Exemplar 3.5 Sleep-Rest Disorders 1) A client having difficulty sleeping asks the nurse what the complications of sleep deprivation might be. What should the nurse explain is a result of sleep deprivation? A) Fatigue occurring at night B) Auditory hallucinations C) Improved wound healing D) Development of Alzheimer's disease

b

2) The nurse, caring for a 1-year-old client recovering from a tonsillectomy, assesses the child for pain. If pain level is not addressed, what additional health problem could occur? A) Urinary retention B) Bowel obstruction C) Respiratory compromise D) Bradycardia

c

3) A client is experiencing severe pain in the left lower quadrant of the abdomen that is rated as a 10 on a pain scale of 0-10. The client is also experiencing nausea, vomiting, and restlessness. Which type of pain should the nurse suspect the client is experiencing? A) Somatic pain B) Referred pain C) Visceral pain D) Chronic pain

c

3) A client who has been undergoing treatment for chronic back pain has been considering complementary and alternative therapies to manage the pain. The nurse has assessed the client's needs and discussed the use of available methods with the client. Which client statement indicates the need for further instruction? A) "Caution is needed with alternative therapies, as they have not been tested by the FDA." B) "Chondroitin sulfate is a dietary supplement that I can get over the counter." C) "Glucosamine sulfate is a medication that must be prescribed by my physician." D) "I may have some stomach upset associated with glucosamine sulfate."

c

3) During an assessment, an adolescent reports: "I get up at 6 a.m., I attend early-morning band classes three times each week, I play sports for 2 hours each day after school, and homework takes me 3 hours each night. I always feel tired." Which history question would be the priority for the nurse to ask at this time? A) Do you think you are involved in too many activities? B) Do you consume foods high in iron such as red meat and green, leafy vegetables? C) How many hours of sleep do you get each night? D) Have you considered talking with your teachers about decreasing your homework, since you have so many extracurricular activities?

c

6) The nurse is teaching a female client with chronic fatigue due to clinical depression regarding ways to increase energy levels. Which client statement indicates that teaching has been effective? A) "I need to increase exercise time each week." B) "I will spend time with friends." C) "I will take Wellbutrin as prescribed." D) "I will go shopping once a week."

c

7) A client with a history of insomnia is scheduled for a polysomnogram that requires an overnight stay in a sleep laboratory. What additional information about this test should the nurse provide to the client? A) The test occurs 2 hours after awakening from the overnight sleep study. B) The test requires a 24-hour interval of sleep deprivation. C) The test records the biophysical changes the client experiences during sleep. D) The test consists of five 20-minute nap trials.

c

1) The nurse is teaching a class on the perception of pain. What will the nurse teach as being the second step in processing pain stimuli? A) Thalamus B) Reticular system C) Limbic system D) Cerebral cortex

d

3) An older client is talking with the nurse about sleep problems. What fact regarding sleep should the nurse teach this older client? A) All elderly individuals experience disrupted sleep and depression. B) The need for sleep decreases with age. C) Normally, a person should not awaken more than once during the night. D) The elderly do not experience as much deep sleep as a younger person

d

8) A 6-year-old client's IV has infiltrated and must be restarted immediately for medication administration. There is no time for placing local anesthetic cream on the skin to decrease the pain associated with the procedure. What complementary therapies would be most helpful when placing the IV for this pediatric client? A) Moderate sedation B) Restraint using a "Mummy Wrap" C) Anesthesia D) Distraction using bubbles

d

Exemplar 3.3 Fatigue 1) A client reports feeling tired and not refreshed after sleeping even when everyone at home laughs about her loud snoring at night. What should the nurse suspect as being the cause of this client's fatigue? A) Insomnia B) Depression C) Thyroid disorder D) Sleep apnea

d