A nurse in a long-term care facility is caring for an older adult client who is anxious and has trouble sleeping at night. Which of the following nursing measures should the nurse implement?

Get the client ready for sleep at the same time each night.

Move the client to a room next to the open nurses' station.

Encourage client to take a 1-hr nap each afternoon.

Play the client's favorite music in the room while the client is sleeping.

Answer and Explanation

The Correct Answer is A

Establishing a consistent bedtime routine and sleep schedule can promote better sleep hygiene and help regulate the client's sleep-wake cycle. By getting the client ready for sleep at the same time each night, the nurse helps create a predictable and calming routine that signals to the body that it is time to sleep.

Incorrect:

B. Move the client to a room next to the open nurses' station: This measure may increase noise and disturbances, which can further disrupt the client's sleep. Providing a quiet and peaceful environment is generally more conducive to restful sleep.

C. Encourage the client to take a 1-hour nap each afternoon: While short daytime naps can be beneficial for some individuals, they may interfere with the client's ability to fall asleep or stay asleep at night. It is generally recommended to limit daytime napping, especially if the client is having trouble sleeping at night.

D. Play the client's favorite music in the room while the client is sleeping: While some individuals find soothing music helpful for relaxation and sleep, it is essential to consider the client's preferences. Not everyone finds music helpful for sleep, and it is important to respect the client's preferences and individual needs. Some clients may find silence or white noise more conducive to sleep.

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Correct Answer is C

Explanation

The perception of family can vary among individuals, and it is important to respect the client's definition of family. By including people whom the client views as family, the nurse acknowledges the client's preferences and ensures that those who hold significance and provide support in the client's life are present during the interview.

Let's review the other options and explain why they may not be the most appropriate methods:

A. Include people who can support the client adequately: While it is important to involve individuals who can support the client, determining who can provide adequate support should be based on the client's perception and preference. The client's perspective on who can offer support may differ from the nurse's assessment, so it is crucial to involve individuals whom the client identifies as supportive.

B. Include people who live in the same house with the client: Proximity of residence does not necessarily determine the level of support or the client's perception of family. Including only individuals who live with the client may exclude other significant individuals in the client's life who may play a vital role in their support network.

D. Include people who are related to the client by blood and marriage: While blood relatives and family members by marriage can be important sources of support, it is not the sole criterion for inclusion. Clients may have chosen family or close friends who they consider to be their primary support system.

A. Repression B. Introjection C. Dissociation D. Regression

Correct Answer is D

Explanation

Regression is a defense mechanism that involves reverting to an earlier stage of development or behaving in a way that is characteristic of an earlier developmental level in response to stress or anxiety. It is a way for individuals to cope with overwhelming emotions or situations by retreating to a previous, more comfortable state.

In the scenario described, the client's behavior of consistently being late for appointments and ignoring household chores while expressing the need to be taken care of indicates a regressive response to stress. By relying on others to take care of their responsibilities, the client is seeking a sense of security and support, similar to how they may have relied on others in the past, such as during childhood.

Inc

A- Repression involves the unconscious blocking of unacceptable thoughts or impulses from conscious awareness.

B- Introjection is the internalization of values or qualities of another person or group.

C- Dissociation is a defense mechanism that involves detaching oneself from reality or the present moment to avoid emotional distress.

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A nurse in a long-term care facility is caring for an older adult client who is anxious and has trouble sleeping at night. Which of the following nursing measures should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning an Interview for a newly admitted client and plans to Include the client's family members. Which of the following methods should the nurse use to determine who to include in the interview?

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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