A nurse in an acute facility is assisting with the development of an in-service about reducing environmental stressors to improve client’s sleep. Which of the following instructions should the nurse include?

Turn on overhead lights briefly when checking IV line

Open curtains between clients semiprivate rooms

Conduct change-of-shift report near the clients’ rooms.

Wear shoes with rubber soles

Answer and Explanation

The Correct Answer is D

A) "Turn on overhead lights briefly when checking IV line.": Turning on overhead lights can disrupt the client’s sleep, especially if done during the night. Light exposure can interfere with the body’s natural circadian rhythm, making it harder for the client to fall asleep and stay asleep. A more appropriate action would be to use a dim light or portable light to minimize disturbance.

B) "Open curtains between clients’ semiprivate rooms.": Opening the curtains between semiprivate rooms could increase noise and visual distractions, which may disturb the client's sleep. Keeping the environment as calm and private as possible is essential to reduce stress and promote restful sleep. Curtains should ideally remain closed to promote privacy and minimize distractions.

C) "Conduct change-of-shift report near the clients’ rooms.": Conducting report near the client's rooms can create unnecessary noise and disturb the client’s sleep. The change-of-shift report should ideally take place in a designated area, away from patient rooms, to reduce noise and disturbances in the environment.

D) "Wear shoes with rubber soles.": Wearing shoes with rubber soles reduces noise when walking, which is particularly important in an acute care setting where patients need rest. Quiet movement helps to maintain a peaceful environment, reducing the environmental stressors that can impact sleep quality for clients.

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Correct Answer is D

Explanation

A) "I will make sure that my baby's diaper is applied snugly":
A snug diaper could potentially cause irritation or pressure on the circumcision site, increasing the risk of complications such as discomfort or delayed healing. Diapers should be fitted appropriately but not excessively tight around the area to avoid friction on the circumcised site.

B) "I will wipe away yellow crusts that form around the incision":
Yellow crusts are a normal part of the healing process following a Plastibell circumcision, and they should not be wiped away. These crusts form as part of the natural healing process, and removing them prematurely can disrupt the healing tissue or cause unnecessary bleeding or infection.

C) "I will apply antibiotic ointment to my baby's penis":
Antibiotic ointment is generally not recommended for use after a Plastibell circumcision, as it can interfere with the healing process. The Plastibell procedure typically heals with just proper care and the use of a clean diaper. Applying ointments can cause excess moisture that might lead to infection.

D) "I will apply pressure with gauze if I see bleeding":
This is the correct response. If bleeding occurs after a Plastibell circumcision, the appropriate action is to apply gentle pressure with sterile gauze to control the bleeding. Excessive bleeding or uncontrolled bleeding after the procedure may require medical attention, but applying pressure is the first step in addressing this issue.

A. "The headaches should decrease as you get used to the medication." B. "You should take the medication an empty stomach to prevent a headache." C. "You can discontinue the medication until the headache goes away." D. "Swallow the tablet whole to minimize your headaches."

Correct Answer is A

Explanation

A) "The headaches should decrease as you get used to the medication.": This statement is correct. A common side effect of isosorbide dinitrate is headaches, as the medication works by dilating blood vessels, which can cause a drop in blood pressure. These headaches typically occur when the medication starts, but they often decrease over time as the body adjusts to the drug. The nurse should reassure the client that this side effect is generally temporary.

B) "You should take the medication on an empty stomach to prevent a headache.": This statement is incorrect. While taking certain medications on an empty stomach may affect their absorption, isosorbide dinitrate is typically not recommended to be taken on an empty stomach to avoid headaches. In fact, it is more common for people to take it with food if it causes gastrointestinal discomfort, but this is not directly related to preventing headaches.

C) "You can discontinue the medication until the headache goes away.": This statement is incorrect. The client should not discontinue the medication without consulting the healthcare provider. Abruptly stopping isosorbide dinitrate can lead to withdrawal symptoms and potentially worsen the client's condition. The nurse should encourage the client to talk to their provider if the headache becomes unbearable or persistent, but not to stop the medication without guidance.

D) "Swallow the tablet whole to minimize your headaches.": This statement is incorrect. Isosorbide dinitrate in chewable form is designed to be chewed, as this method of administration helps the drug be absorbed more quickly and effectively. Swallowing the tablet whole would not address the issue of headaches and could affect how the medication works.

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A nurse in an acute facility is assisting with the development of an in-service about reducing environmental stressors to improve client’s sleep. Which of the following instructions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching about circumcision care with the parent of an infant who just underwent a Plastibell circumcision. Which of the following statements by the parent indicates an understanding of the teaching?

Correct Answer is D

Explanation

A nurse is caring for a client who reports he has headaches after taking chewable isosorbide dinitrate. Which of the following statements should the nurse make?

Correct Answer is A

Explanation

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