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 C

Explanation

A) Impetigo contagiosa: Impetigo contagiosa is a bacterial skin infection caused by either Staphylococcus aureus or Streptococcus pyogenes. While it is contagious, it is not typically required to be reported to the state health department, as it is not considered a high-priority communicable disease that mandates immediate reporting.

B) Sarcoptes scabiei: Scabies, caused by the mite Sarcoptes scabiei, is a contagious parasitic skin infection. Although scabies can be easily spread, it is generally not a reportable disease to the state health department unless there is an outbreak in a specific setting, such as a healthcare facility or school.

C) Neisseria gonorrhoeae: Neisseria gonorrhoeae, the bacterium that causes gonorrhea, is a sexually transmitted infection (STI) that is required by law to be reported to the state health department. Gonorrhea is a notifiable disease because of its potential for rapid transmission, complications, and its increasing resistance to antibiotics. Early reporting helps control the spread and provides opportunities for public health interventions.

D) Human papillomavirus (HPV): Human papillomavirus (HPV) is a viral infection that is not required to be reported to the state health department. While HPV is the most common STI and can lead to cancers such as cervical cancer, it is not mandated for reporting as an individual infection. However, certain types of HPV-related cancers may be tracked through cancer registries.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}

Explanation

Fear of abandonment: Clients with borderline personality disorder (BPD) often have an intense fear of abandonment, leading to unstable relationships and emotional outbursts. The client’s fluctuating behavior towards the nurse (from anger to admiration) suggests this pattern.

Emotional instability: BPD is characterized by rapid mood changes and intense emotional reactions. The client displays aggression, impulsivity, and mood shifts, as seen in their outbursts and sudden praise for the nurse.

Incorrect:

Elevated body temperature: Fever is not a characteristic of BPD. It is more commonly associated with infections or inflammatory conditions.

Tactile hallucinations: Hallucinations are more common in psychotic disorders or substance withdrawal rather than BPD.

Increased heart rate: Tachycardia is a physiological response to stress, anxiety, or substance use but is not a defining feature of BPD.

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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?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

A nurse is assisting with the care of a client. The nurse is collecting data from the client. Select words from the choices to fill in each blank in the following sentence The nurse should identify that ____ and ____ Indicate manifestations of borderline personality disorder

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}

Explanation

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