A nurse is caring for a client who has cardiomyopathy and is experiencing sensory overload. Which of the following actions should the nurse take?
Ensure the blinds in the client's room remain open.
Place the client in a room near the nurses' station.
Play quiet music in the client's room.
Break up nursing care into small, frequent sessions.
The Correct Answer is D
Choice A Reason:
Ensure the blinds in the client's room remain open is not appropriate. Bright light can contribute to sensory overload. It's better to create a subdued and calming environment, so keeping the blinds closed or partially closed might help reduce excess stimuli.
Choice B Reason:
Place the client in a room near the nurses' station is not appropriate. Being near the nurses' station could increase the noise and activity around the client, potentially worsening sensory overload. It's advisable to place the client in a quieter area away from high-traffic zones to minimize auditory and visual stimulation.
Choice C Reason:
Play quiet music in the client's room is incorrect. While soothing music might help some individuals relax, for someone experiencing sensory overload, even low-volume music could add to the stimuli. Silence or minimal ambient noise might be more beneficial.
Choice D Reason:
Break up nursing care into small, frequent sessions is correct. This action is beneficial for managing sensory overload. Breaking up care into smaller sessions allows for adequate rest periods between activities, reducing the overall sensory input at any given time.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["1000"]
Explanation
To lose 0.9 kg (2 lb.) of body fat per week, we can calculate the daily caloric deficit required.
1 lb. of body fat = 3,500 calories
So, for 2 lb. of body fat = 2 * 3,500 = 7,000 calories per week
To lose 0.9 kg (2 lb.) of body fat per week:
7,000 calories ÷ 7 days = 1,000 calories per day
Therefore, the client should reduce their daily caloric intake by approximately 1,000 calories per day to achieve a weight loss of 0.9 kg (2 lb.) of body fat per week.
Correct Answer is C
Explanation
Choice A Reason:
Instructing the client to tilt their head back to facilitate swallowing is not appropriate. Tilting the head back can increase the risk of aspiration (food or liquid entering the airway) for individuals with dysphagia. Instead, the client should maintain an upright position while eating.
Choice B Reason:
Encouraging the client to use a straw is inappropriate. Using a straw might increase the risk of aspiration because it can bypass the control mechanisms involved in safe swallowing, especially for someone with swallowing difficulties.
Choice C Reason:
Providing oral care before meals is correct. Providing oral care before meals helps to ensure that the client's mouth is clean, reducing the risk of infections and improving taste perception, which can enhance the client's willingness and ability to eat.
Choice D Reason:
Schedule physical therapy directly before meals is incorrect. Scheduling physical therapy directly before meals might tire the client and impact their ability to eat. Fatigue can negatively affect swallowing ability, so it's generally better to allow some rest or recovery time before meals.
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