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A nurse is caring for a client who has insomnia. Which of the following actions should the nurse take?

Administer prescribed diuretics in the evening.

Use overhead lighting when checking equipment.

Keep the door to the client's room closed.

Provide the client with snug-fitting nightwear.

Answer and Explanation

The Correct Answer is C

Rationale:

A. Administering diuretics in the evening may increase the client's need to urinate and disrupt sleep.

B. Using overhead lighting when checking equipment may disrupt the client's sleep and should be avoided.

C. Keeping the door to the client's room closed can reduce noise and disturbances from the hallway, promoting a more restful sleep environment.

D. Providing snug-fitting nightwear may be uncomfortable and restrict movement during sleep.

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Correct Answer is D

Explanation

Rationale:

A. Washing the client's face is part of postmortem care and is appropriate.

B. Gathering the client's personal belongings is part of postmortem care and is appropriate.

C. Closing the client's eyes is part of postmortem care and is appropriate.

D. Removing the client's dentures from their mouth is not part of postmortem care and may be distressing for the family. The nurse should intervene and ensure the dentures are left in place.

A. Provide oral care to the client once every 8 hr. B. Reposition the client once every 4 hr. C. Place the head of the client's bed flat. D. Use a fan to circulate air in the client's room.

Correct Answer is B

Explanation

Rationale for A: Providing oral care once every 8 hours is not directly related to relieving dyspnea. Oral care addresses comfort related to dry mouth, but it doesn't improve breathing difficulties.

Rationale for B: Repositioning the client every 4 hours can help alleviate dyspnea by improving lung expansion and preventing pooling of secretions. It also helps in reducing pressure injuries, promoting comfort, and preventing complications.

Rationale for C: Placing the head of the bed flat can exacerbate dyspnea by hindering lung expansion. It is recommended to elevate the head of the bed to improve air exchange and breathing.

Rationale for D: While using a fan can help with the sensation of breathlessness, repositioning every 4 hours is a more direct action to support ventilation and reduce dyspnea.

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A nurse is caring for a client who has insomnia. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is observing an assistive personnel (AP) provide postmortem care for a client prior to visitation by their loved ones. Which of the following actions by the AP requires intervention by the nurse?

Correct Answer is D

Explanation

A nurse is providing end-of-life care to a client who is experiencing dyspnea. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

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