A nurse is conducting an assessment on a client diagnosed with narcolepsy. The nurse should anticipate which of the following findings? Select all that apply.

Hallucinations at the onset of sleep

Sleep apnea

A lack of rapid eye movement (REM) sleep

The urge to move the legs when trying to sleep

Sudden attacks of sleep

Answer and Explanation

Correct Answer : A,B,E

During an assessment of a client diagnosed with narcolepsy, the nurse should anticipate the following findings: Hallucinations at the onset of sleep, Sleep apnea, and Sudden attacks of sleep ². These are common symptoms of narcolepsy. The other options (A lack of rapid eye movement (REM) sleep and The urge to move the legs when trying to sleep) are not directly related to narcolepsy.

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Correct Answer is A

Explanation

A stage II pressure ulcer is a wound that presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. This type of wound is caused by unrelieved pressure on the skin, resulting in damage to the underlying tissue. In this scenario, the nurse notes an area of tissue injury on the client's sacral area that matches the description of a stage II pressure ulcer. Stage I pressure ulcers are characterized by non-blanchable erythema of intact skin, while stage III and IV pressure ulcers involve full-thickness tissue loss and may expose underlying muscle, bone, or other structures.

A. Call a partial code. B. Call a code. C. Call the physician. D. Call a "slow code."

Correct Answer is B

Explanation

In the absence of an advance directive, the nurse should call a code ³. This means initiating emergency resuscitation measures to try to revive the client. The other options (Call a partial code, Call the physician, and Call a "slow code") are not appropriate in this situation.

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A nurse is conducting an assessment on a client diagnosed with narcolepsy. The nurse should anticipate which of the following findings? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While performing a bed bath, the nurse notes an area of tissue injury on the client's sacral area. The wound presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. What is the correct name of this wound?

Correct Answer is A

Explanation

A client with a terminal illness without an advance directive stops breathing and does not have a heartbeat. What should the nurse do?

Correct Answer is B

Explanation

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