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Exhibits

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0900

Pain assessment completed. The client's pain is 2 on a 0 to 10 pain scale. The client requests sleeping medication for the night. She explains that she keeps having horrible thoughts and memories about the house collapsing and that it is keeping her from falling asleep. She states, "I used to be so happy before all of this happened. Now I can't seem to get out of this funk I am in." The client would also prefer to be in a quieter area of the unit as she is currently by the nurses' station and hears talking

requests sleeping medication for the night

keeps having horrible thoughts and memories about the house collapsing and that it is keeping her from falling asleep

can't seem to get out of this funk I am in

prefer to be in a quieter area of the unit

currently by the nurses' station

pain is 2 on a 0 to 10 pain scale

Answer and Explanation

The Correct Answer is ["A","B","C","D"]

Rationale

The client is experiencing significant psychological distress characterized by intrusive thoughts and memories related to the traumatic event (house collapsing during a hurricane). These thoughts are causing her difficulty in falling asleep and impacting her emotional well-being. Her statement about feeling unable to get out of a "funk" suggests that she may be experiencing symptoms of acute stress or post-traumatic stress disorder (PTSD). It's crucial to address her psychological distress promptly to provide support and prevent exacerbation of her symptoms.

Sleep Difficulties: The client requests sleeping medication due to her difficulty in falling asleep. Sleep disturbances are common after experiencing a traumatic event and can further contribute to emotional distress and hinder recovery. It's important to assess her sleep patterns and consider appropriate interventions, such as pharmacological sleep aids under medical supervision, to help her achieve adequate restorative sleep.

Environment: The client expresses a preference for a quieter area of the unit away from constant noise (talking and alarms). Hospital environments can be noisy and disruptive, which can exacerbate anxiety and sleep difficulties. Ensuring she is in a quieter environment or making adjustments to minimize noise near her can improve her comfort and facilitate better sleep, which is essential for recovery and emotional well-being.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

Rationale

A. The client's pH is low (acidotic), and the PaCO2 is high (respiratory acidosis). Increasing the rate of ventilation (respiratory rate) can help to decrease PaCO2 by increasing alveolar ventilation, thereby helping to correct respiratory acidosis.

B. Expiratory flow time affects the time available for exhalation. While this may affect the overall mechanics of ventilation, it is not directly targeting the primary issue of elevated PaCO2 and acidosis.

C. Increasing tidal volume increases the volume of air delivered with each breath. This can improve ventilation efficiency but may not address the underlying problem of elevated PaCO2 unless it leads to increased minute ventilation.

D. Expiratory pressure is related to positive end-expiratory pressure (PEEP), which helps maintain alveolar recruitment and improve oxygenation. Decreasing expiratory pressure may not directly address the elevated PaCO2 and acidosis.

A. I should have taken an extra dose of fluticasone- salmeterol. B. I should have taken some allergy medications before going on the hike. C. I have been very stressed out lately and should work on stress management. D. I should have eaten a snack halfway through the hike. E. My friend smoked cigarettes during the hike

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"}}

Explanation

Correct choices are;

A.I should have taken an extra dose of fluticasone-salmeterol -No Understanding
Explanation: Fluticasone/salmeterol is a long-acting inhaler used for maintenance therapy in asthma. It is not meant to be used as a rescue medication for acute symptoms or exacerbations. Therefore, taking an extra dose in response to symptoms would not be appropriate.

B. I should have taken some allergy medications before going on the hike -Understanding
Explanation: Allergy medications, such as antihistamines or nasal sprays, can help reduce allergic triggers that can exacerbate asthma symptoms. Taking these medications before exposure to known triggers (like allergens during a hike) can help prevent an asthma exacerbation.

C. I have been very stressed out lately and should work on stress management -Understanding
Explanation: Stress is a known trigger for asthma exacerbations. Managing stress through techniques such as relaxation exercises, mindfulness, or therapy can help reduce the likelihood of triggering asthma symptoms.

D. I should have eaten a snack halfway through the hike - No Understanding
Explanation: While maintaining good nutrition and hydration is important for overall health, eating a snack would not necessarily prevent an asthma exacerbation unless the snack contained medications or substances that specifically manage asthma symptoms.

E. My friend smoked cigarettes during the hike - Understanding
Explanation: Secondhand smoke is a common trigger for asthma exacerbations. Being exposed to cigarette smoke can irritate the airways and worsen asthma symptoms.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

Exhibits The nurse begins client education and asks the client what potential asthma triggers may have been involved in her recent exacerbation. For each statement click to specify if the client has an understanding or no understanding of asthma triggers. Each row must have one option selected.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"A"}}

Explanation

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