The client who has sleep apnoea reports falling asleep while driving, almost being involved in an accident, and frequent episodes of sleepwalking. What nursing diagnosis should be a priority for this client?
Disturbed Sleep Pattern related to difficulty staying asleep
Disturbed Thought Processes related to chronic insomnia
Risk for injury related to somnambulism
Risk for Impaired Gas Exchange related to sleep apnea
The Correct Answer is C
The priority nursing diagnosis for this client should be Risk for injury related to somnambulism. Somnambulism, also known as sleepwalking, can put the client at risk for injury as they may engage in activities while not fully conscious. The client's report of falling asleep while driving and almost being involved in an accident further highlights the potential risk for injury. It is important for the nurse to address this risk and develop a plan to ensure the client's safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
An unlicensed assistive person (UAP) is a healthcare worker who is not licensed to perform nursing tasks but can assist with basic care under the supervision of a licensed nurse. Taking and recording vital signs is a task that can be delegated to a UAP. Making a bed and assisting with bathing are also tasks that can be delegated to a UAP. However, an unlicensed assistive person may not delegate tasks to others as they are not licensed to do so.
Correct Answer is A
Explanation
The nurse should implement the measure of encouraging the client's daughter to prepare food at home and bring it to the client. This can help improve the client's nutritional intake by providing familiar and appetizing meals that may be more appealing to the client than hospital food. It is important for the nurse to work with the client and their family to identify strategies that can help improve the client's nutritional intake during their hospitalization.
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