The nurse is caring for a 96-year-old client who has been admitted for treatment of a urinary tract infection. The nurse notices that the client takes two one-hour naps each day, one mid-morning and the other late afternoon. What intervention should the nurse implement?

Encourage the client to try ways to stay awake during the day.

Substitute physical therapy for one of the client's usual nap times.

Ask the physician to order a sleeping pill for the client to take at night.

Do nothing, as no action is necessary in this situation.

Answer and Explanation

The Correct Answer is D

D. It is important to recognize and respect the client's natural sleep patterns, especially considering their age and current health status. Napping during the day can be a normal and beneficial behavior for older adults, helping to replenish energy levels and promote overall well-being. As long as the client's napping does not interfere with their ability to sleep at night or their daily activities, no intervention may be necessary.
A. Encouraging the client to stay awake during the day may not be appropriate, especially considering the client's age and natural sleep patterns. Older adults often experience changes in their sleep-wake cycle, including more frequent napping during the day.
B. Physical activity is important for maintaining mobility and overall health but substituting physical therapy for one of the client's usual nap times may not be feasible or beneficial. The client's need for rest and sleep should be respected, especially if they are experiencing fatigue or illness.
C. Prescribing a sleeping pill for the client may not be appropriate, especially if they are already napping during the day. Sleep medications can have side effects, including drowsiness, confusion, and increased risk of falls, particularly in older adults.

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

Explanation

A. A healthy stoma should appear moist and shiny, indicating adequate blood supply and hydration of the tissue. Dryness or dullness of the stoma may indicate poor blood flow or dehydration and should be further evaluated.
B. A healthy stoma typically appears deep pink to red in color, indicating good tissue perfusion. Pallor or cyanosis of the stoma may indicate inadequate blood supply and should be assessed promptly.
C. The skin around the stoma, known as the peristomal skin, should be intact, without signs of irritation, redness, or tenderness. Irritation or breakdown of the peristomal skin can occur due to leakage of stool or irritation from ostomy appliances and should be addressed promptly to prevent skin complications.
D. A flat abdomen suggests normal abdominal contour without distention or bulging. Distention or bulging of the abdomen may indicate underlying issues such as bowel obstruction, gas accumulation, or fluid retention and should be assessed further.

E. Bowel sounds are indicative of gastrointestinal motility and function. Normal bowel sounds are present and audible in healthy individuals and are characterized by 8 to 10 clicks or gurgles per minute. Absence or abnormal bowel sounds may indicate bowel obstruction, ileus, or other gastrointestinal disorders and should be assessed further.

A. accommodate highly irritating and hyperosmolar solutions. B. provide the ability to draw blood for laboratory tests. C. establish a venous route for clients when their condition changes. D. allow for prolonged IV antibiotic administration.

Correct Answer is C

Explanation

C. This allows healthcare providers to quickly administer treatments without the need for repeated venipuncture, which can be beneficial in various medical situations where time and vein preservation are critical.
A. Peripheral intravenous saline locks are not typically used to accommodate highly irritating or hyperosmolar solutions. Saline locks are used to maintain venous access without continuous infusion, and they are generally used with isotonic solutions to prevent complications such as phlebitis or infiltration.
B. The access is not very reliable when used for drawing samples repeatedly.
D. While peripheral intravenous saline locks can be used for intermittent administration of IV antibiotics or other medications, they are not typically used for prolonged IV antibiotic administration.

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The nurse is caring for a 96-year-old client who has been admitted for treatment of a urinary tract infection. The nurse notices that the client takes two one-hour naps each day, one mid-morning and the other late afternoon. What intervention should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The home care nurse is assessing a client's abdomen 4 weeks after a colostomy in the descending colon was created. What are the expected findings of the a healthy client's abdominal assessment? (SELECT ALL THAT APPLY)

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

Explanation

A nurse caring for a client who has a peripheral intravenous saline lock understands that its purpose is to:

Correct Answer is C

Explanation

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