The nurse is discharging a patient with chronic obstructive pulmonary disease (COPD) who was prescribed a short course of prednisone. The patient tells the nurse that one of the side effects may be insomnia and that they already have a hard time sleeping. What can I do to help with that? Which recommendations will the nurse provide? (Select All That Apply)

Avoid alcoholic beverages late in the evening

Take the medication in the evening

Do a vigorous exercise routine right before bed

Maintain the same consistent sleep schedule

Read or do another quiet, noncomputer activity before bed

Answer and Explanation

Correct Answer : A,D,E

Choice A reason: Avoiding alcoholic beverages late in the evening can help improve sleep quality. Alcohol can disrupt the sleep cycle and lead to fragmented sleep. For someone experiencing insomnia, avoiding alcohol close to bedtime can prevent further sleep disturbances and help maintain a more restful sleep.

Choice B reason: Taking the medication in the evening is not recommended for patients experiencing insomnia as a side effect of prednisone. Prednisone is a corticosteroid that can increase alertness and cause difficulty sleeping. It is typically recommended to take the medication in the morning to align with the body's natural cortisol production and minimize sleep disturbances.

Choice C reason: Doing a vigorous exercise routine right before bed is not advisable. While regular exercise can promote better sleep, vigorous physical activity close to bedtime can stimulate the body and make it harder to fall asleep. It is better to exercise earlier in the day and engage in relaxing activities before bed to prepare the body for sleep.

Choice D reason: Maintaining the same consistent sleep schedule is crucial for managing insomnia. Going to bed and waking up at the same time every day helps regulate the body's internal clock and improve sleep quality. Consistency in sleep routines can make it easier to fall asleep and wake up refreshed.

Choice E reason: Reading or doing another quiet, noncomputer activity before bed is a good recommendation for improving sleep. Engaging in calming activities such as reading a book, listening to soothing music, or practicing relaxation exercises can help prepare the mind and body for sleep. Avoiding screens and bright lights before bed is important as they can interfere with the production of melatonin, a hormone that regulates sleep.

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Correct Answer is B

Explanation

Choice A reason: Chronic renal disease typically leads to metabolic acidosis, not alkalosis, due to the accumulation of acids that the kidney cannot excrete.

Choice B reason: Prolonged vomiting leads to the loss of hydrochloric acid from the stomach, which can result in metabolic alkalosis due to the imbalance caused by the loss of stomach acid.

Choice C reason: Hyperventilation leads to respiratory alkalosis due to the excessive exhalation of carbon dioxide, reducing hydrogen ion concentration in the blood.

Choice D reason: Obstructive sleep apnea is typically associated with respiratory acidosis, not metabolic alkalosis, due to episodes of hypoventilation during sleep.

A. Potassium supplements can cause irregular heart rhythm and must be avoided. B. Instruct the patient to take diuretics at bedtime to promote diuresis during the night. C. Notify the physician if weight increases by three pounds in one week. D. Administer diuretics in the morning and notify physician of decreased urine output.

Correct Answer is C

Explanation

Choice A reason: Potassium supplements can actually be important for patients on diuretic therapy, especially if they are taking loop diuretics like furosemide, which can cause potassium loss. However, it is important to monitor potassium levels and follow the physician's guidance on supplement use.

Choice B reason: Instructing the patient to take diuretics at bedtime is not recommended. Diuretics should be taken in the morning to avoid frequent urination during the night, which can disrupt sleep.

Choice C reason: Notifying the physician if weight increases by three pounds in one week is a key instruction for patients with heart failure. Rapid weight gain can indicate fluid retention and worsening heart failure, requiring prompt medical evaluation and adjustment of treatment.

Choice D reason: Administering diuretics in the morning and notifying the physician of decreased urine output is important, but the focus on notifying the physician about significant weight gain provides a more specific and actionable guideline for managing heart failure.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with metabolic alkalosis. What will the nurse recognize as the common cause of this acid-base imbalance?

Correct Answer is B

Explanation

The nursing students are preparing a care plan for a patient with heart failure. The patient will be prescribed diuretic therapy after discharge. What evidence-based instructions will the nurse include in this plan?

Correct Answer is C

Explanation

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The nurse is caring for a patient with diabetes who presents with a hyperglycemic emergency. The patient's lab values are in the chart below. Which healthcare provider's (HCP) order will the nurse implement?

The nurse is caring for a patient with respiratory alkalosis. What will the nurse recognize as the potential cause of this acid-base imbalance?