week 10 sherpath Flashcards
Which elements are included in the assessment of the mouth and pharynx?
Palpating the thyroid
Testing the gag reflex
Inspecting the septum
Assessing the carotid pulse
Testing the gag reflex
Which position should be used to inspect the back and auscultate the posterior lungs?
Patient reclining at 45 degrees
Patient supine with chest exposed
Patient seated with back exposed
Patient seated with chest exposed
Patient seated with back exposed
Place the elements of a seated examination in the correct order.
Gather supplies and greet the patient
Auscultate anterior chest and palpate breasts
Inspect back and percuss posterior chest
Assess head, ears, eyes, nose, and throat
Gather supplies and greet the patient
Assess head, ears, eyes, nose, and throat
Inspect back and percuss posterior chest
Auscultate anterior chest and palpate breasts
Which element of the examination is best performed while the adult patient is reclining at 45 degrees?
Testing range of motion of feet, ankles, and knees
Inspecting jugular venous distention and pulsation
Performing bimanual palpation of uterus and cervix
Observing the patient move from lying down to a seated position
Inspecting jugular venous distention and pulsation
Which elements are included in the assessment of the hips of an adult patient?
Select all that apply.
Testing range of motion
Palpating popliteal pulse
Auscultating systematically
Percussing for finger bone dullness
Palpating for stability of joint
Testing range of motion
Palpating for stability of joint
Order the elements of an abdominal examination of an adult who is supine.
Inspect the skin and contour
Percuss all four quadrants for tone
Lightly palpate all four quadrants
Auscultate all four quadrants
Deeply palpate all four quadrants
Inspect the skin and contour
Auscultate all four quadrants
Percuss all four quadrants for tone
Lightly palpate all four quadrants
Deeply palpate all four quadrants
Which assessment element of the adult head-to-toe examination is best performed with the patient standing?
Palpating the abdomen
Testing plantar reflexes
Assessing jugular pulsation
The Romberg test
The Romberg test
Which element of the examination would the nurse perform while the adult patient is in a standing position?
Auscultating lungs
Inspecting the spine
Testing stereognosis
Palpating the carotid pulse
Inspecting the spine
Order the elements of the abdominal/genital assessment that should be performed while the male patient is standing.
Ask the patient to lean over examination table
Inspect the perianal area
Palpate rectal sphincter tone
Instruct the patient to relax the buttocks
Ask the patient to lean over examination table
Instruct the patient to relax the buttocks
Inspect the perianal area
Palpate rectal sphincter tone
Which components are included in the functional assessment?
Select all that apply.
Social assessment
Injury assessment
Physical examination
Evaluation of activities of daily living
Comprehensive history
Social assessment
Physical examination
Evaluation of activities of daily living
Comprehensive history
Which elements are included in the review of systems for the functional assessment?
Select all that apply.
Nutritional status
Memory changes
Urinary incontinence
Prior falls or fear of falling
Identification of caregivers
Nutritional status
Memory changes
Urinary incontinence
Prior falls or fear of falling
Which element is included in the physical examination component of the functional assessment?
Reviewing health insurance coverage
Determining existence of advance directives
Assessing the skin for signs of decubitus ulcers
Asking the patient about activities of daily living
Assessing the skin for signs of decubitus ulcers
Palpation of the thyroid and cervical lymph nodes is included in examination of which part of the body?
Eyes
Neck
Mouth
Pharynx
neck
Which element of the assessment should be performed with the patient seated and wearing a gown?
Percussion of the posterior chest
Inspection of facial symmetry
Auscultation of heart and lungs
Palpation of axillary lymph nodes
Inspection of facial symmetry
Which element of the assessment should be performed after assessment of the patient’s back, posterior chest, and lungs?
Weber test
Palpation of apical pulse
Palpation of posterior chest
Inspection of spine and scapula
Palpation of apical pulse
Which elements should be performed after light palpation of all quadrants of the abdomen in the adult patient?
Percussion of all quadrants
Auscultation for bowel sounds
Deep palpation of all quadrants
Inspection of abdominal contour
Deep palpation of all quadrants
Which examination component should be performed while the adult patient is supine with the legs exposed?
Palpation of breast tissue
Palpation of popliteal pulse
Palpation for inguinal hernia
Palpation for aortic pulsation
Palpation of popliteal pulse
Place the examination components in order for the adult patient who is supine.
Inspect abdomen
Auscultate heart
Percuss liver border
Palpate for pedal edema
Auscultate heart
Inspect abdomen
Percuss liver border
Palpate for pedal edema
The healthcare provider palpates the prostate gland and seminal vesicles with the patient standing as part of which element of the examination?
Spinal
Rectal
Neurologic
Abdominal/Genital
Abdominal/Genital
Which element is performed after inspection and palpation of the patient’s spine while the patient is standing?
Test abdominal reflexes
Palpate axillary lymph nodes
Assess radial and brachial pulses
Observe the patient walk heel to toe
Observe the patient walk heel to toe
Observing the patient’s gait and testing balance are included in which element of the adult head-to-toe examination with patient standing?
Spinal
Abdominal
Neurologic
Musculoskeletal
Neurologic
The assessment of financial resources and health insurance is included in which element of the functional examination?
Social situation
Review of systems
Physical examination
Activities of daily living
Social situation
Which element of the functional assessment should be included during the review of systems?
Blood pressure
Ability to bathe
Neurologic function
Signs of dementia
Signs of dementia
On which elements should the nurse focus when performing the physical examination component of the functional assessment?
Select all that apply.
Determining caregiver’s abilities
Evaluating coordination and gait
Assessing for dyspnea with exertion
Asking about use of a cane or walker
Measuring blood pressure while the patient is seated and standing
Evaluating coordination and gait
Assessing for dyspnea with exertion
Measuring blood pressure while the patient is seated and standing
Which questions or statements made by the nurse during the sexual health history demonstrate appropriate attitudes and practices for beginning and maintaining a meaningful sexual health discussion?
Select all that apply.
“Even though the medical diagnosis is impotence, we do not have to talk about this issue.”
“We’ll go through this very quickly.”
“Is it okay if we discuss any sexual concerns you might have?”
“Why are you a lesbian?”
“The issue you’re referring to is known as erectile dysfunction.”
“Is it okay if we discuss any sexual concerns you might have?”
“The issue you’re referring to is known as erectile dysfunction.”
Which term is represented by the “P” in the PLISSIT model?
Permission
Privacy
Patient
Problems
Permission
Which question asked by the nurse indicates the discussion has reached the level of providing intensive therapy according to the PLISSIT model?
“What concerns do you have related to your sexual health function?”
“Many women experiencing menopause have sexual concerns. Do you?”
“What do you mean by that?”
“Would you like information about specialists who may be able to help?
“Would you like information about specialists who may be able to help?
Which patient assessment topics are components of a sexual health history?
Select all that apply.
Past and current general health
Exercise habits
Frequency of testicular self-examination (TSE)
Type of diet
Medications like antidepressants or antihypertensives
Past and current general health
Frequency of testicular self-examination (TSE)
Medications like antidepressants or antihypertensives
Match the sexual disorder to its description.
Painful intercourse
Decreased libido
Impotence
Inability to conceive
Answer choices
Anorgasmia
Erectile dysfunction
Low sexual desire
Dyspareunia
Infertility
Premature ejaculation
Painful intercourse
Dyspareunia
Decreased libido
Low sexual desire
Impotence
Erectile dysfunction
Inability to conceive
Infertility
Which response would the nurse make to a patient who has experienced sexual violence?
“What caused you to go with that group of guys?”
“You should not have dressed that way.”
“This was not your fault.”
“Why do you still stay with your partner?”
“This was not your fault.”
Match the sexually transmitted disease to its cues.
Genital warts possible; can undergo transformation to various cancers
Lesions advance to rash with mucous membrane lesions; ends with CNS effects
Flu-like symptoms; genital discharge; burning with urination
Genital discomfort; lesions that heal within 2–4 weeks
Answer choices
Human papillomavirus
Chlamydia
Syphilis
Genital herpes
Gonorrhea
Genital warts possible; can undergo transformation to various cancers
Human papillomavirus
Lesions advance to rash with mucous membrane lesions; ends with CNS effects
Syphilis
Flu-like symptoms; genital discharge; burning with urination
Chlamydia
Genital discomfort; lesions that heal within 2–4 weeks
Genital herpes
Match the phase of human immunodeficiency virus (HIV) to its characteristic.
Flu-like manifestations
Decreased transmission risk
Increasing number of opportunistic infections
Answer choices
Clinical latency
Acquired immunodeficiency syndrome (AIDS)
Acute
Flu-like manifestations
Acute
Decreased transmission risk
Clinical latency
Increasing number of opportunistic infections
Acquired immunodeficiency syndrome (AIDS)
Which situation is an example of sexual harassment?
Male supervisor continually places hand on female’s leg.
Female asks a male coworker out for coffee one time.
Patient makes one sexual comment to the nurse.
Female hugs a female coworker at a funeral.
Male supervisor continually places hand on female’s leg.
Which step in the PLISSIT model is being used when the nurse states, “I would like to ask you some questions pertaining to your sexual history”?
P
LI
SS
IT
P
Which practices do the acts of pulling the curtain around the bed and sitting on the chair facing the patient convey to the patient who has human immunodeficiency virus (HIV) infection?
Select all that apply.
Respecting privacy
Showing tolerance
Overcoming prejudice
Preparing to listen actively
Advocating for the patient’s needs
Respecting privacy
Preparing to listen actively
Which purposes are achieved by conducting a sexual health history for a patient with possible sexually transmitted diseases/infections?
Select all that apply.
Provide an opportunity for patient education.
Determine whether the patient falls within sexual norms.
Identify the patient’s sexual concerns.
Provide treatment for sexual dysfunction.
Highlight any high-risk sexual behaviors.
Provide an opportunity for patient education.
Identify the patient’s sexual concerns.
Highlight any high-risk sexual behaviors.
Which question or statement would the nurse use to therapeutically obtain information about a patient’s sexual orientation?
“Tell me about your partner.”
“Do you prefer anal sex?”
“Are you sexually active?”
“Are you gay?”
“Tell me about your partner.”
Which action would the nurse take when a patient is embarrassed to talk about human immunodeficiency virus (HIV) symptoms?
Select all that apply.
Call the charge nurse to go in the room and help.
Call a chaplain to help discuss the situation.
Be nonjudgmental.
Be empathetic.
Avoid the subject.
Be nonjudgmental.
Be empathetic.
Which approach would the nurse use to collect cues about a patient who has low testosterone?
Assure the patient that the sexual health history will be brief.
Ask questions in a routine, matter-of-fact manner.
Use story-telling to alleviate the patient’s anxiety.
Share personal experiences to build rapport and trust.
Ask questions in a routine, matter-of-fact manner.
Which response would the nurse make when the patient appears shocked and asks, “Why are you asking me about sexually transmitted diseases (STDs) and infections (STIs)?”
“I am concerned that you engage in risky sexual behavior and you seem likely to have had an STD/STI.”
“Asking about STDs/STIs is a routine part of our health history collection process.”
“If you have a history of STDs/STIs, I will need to use appropriate protection during your examination.”
“I’m sorry, I didn’t mean to offend you. Let’s move on to the next question.”
“Asking about STDs/STIs is a routine part of our health history collection process.”
Which sexually transmitted disease/infection (STD/STI) risk is reduced when the patient receives a Cervarix vaccine?
Human immunodeficiency virus (HIV)
Syphilis
Human papillomavirus (HPV)
Genital herpes
Human papillomavirus (HPV)
Which statements regarding sexually transmitted diseases or infections (STDs/STIs) are true?
Select all that apply.
Bacteria and viruses can cause STDs/STIs.
STDs/STIs can be contracted via sexual intercourse or intimate contact with an infected person.
Use of condoms eliminates the risk for STD/STI transmission.
STDs/STIs cannot be transmitted through oral sex.
All STDs/STIs can be contracted by both males and females.
Bacteria and viruses can cause STDs/STIs.
STDs/STIs can be contracted via sexual intercourse or intimate contact with an infected person.
All STDs/STIs can be contracted by both males and females.
Which protective strategy for genital herpes would the nurse teach the patient?
Condoms will prevent the infection of a partner.
Annual testing should be done for genital herpes.
Vaccination can prevent genital herpes.
Abstinence should be practiced when lesions are present.
Abstinence should be practiced when lesions are present.
Which term would the nurse use for a patient who has painful intercourse from insufficient vaginal lubrication?
Dyspareunia
Vaginismus
Anorgasmia
Impotence
Dyspareunia
Which situations describe how human immunodeficiency virus (HIV) is most commonly transmitted?
Select all that apply.
Exchange of bodily fluids during vaginal or anal sex with an - HIV-positive individual
Shared use of drug needles or syringes with an HIV-positive individual
Caring for an HIV-positive patient
Transfusion of infected blood products
Oral sex with an HIV-positive individual
Exchange of bodily fluids during vaginal or anal sex with an - HIV-positive individual
Shared use of drug needles or syringes with an HIV-positive individual
Which statement would the nurse expect to hear from a patient who has impotence?
“I have a lesion on my penis.”
“I can’t have an erection.”
“I seem to ejaculate too fast.”
“I am having penis discharge.”
“I can’t have an erection.”
Which cues indicate the patient is having a problem with vaginismus?
Select all that apply.
History of inability to have intercourse
Reports trying to get pregnant for over a year
States wanting to have intercourse but cannot
Partner states that the penis cannot enter the vagina
Laboratory results indicate a low level of CD4 count
History of inability to have intercourse
States wanting to have intercourse but cannot
Partner states that the penis cannot enter the vagina
Which initial action would the nurse take for a patient who is trying to grab the nurse’s buttocks?
Tell the patient to “stop.”
Ignore the behavior.
Make a joke about the behavior.
Refuse to care for the patient.
Tell the patient to “stop.”
Which cue is relevant regarding a patient’s sexual health?
Low creatinine levels
High progesterone levels
Elevated blood urea nitrogen levels
Decreased sodium levels
High progesterone levels
Which cues would the nurse observe in a patient who is a victim of human trafficking?
Select all that apply.
Appropriate weight for height
Evidence of forced vaginal or anal entry
Extremely fearful
Possible drug use marks
Unable to provide a history
Evidence of forced vaginal or anal entry
Extremely fearful
Possible drug use marks
Unable to provide a history
Which information about human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) would the nurse share with the patient?
Select all that apply.
The acute phase of HIV may last for several years.
HIV infection can be cured through the use of antiretroviral therapy (ART).
Patients with HIV may not have symptoms during the clinical latency phase.
Lung infections are possible in the AIDS phase of the disease.
Sharing towels and eating utensils is not advised.
Patients with HIV may not have symptoms during the clinical latency phase.
Lung infections are possible in the AIDS phase of the disease.
Which statements align with the concept of spirituality?
Select all that apply.
Spirituality is synonymous with religion.
Spirituality is defined by belonging to an organized religion.
Spirituality is the expression of meaning and purpose in life.
Spirituality exists regardless of religious beliefs.
Spirituality is a personal experience.
Spirituality is the expression of meaning and purpose in life.
Spirituality exists regardless of religious beliefs.
Spirituality is a personal experience.
Which statements are true about religion?
Select all that apply.
Religion usually follows specific rituals or rules.
Religion is linked to a defined system of worship or faith-based organization.
Spirituality is viewed the same regardless of one’s identified religion.
Religious beliefs can affect medical decisions.
People from the same religion all follow the same beliefs.
Religion usually follows specific rituals or rules.
Religion is linked to a defined system of worship or faith-based organization.
Religious beliefs can affect medical decisions.
Match the term associated with spirituality with its description.
Connecting to one’s inner self, which allows one to connect to others
Being connected to oneself, others, and a higher power
An energy source that inspires motivation
Peace during times of great stress
Answer choices
Connectedness
Self-transcendence
Meaning/Life purpose
Inner strength
Faith/hope
Connecting to one’s inner self, which allows one to connect to others
Self-transcendence
Being connected to oneself, others, and a higher power
Connectedness
An energy source that inspires motivation
Inner strength
Peace during times of great stress
Faith/hope
For which reasons is it important for the nurse to have knowledge about different religious and spiritual health practices?
Select all that apply.
Allows understanding of rationales behind specific behaviors
Improves communication between cultures
Improves the patient’s confidence in the nurse’s skill
Allows for more tailored nursing care
Often improves medical treatment adherence
Allows understanding of rationales behind specific behaviors
Improves communication between cultures
Allows for more tailored nursing care
Often improves medical treatment adherence
Which concept does the “I” represent in the FICA Assessment Tool?
Inclusion of family in medical decision making
Integration in a community
Importance of faith
Inspiration and hope
Importance of faith
Which statements comply with The Joint Commission’s (TJC) requirements to incorporate spiritual health into patient care?
Select all that apply.
Do you belong to a faith community?
How often do you attend religious gatherings?
Do you require a special diet because of spiritual beliefs?
Do you and your spouse share the same spiritual beliefs?
Do you have family members that you are close to and that live nearby?
Do you belong to a faith community?
Do you require a special diet because of spiritual beliefs?
Do you have family members that you are close to and that live nearby?
Which activities would be recommended for nurses who wish to explore their own spirituality more thoroughly?
Select all that apply.
Journaling specific beliefs and thoughts
Questioning why someone believes the way they do
Learning from others with different beliefs
Identifying which spiritual beliefs are most important
Attending a spiritual service different from one’s own
Journaling specific beliefs and thoughts
Learning from others with different beliefs
Identifying which spiritual beliefs are most important
Attending a spiritual service different from one’s own
The nurse is providing care for a patient with a new breast cancer diagnosis. Which question by the nurse represents the spiritual connection practice of reflection?
This is a tough thing to hear. Do you know anyone who has had breast cancer?
Have you told your children yet?
What are your thoughts about this new diagnosis?
Have you decided whether you are going to have mastectomy?
What are your thoughts about this new diagnosis?
Which spirituality-related outcome written by a student nurse suggests the need for additional learning?
After consulting with the dietician, the patient will identify acceptable ways to blend dietary restrictions with religious customs.
Patient will discuss treatment choices with a trusted confidant to explore acceptable options before beginning treatment.
Patient will contact a spiritual counselor within 2 weeks of discharge.
Patient will start attending church every Sunday immediately after discharge.
Patient will start attending church every Sunday immediately after discharge.
A patient is a Jehovah’s Witness and does not want a blood transfusion, but her health care provider has indicated that her life is at risk without it. According to the ICNP nursing analysis during times of spiritual distress, the nurse would expect to provide support to the patient for which need?
Moral Distress
Spiritual Distress
Decisional Conflict
Hopelessness
Moral Distress
Which activities would most likely be considered a way to practice spirituality?
Select all that apply.
Prayer
Meditation
Reflection
Working
Yoga
Prayer
Meditation
Reflection
Yoga
For which reasons is it important to encourage the practice of spirituality when caring for patients, regardless of whether the patient follows an organized religious community?
Select all that apply.
Spirituality has been shown to improve treatment adherence.
Spirituality has been shown to have a positive impact on health and well-being.
A strong sense of spirituality can help lower anxiety levels.
Spiritual people have a greater tendency to find joy in life.
Spiritual people believe in God, which provides hope
Spirituality has been shown to improve treatment adherence.
Spirituality has been shown to have a positive impact on health and well-being.
A strong sense of spirituality can help lower anxiety levels.
Spiritual people have a greater tendency to find joy in life.
The nurse is caring for a patient recently diagnosed with stage 4 breast cancer. The nurse is amazed because the patient always has a smile on her face, frequently talks about her future goals, and often states “I know God has a plan for me.” Which characteristics of spirituality is the patient showing based on these behaviors?
Select all that apply.
Connectedness
Self-transcendence
Inner strength
Faith and hope
Meaning/purpose in life
Connectedness
Inner strength
Faith and hope
Meaning/purpose in life
The nurse is caring for a newly diagnosed paraplegic patient after a car accident. The patient is angry, withdrawn, and not sleeping well. Which spiritual concept might the patient be experiencing?
Spiritual distress
Spiritual sensitivity
Spiritual regret
Spiritual adversity
Spiritual distress
The nurse is caring for a patient who is refusing an important medical treatment because of personal religious beliefs. Which action is best for the nurse to take?
Talk to the patient’s family about the importance of accepting the treatment.
Respect the patient’s right to refuse the treatment, and notify the prescribing health care provider.
Explain again the risks associated with refusal of treatment.
Talk to the patient about the need to incorporate the patient’s beliefs into his or her care
Talk to the patient about the need to incorporate the patient’s beliefs into his or her care
The nurse is performing a spiritual assessment on a new admission and is using the FICA spiritual assessment tool to assist with the process. Which questions are specific to the FICA assessment tool?
Select all that apply.
“Do you consider yourself spiritual or religious?”
“Do your spiritual beliefs influence your health or medical decisions?”
“Are you a part of a spiritual community or church?”
“Where do you find your source of hope?”
“How would you like me to address your health care concerns?”
“Do you consider yourself spiritual or religious?”
“Do your spiritual beliefs influence your health or medical decisions?”
“Are you a part of a spiritual community or church?”
“How would you like me to address your health care concerns?”
The nurse is performing wound care on a patient after a double mastectomy. The patient quietly asks, “Do you think my husband will still love me after he sees how I look now?” Which nursing intervention encourages open reflection by the patient?
Continue performing tasks while the patient is speaking.
Tell the patient you are busy but you will send a psychologist to talk with her.
Be physically present and actively listen when the patient is talking.
Call the hospital chaplain who also had a mastectomy to meet with the patient.
Be physically present and actively listen when the patient is talking.
Which actions by the nurse would be considered spiritual care interventions?
Select all that apply.
Encouraging the patient to practice deep breathing exercises
Telling the patient that prayer helps and you want to pray with him or her
Bringing a bible for the patient to read and learn about Jesus
Asking if the hospital could provide a specific spiritual provider
Encouraging therapeutic touch sessions such as massage
Encouraging the patient to practice deep breathing exercises
Asking if the hospital could provide a specific spiritual provider
Encouraging therapeutic touch sessions such as massage
A patient who has battled lung cancer for 5 years states that he has not prayed since the diagnosis because he did not believe it would help. He now wants to start praying and going to church. Which spiritual goal would be appropriate for this patient?
Patient will attend church every Sunday for the next 6 weeks.
Patient will speak to a spiritual counselor within 1 week of discharge.
Patient will consult with family members about his desire to start attending church.
Patient will start praying this afternoon.
Patient will speak to a spiritual counselor within 1 week of discharge.
Which nonpharmacologic interventions would the nurse suggest to a patient for a healthy bedtime routine?
Select all that apply.
Taking a warm bath
Reading for 20 minutes
Going for a jog
Aromatherapy
Drinking a glass of wine
Taking a warm bath
Reading for 20 minute
Aromatherapy
Which nonpharmacologic interventions would the nurse provide to an inpatient as part of evening care to promote uninterrupted sleep?
Select all that apply.
Offering a large meal
Changing bed linens
Providing skin care
Providing oral care
Performing a partial bath
Changing bed linens
Providing skin care
Providing oral care
Performing a partial bath
Which interventions would the nurse take to reduce noise and promote sleep for a hospitalized patient?
Select all that apply.
Lower volume of telephone ringtones.
Limit overhead pages to emergencies only at night.
Monitor equipment frequently.
Conduct shift reports inside the patient’s room.
Provide privacy by drawing curtains between patients.
Lower volume of telephone ringtones.
Limit overhead pages to emergencies only at night.
Monitor equipment frequently.
Provide privacy by drawing curtains between patients.
Which bedtime snack would be appropriate for the nurse to offer a patient to promote sleep?
Chips with salsa
Cup of black tea
Chocolate pudding
Piece of oat bran toast
Piece of oat bran toast
Which medications may be effective in managing sleep disorders?
Select all that apply.
Antiemetics
Benzodiazepines
Anticoagulants
Antidepressants
Antibiotics
Benzodiazepines
Antidepressants
Which statement regarding common side effects would the nurse include in a teaching session for a patient who is prescribed an antidepressant for insomnia?
“An increased sexual desire often occurs while taking this medication.”
“Headache and nausea often occur; however, these side effects will improve within several months of taking this medication.”
“Nervousness often occurs; however, this should improve within several weeks.”
“Skin rashes often occur while taking this medication.”
“Nervousness often occurs; however, this should improve within several weeks.”
Match the medication prescribed for sleep with the corresponding category.
Sedative-hypnotic
Benzodiazepine
Melatonin receptor agonist
Antidepressant
Answer choices
Zolpidem
Alprazolam
Diphenhydramine
Amitriptyline
Ramelteon
Doxylamine
Sedative-hypnotic
Zolpidem
Benzodiazepine
Alprazolam
Melatonin receptor agonist
Ramelteon
Antidepressant
Amitriptyline
Which interventions related to sleep would the nurse recommend to the parent of a pediatric patient?
Select all that apply.
Give a warm bath
Read a bedtime story
Provide a favorite soft toy or blanket
Offer a large glass of water
Play soft, soothing music
Give a warm bath
Read a bedtime story
Provide a favorite soft toy or blanket
Play soft, soothing music
Which nonpharmacologic intervention would the nurse initiate for a patient who is having difficulty falling asleep because of mild back pain?
Giving the patient a massage
Providing the patient with a warm cloth to wash the face
Changing the patient’s bed linens
Asking the family to sit with the patient
Giving the patient a massage
Which type of exercise would the nurse suggest a patient perform just before bed to promote sleep?
Yoga
Weight lifting
Brisk walking
Basketball
yoga
Which statement by the patient regarding foods that promote sleep indicates the need for further education from the nurse?
“A glass of milk before bed stimulates the production of serotonin, enhancing sleep.”
“Coffee should be avoided prior to bed as the caffeine is a stimulant, which interferes with sleep.”
“I should limit my intake of fluid in the evening as it may cause the need to urinate while sleeping.”
“I should drink a few glasses of red wine in the evening to enhance the sleep I get overnight.”
“I should drink a few glasses of red wine in the evening to enhance the sleep I get overnight.”
Which nonpharmacologic intervention is most appropriate to promote rest in a patient with restless legs syndrome (RLS)?
Using aromatherapy each evening
Suggesting several glasses of red wine each night
Encouraging deep knee bends
Providing a light meal high in protein
Encouraging deep knee bends
Which pharmacologic interventions would the nurse suggest for a patient with chronic insomnia who prefers to use supplements over medications?
Select all that apply.
Melatonin
Valerian
Amitriptyline
Diphenhydramine
Doxylamine
Melatonin
Valerian
Which statement made by a patient after education regarding the safe administration of common sleep medications indicates a need for further teaching?
“I must read the warnings to help me understand the potential severe allergic reactions and dangerous sleep behaviors, such as sleep-driving.”
“I understand that long-term use of benzodiazepine medications may actually cause additional sleep problems.”
“Since I am an older adult, I will take the medicine with care so as to lessen my risk of side effects.”
“Maybe I should take a higher dose of antidepressants since it is my first time taking them for my sleep problems.”
“Maybe I should take a higher dose of antidepressants since it is my first time taking them for my sleep problems.”
Which statements made by the patient would indicate a sleep medication was ineffective?
Select all that apply.
“It took a lot longer to fall asleep than normal.”
“I am a lot less tired today than yesterday.”
“I slept several more hours last night than I usually do.”
“I woke up more frequently in the night.”
“My mind was very active last night after taking the medication.”
“It took a lot longer to fall asleep than normal.”
“I woke up more frequently in the night.”
“My mind was very active last night after taking the medication.”
