The nurse is discussing sleep habits with the client in the sleep-assessment clinic. Of the following activities performed before sleeping, the nurse is alert to which one as potentially in-terfering with the client's sleep?
a. Listening to classical music
b. Finishing office work
c. Reading novels
d. Drinking warm milk
B
At home, a client should not try to finish office work or resolve family problems before bedtime.
Noise should be kept to a minimum. Soft music may be used to mask noise if necessary.
Reading a light novel, watching an enjoyable television program, or listening to music helps a person to relax. Relaxation exercises can be useful at bedtime.
A dairy-product snack, such as warm milk that contains L-tryptophan, may be helpful in pro-moting sleep.
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A premature infant has not had a bowel movement, and the nurse assesses abdominal distention after the last feeding. What action by the nurse takes priority?
A. Document the findings in the chart. B. Facilitate a bowel x-ray. C. Notify the health-care provider. D. Place the infant on NPO status.
A client is being treated for hyperglycemic-hyperosmolar state (HHS). Which clinical manifesta-tion indicates to the nurse that the therapy needs to be adjusted?
a. Serum potassium level has increased from 2.8 to 3.2 mEq/L. b. Blood osmolarity has decreased from 350 to 330 mOsm. c. Score on the Glasgow Coma Scale is un-changed from 3 hours ago. d. Urine has remained negative for ketone bodies for the past 3 hours.
How should the nurse position the patient who is to receive an enema?
a. left side-lying with right knee bent c. prone b. supine d. right side-lying
When the nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action by the nurse?
a. Patient complaint of feeling tired b. Pulse change from 87 to 101 beats/minute c. Blood pressure (BP) increase from 134/68 to 150/80 mm Hg d. Newly inverted T waves on the electro-cardiogram