Exam 4

anuria

bladder ultrasound

catheter-associated urinary tract infection

cystectomy

cystocele

detrusor muscle

diuresis

diuretic

dysuria

enuresis

hematuria

hydronephrosis

ileal conduit

intermittent catheterization

micturition

nocturia

oliguria

overactive bladder

polyuria

pyuria

urgency

urinary incontinence

urinary retention

The voluntary process of micturition is stimulated by:

A normal void consists of:

As children approach _________ age, their kidneys mature and they achieve voluntary control over urinary elimination; kidney function declines in older adults because of __________.

Many factors, such as _____________, can affect urinary elimination.

Manifestations of altered urinary function include:

Physical assessment of urinary function includes:

Diagnostic tests and procedures that are helpful in identifying urinary dysfunction include:

Nursing measures to promote normal urinary function include:

Independent nursing interventions for urinary

Collaborative nursing interventions for management of altered urinary function include:

Self-management of many urologic problems occurs _______ with adequate support from _________.

Selective reabsorption of water and ions occurs in which part of the nephron?
A. Bowman capsule
B. Tubules
C. Glomerulus
D. Small intestine

Micturition occurs when:
A. Sympathetic impulses cause stimulation of the internal sphincter
B. Increased pressure stretches the detrusor muscle
C. Pelvic muscles relax and abdominal muscles contract
D. Glomerular filtration enters the tubule

Your patient is diagnosed with a UTI. Which urinary signs would best support this diagnosis?
A. Dark amber color
B. Sediment in the catheter tubing
C. No odor from urinal
D. Cloudy urine

Which patient condition would you expect to have decreased urinary output (volume)?
A. A postoperative patient in recovery room
B. An elderly patient with urinary frequency
C. A pregnant patient with occasional nausea
D. A patient following a cerebrovascular accident (CVA)
E. All of the above

Which urinary output represents abnormal findings?
A. Newborn voids 30 to 40 times per day
B. Nocturia in elderly male patient
C. Incontinence in an elderly female patient
D. Nighttime incontinence in a 6 year old

Which of the following are expected findings?
A. Polyuria in a patient with poorly managed diabetes
B. Anuria in a patient with end-stage renal disease
C. Hematuria in a patient with a UTI
D. Urinary retention in patient with thoracic spinal cord injury
E. All of the above

Your patient had a urinary catheter removed at 06:00, and it is now 14:00. What would you do first?
A. Assess sensations of fullness, distention
B. Encourage increased oral intake
C. Perform BUS
D. Assist patient to bathroom to void

Your assessment of an elderly female indicates the following: alert and oriented, ambulates independently, reports urinary frequency, and incontinence with coughing. Which nursing diagnosis best describes this patient’s condition?
A. Urge incontinence
B. Reflex urinary incontinence
C. Stress incontinence
D. Functional urinary incontinence

You are working with an elderly patient with altered mental status and urinary incontinence. What nursing interventions would be most appropriate?
a. Encourage patient to avoid smoking and drinking coffee
b. Schedule toileting at least every 2 hours
c. Provide medications to improve bowel function
d. Request physician order to insert urinary catheter

Indwelling urinary catheters are not indicated in which of the following patient conditions?
A. Impaired mobility
B. Incontinence with pressure ulcers
C. Recurrent urinary retention
D. Surgical procedures with general anesthetic

borborygmi

Clostridium difficile

colonoscopy

colostomy

constipation

defecation reflex

diarrhea

distention

enema

fecal impaction

fecal occult blood test

flatus

gastric lavage

hemorrhoids

ileostomy

meconium

paralytic ileus

peristalsis

sigmoidoscopy

stoma

suppository

Valsalva’s maneuver

Defecation, the process of eliminating feces from the body, is initiated by:

Many lifestyle habits affect stool __________. Physiologic alterations of the intestines also can adversely affect bowel elimination.

The characteristics of feces and bowel elimination patterns change:

Altered bowel elimination can be a source of:

The manifestations of altered bowel elimination are:

A focused nursing assessment of bowel elimination includes:

The nurse has ________ responsibilities in laboratory analysis of the feces and other diagnostic procedures.

The nurse can diagnose and collaboratively treat altered bowel elimination. Treatment measures include:

Discharge planning considers the home environment, such as:

Continuation, modification, and termination of nursing strategies are based on:

Which of the following bowel habits are abnormal?
A. Preschooler with bowel control but not bladder control
B. Breast-fed infant with stool once every 3 days
C. Toddler smearing or playing with feces
D. Elderly adult with fecal incontinence

You are assessing factors related to constipation in your postoperative patient. Which of the following could contribute to constipation? Select all that apply:
a. Opioid analgesics
b. Decreased mobility
c. Fear of pain
d. Supine position
e. Lack of privacy

This morning, your adult patient reports new onset of frequent diarrhea with mucus and a foul odor. Which medication class would you suspect as being related?
A. Diuretic
B. Opioid analgesic
C. Antibiotic
D. Dietary supplement

Which of the following findings are abnormal?
A. Convex shape
B. Borborygmi present
C. Tympany in LUQ
D. Positive FOBT guaiac

You perform a FOBT guaiac test on a stool sample from a patient with a history of gastrointestinal bleeding. Which step would you do first after applying stool to the Hemoccult slide?
A. Open flap on reverse side.
B. Apply developing solution.
C. Document.
D. Wait 3 to 5 minutes.

You are caring for a female patient who is concerned that she has not had a bowel movement since yesterday and hasn’t taken her laxative. You assess her abdomen and find bowel tones throughout all quadrants, reports of flatus, and abdomen is soft and not distended or tender. Which nursing diagnosis would be most appropriate for this patient?
A. Perceived Constipation
B. Deficient Fluid Volume
C. Anxiety
D. Constipation

You determine that your patient is at risk for constipation related to his postoperative status. What interventions can you provide to reduce this risk?
A. Encourage foods high in magnesium.
B. Promote intake of cold fluids.
C. Promote ambulation as tolerated.
D. Request high-protein foods to be included on the dietary tray.

You have just placed a nasogastric tube for gastric decompression secondary to a paralytic ileus. What is the first thing that you need to do?
A. Connect tubing to intermittent suction.
B. Provide liquid medications via tube.
C. Ensure accurate placement.
D. Irrigate tube to maintain patency.

You are providing discharge teaching to a patient with a colostomy. You include the following instructions about applying the colostomy wafer and bag. Select all that apply:
a. Ensure that the opening in the wafer is tight to the stoma to prevent leakage.
b. Leakage of colostomy contents to the surrounding area may lead to skin breakdown.
c. Stoma coloring that is dusky or pale like the surrounding skin is normal.
d. Some bleeding may occur because stoma tissues are fragile.

The wound nurse is visiting a patient with a new colostomy for a final appointment prior to discharge. Which patient statements would be most concerning?
A. “I know that I have to empty the bag when it is one third full.”
B. “I have trouble securing the wafer because of abdominal discomfort.”
C. “The stoma is beefy red, which is normal.”
D. “I can’t stand to even look at my stomach!”

absorption

anorexia

anorexia nervosa

basal metabolism

calorie (kilocalorie)

carbohydrates

complete proteins

digestion

gastric residual volumes (GRVs)

glycogenesis

incomplete proteins

macronutrients

metabolism

micronutrients

monosaccharide

monounsaturated fatty acid

nutrients

obese

overweight

partially complete proteins

polysaccharide

polyunsaturated fatty acid

proteins

saturated fats

small-bore feeding tubes

trans fatty acids

trace elements

underweight

unsaturated fats

vitamins

Adequate nutritional intake is important to maintain:

Essential nutrients are:

The complex processes of digestion, absorption, and metabolism permit the body to:

Great variations exist in dietary intake among people, but _____ are useful when evaluating adequate intake.

Manifestations of altered nutrition include:

A nutritional health assessment includes:

What objective data is gathered to help assess a patient's nutritional state?

NANDA-I nursing diagnoses in the area of nutrition are

Health promotion for optimal nutrition includes:

Therapeutic diets are used to promote:

Various ______ are useful for patients who have nutritional needs.

You are taking care of an elderly patient with osteoporosis. Which dietary supplements would be most appropriate as a treatment regimen?
A. Calcium and vitamin D
B. Iron and calcium
C. Vitamin K and B-complex vitamins
D. Fluoride and iron

Impaired liver function related to chronic alcohol use may result in inadequate digestive function. Which of the following processes would be impacted? Select all that apply:
a. Digestion
b. Absorption
c. Metabolism
d. Excretion

The following groups must increase their calcium, protein, and iron intakes to prevent nutritional deficits:
A. Lactating women
B. Pregnant women
C. Newborns
D. Older adults

You are providing patient education for a patient with anemia. Which of the following foods should you recommend that the patient includes in her regular diet? Select all that apply:
a. Beef
b. Spinach
c. Milk
d. Enriched whole wheat bread

In caring for a patient with a history of alcohol abuse, you administer thiamine, niacin, folate, and IV TPN with lipids. Your patient education should consist of which of the following? Select all that apply:
a. “B-complex vitamin supplements are quickly used up in alcohol metabolism, leaving your body at a deficit.”
b. “Liver damage impairs your ability to metabolize fats and nutrients.”
c. “Nutrient absorption in the intestines is impaired by alcohol’s effects on the mucosa.”
d. “Your appetite and oral intake is excellent; I’ll talk to the physician about canceling these supplements.”

You hear in report that your elderly patient was admitted for malnutrition. In planning for discharge to home, you discuss which of the following issues with the social worker? Select all that apply:
a. Local food availability
b. History of depression
c. Poor-fitting dentures
d. Impaired mobility

Your physical assessment findings include poor blood clotting, muscle weakness, and delayed fracture healing. Which of the following nutritional deficits is most likely based on these findings?
A. Iron deficiency
B. Protein deficiency
C. B-complex deficiency
D. Calcium deficiency

Your patient reports that he just started a new diet including spinach salads daily for lunch and kale, chard, or broccoli for dinner. He has been taking Coumadin for a history of deep vein thrombosis. Which of the following symptoms would be most concerning?
A. International normalized ratio (INR) 2.6
B. Serum iron within normal limits
C. Bleeding gums
D. Leg pain and swelling

You suspect that your patient is experiencing acute malnutrition. Which lab would give you the best indication of the patient’s current nutritional status?
A. Elevated cholesterol
B. Elevated white blood cell count
C. Low albumin
D. Low prealbumin

You are monitoring a tube feeding for a patient with altered mental status following a CVA. Which of the following would you do to prevent aspiration?
A. Check residual volumes hourly.
B. Maintain the head of the bed greater than 30 degrees.
C. Hold tube feeding if residual volumes are greater than 100 mL.
D. Monitor blood glucose two to four times per day while on tube feeding.

cultural diversity

cultural relativity

culturally competent nursing

culture

culture shock

ethnicity or ethnic identity

ethnocentrism

health disparity

health equity

implicit bias

key informants

minority

race

racism

rituals

stereotypes

subculture

Culture is defined as:

Culture enables a person to ______ in contexts that the person shares with members of the same culture.

Culture is an integral component of:

Accurate nursing assessments require that the nurse ______ his or her ethnocentric tendencies and ______ cultural sensitivity.

Patient assessments that consider the patient’s ______ are most likely to yield diagnoses and interventions appropriate to the patient.

Methods to gain the patient’s perspective include:

Which of the following are characteristics of culture? Select all that apply:
a. Learned
b. Dynamic
c. Ethnocentric
d. Relative to context
e. Logical
f. A set of traits

Nursing care may be influenced by the culture of both the patient and nurse. Which of the following techniques will assist nurses in performing culturally competent care? Select all that apply:
a. Minimize ethnocentric tendencies
b. Knowledge of biocultural variation
c. Use family as bilingual interpreters
d. Consider patient perspective
e. Assign to specific category based on culture

Shared culture is most accurately seen among people with which of the same traits?
A. Rituals
B. Skin color
C. Language
D. Ethnicity

When language differences exist between the nurse and patient, the nurse should do which of the following first?
A. Use a bilingual family member to facilitate assessment/care
B. Act in the patient’s best interest
C. Obtain a key informant to navigate patient’s cultural cues
D. Establish whether a trained interpreter is needed

Examples of subcultures include which of the following communities? Select all that apply:
a. Deaf or hearing impaired
b. Lesbian, gay, bisexual, transgender, queer (LGBTQ)
c. HIV/AIDs
d. Truck drivers
e. Impoverished

anticipatory grief

bereavement

death

dying

dysfunctional grief

grief

hospice

loss

mourning

palliative care

Loss is a universal experience, and grieving is a ____ response to loss.

Models of the grief process provide direction for

The grief process is similar regardless of

A major loss results in

Response to loss is influenced by the person’s

The characteristics of the loss, personal resources and stressors, and sociocultural resources and stressors affect

The outcome of a loss experience is not predetermined but rather is determined by the balance of

Risk of dysfunctional grieving can be identified through analysis of

Physical health and psychosocial adjustment during the grief process are

_____ should be based on knowledge of the long-term nature of the grief process.

Many grief manifestations, identified in previous literature as dysfunctional, are considered to be components of

Discharge planning must consider the long-term nature of

End-of-life care should promote quality of life through

Palliative care should be offered to all patients experiencing

Hospice care is a viable option for

In admitting a patient with confusion and labile affect, the nurse discovers that the patient recently lost his son in a motor vehicle accident. Which nursing diagnosis best describes this patient?
A. Impaired Family Processes
B. Dysfunctional Grieving
C. Ineffective Health Maintenance
D. Anticipatory Grieving

The nurse is caring for an East African family that has just experienced a fetal demise at full term. The family initially refuses to see the stillborn infant. What should the nurse do first?
A. Ask the family about their expectations for mourning
B. Assist family members to see the infant in order to gain closure
C. Evaluate the need for emotional and practical help
D. Provide educational materials about loss of an infant

A nurse is talking with a wife whose husband just expired. What would appropriate nursing interventions be for someone in the Shock Phase of the Grief Cycle Model? Select all that apply:
a. Help mobilize a support system
b. Encourage expression of diverse feelings
c. Help to establish coping behaviors used in past
d. Provide role models who have coped with similar loss

The nurse is caring for a patient newly diagnosed with metastatic lung cancer. What would be the most appropriate statement for the nurse to make regarding palliative care resources?
A. “Palliative care can only be done once you discharge from the hospital.”
B. “Once you decide that you don’t want to receive further treatment, palliative care will help keep you comfortable.”
C. “Palliative care focuses on quality of life and may be used from the time of diagnosis.”
D. “Palliative care is for when you have a prognosis of less than 6 months.”

The nurse is caring for an actively dying, unresponsive patient while the family sits at the bedside. The husband asks “Isn’t she hungry? She hasn’t had anything to eat in 24 hours.” Which response by the nurse would be most appropriate?
A. “The body doesn’t need food at this stage.”
B. “Here is a menu—we can order some foods that she enjoys eating.”
C. “Motility of the stomach and intestines are decreased, so eating could make her nauseous.”
D. “We should talk to the physician about placing a feeding tube to help with intake.”

agnosticism

atheism

faith

holism

spiritual care

spiritual crisis

spiritual dimension

spirituality

spiritual need

spiritual well-being

theism

Spirituality, like the role of philosophy, is to help people ask the right questions and develop a view of

The spiritual dimension is the essence of a person and is expressed in the need to

Spiritual well-being is the condition in which a person is at peace with

Fowler’s stages of faith have parallels to

Nurses may provide _________ care if they have not fully addressed their own spirituality and spiritual well-being and if they hesitate to encourage the patient to speak of personal spirituality.

Altered spiritual function may be expressed

Every patient has the right to practice his or her spirituality according to personal preference. The nurse should not be judgmental but should

Nursing interventions include use of

A teen has recently survived a car accident in which his friend was killed. The nurse assigns the nursing diagnosis of Spiritual Distress. Which of the following statements would best support this diagnosis?
A. “Why did I have to survive?”
B. “I just want to sleep!”
C. “I need some time alone; can’t we do this later?”
D. “I don’t want those pills!”

An elderly woman has recently become a resident in a skilled nursing facility as a result of her worsening health conditions. Which of the following may lead to impaired spiritual health? Select all that apply:
A. Fear about living in a new environment
B. Lack of concentration and short-term memory
C. Anger at treatment regimen
D. Lack of transportation to usual meditation group

A Catholic patient is anxious related to her hospitalization. The nurse attending to her is Buddhist. Which statement is most appropriate for the nurse to make?
A. “I have to give pain medications to another patient, so I’ll leave you alone to pray.”
B. “Do you have a Bible or book of Psalms that I can read to you?”
C. “Don’t worry; many patients are anxious about being in the hospital.”
D. “I can’t pray with you; we believe in different Gods.”

A nurse is developing outcome criteria for a patient’s plan of care regarding the patient with spiritual distress. Which of the following is an appropriate criterion?
A. Patient verbalizes feelings.
B. Patient expresses increased understanding and acceptance of current situation.
C. Patient expresses satisfaction with tie to faith community within 1 month.
D. Patient identifies support provided by family.

A nurse is caring for a patient with terminal lung cancer. Which of the following would indicate potential risk for spiritual distress? Select all that apply:
a. Patient has had many visitors while hospitalized.
b. Patient formerly sang in the local choir, quitting due to shortness of breath.
c. Patient is a member of a church group and attends regular mass.
d. Disease prognosis is terminal with projected mortality within 3 months.

circadian rhythms

enuresis

fatigue

hypnotics

hypopnea

insomnia

narcolepsy

parasomnias

polysomnography

rest

sleep

sleep deficiency

sleep-disordered breathing

sleep health

sleepiness

sleep latency

sleep loss

somnambulism

sleep sufficiency

Sleep is a naturally occurring behavioral state of

Rest is a physical and emotional state of

Sleep and rest are important for

The two main types of sleep are

Young adults progress through stages 1–2–3–2–REM in cycles of

Sleep duration and architecture change

Infants have frequent sleep cycles ______ throughout the day and night.

Adequate sleep is associated with

Factors affecting sleep and rest include

Sleep disorders are common in both adults and children and include

Anticipating changes in sleep and needs for rest can contribute to promotion of a healthy balance between

A patient seen at an annual physical is observed to be irritable and unable to concentrate. When questioned about his behavior, he attributes it to working two full-time jobs. What nursing diagnosis would be most appropriate?
A. Disturbed sleep pattern
B. Coping
C. Sleep deprivation
D. Activity intolerance

A postoperative patient with a history of OSA is admitted to your unit. With which assessment finding would you be most concerned?
A. Oxygen saturation of 94% when transferred to the room
B. Apneic periods lasting more than 10 seconds
C. Patient difficult to arouse
D. Oxygen desaturation to 90% when asleep
E. Blood pressure 138/90

A patient complains about inability to sleep in the hospital. Which of the following nursing interventions would be most beneficial to do first?
A. Clustering nursing care to limit disturbances at night
B. Providing warm milk like the patient has at home
C. Transferring the patient to a room away from the nursing station
D. Complete a pain assessment

Which of the following factors influence sleep and rest needs? Select all that apply.
A. Nutrition
B. Relationships
C. Developmental stage
D. Shift work
E. Alcohol

Normal circadian rhythms would be seen in which of the following individuals?
A. Nurse who works in a hospital with variable night shifts
B. A 1-year-old pediatric patient
C. A patient who is homebound without social contact
D. Businesswoman traveling abroad

Laxatives are used to

Laxatives work by

When properly used, laxatives are valuable medications. However, these agents are also

Misuse of laxatives is largely the result of

The term laxative effect refers to production of

The term catharsis refers to

The principal function of the colon is to

When the colon is working correctly, the extent of fluid absorption is such that the resulting stool is

When fluid absorption is excessive, as can happen when transport through the intestine is delayed, the resultant stool is _____________. Conversely, if insufficient fluid is absorbed, _______ result.

Frequency of bowel evacuation

Proper function of the bowel is highly dependent on

Fiber facilitates colonic function in two ways:

Constipation is defined in terms of symptoms, which include

Constipation is determined more by _______ than by ______________.

A common cause of constipation is

In most cases, constipation can be readily corrected. Stools become softer and more easily passed within days of

Laxatives can be highly beneficial when used for

Laxatives may be used in association with

Applications for laxatives include

Laxatives are contraindicated for individuals with

Laxatives should not be used

Laxatives should be used with caution during

Traditionally, laxatives have been classified according to general mechanism of action. This scheme has four major categories:

From a clinical perspective, it can be useful to classify laxatives according to therapeutic effect:

The bulk-forming laxatives have actions and effects much like those of dietary fiber.

Bulk-forming laxatives are preferred agents for

Bulk-forming laxatives are widely used in patients with

Bulk-forming laxatives, by altering fecal consistency, they can provide symptomatic relief of

Bulk-forming laxatives side effects:

Bulk-forming laxatives should be administered with

If their passage through the intestine is arrested, bulk-forming agents may

The surfactants are group _____ laxatives; they produce a soft stool ______ after the onset of treatment.

Surfactants alter stool consistency by

The surfactants may also act on the intestinal wall to:

The surfactant family consists of

Administration of surfactant laxatives should be accompanied by

The stimulant laxatives have two effects on the bowel.

Most stimulant laxatives are group ____ agents—they act on the colon to produce a semifluid stool within _____ after treatment.

Stimulant laxatives are widely used—and abused—by the general public and are a concern for this reason. They have few

Two applications of stimulant laxatives that are legitimate are

______ is unique among the stimulant laxatives in that it can be administered by rectal suppository as well as by mouth.

Oral bisacodyl acts within

Bisacodyl suppositories act ______ (in _____ minutes).

______, a type of stimulant laxative, is plant-derived and contains anthraquinones, its active ingredients.

______ is the only stimulant laxative that acts on the small intestine.

The laxative salts are poorly absorbed salts that have an ______ action that draws water into the intestinal lumen.

Accumulation of water causes the fecal mass to _____, thereby ____ the intestinal wall, which stimulates peristalsis.

The two groups of laxative salts are:

Osmotic laxatives can cause substantial loss of water. To prevent dehydration, patients should:

In patients with renal impairment, magnesium can accumulate to toxic levels. Accordingly, magnesium salts are contraindicated in patients with

Sodium absorption (from sodium phosphate) can cause fluid retention, which in turn can exacerbate

Polyethylene glycol (PEG) is an _____ laxative used widely for chronic constipation.

The most common adverse effects of osmotic laxatives are:

Lubiprostone is the first representative of a new class of drugs:

By activating chloride channels in epithelial cells lining the intestine, lubiprostone:

Lubiprostone has two indications:

Lubiprostone should be taken with _______ to avoid nausea, the most common side effect.

Other gastrointestinal (GI) effects of lubiprostone

Colonoscopy is the most effective method for

Three kinds of bowel cleansers are used to prepare the bowel for a colonoscopy:

The PEG-ELS bowel-cleansing solutions are _____ with body fluids; therefore, water and electrolytes are neither absorbed from nor secreted into the intestinal lumen.

PEG-ELS products are generally well tolerated. The most common adverse effects are

Sodium phosphate is an ______ laxative that draws water into the intestinal lumen, which then softens and swells the fecal mass, which then stretches the intestinal wall to stimulate peristalsis.

The sodium phosphate products can cause:

By drawing a large volume of fluid into the intestinal lumen, sodium phosphate can cause:

One combination product, magnesium oxide/anhydrous citric acid/sodium picosulfate (Prepopik) is approved for

As with _______ products, Prepopik can cause __________. Caution must be employed in patients with __________. The most common adverse reactions are ___________.

Many people believe that a _______ bowel movement is a requisite of good health and that any deviation from this pattern merits correction.

Laxatives can ________ their own use. Strong laxatives can purge the entire bowel. When this occurs, spontaneous evacuation is impossible until bowel content has been replenished, which can take 2 to 5 days.

The first step in breaking the laxative habit is _______ of laxative use. After drug withdrawal, bowel movements will be absent for several days; the patient should be informed of this fact.

Any _______ that the patient has about bowel function should be corrected.

The patient should be taught that a ________ bowel movement may not be normal for him or her and that stool quality is more important than frequency or quantity.

A nurse administering 30 mL of magnesium hydroxide (milk of magnesia) tells the patient to expect a bowel movement when?
A. In 1 to 3 days
B. In 6 to 12 hours
C. In 15 minutes to 1 hour
D. In 2 to 4 hours

A patient with hepatic encephalopathy receives lactulose. The nurse expects which therapeutic outcome if the medication is having the desired effect?
A. Reduced ammonia level
B. Release of glycogen stores
C. Normal serum sodium level
D. Less ascitic fluid

A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium [Metamucil] for 2 weeks. Which is the nurse's priority action?
A. Ask whether the patient is using at least 8 ounces of fluid to prepare the psyllium.
B. Ask whether the patient is toileting at the same time every day.
C. Check the dose, because an increase may be indicated.
D. Consult the physician about another laxative choice.

A postoperative patient is scheduled to start taking a daily oral dose of bisacodyl [Dulcolax]. When does the nurse administer the medication?
A. After ambulating
B. Before the morning bath
C. Just before bedtime
D. At the evening meal

A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The nurse prepares to administer which laxative?
A. Polyethylene glycol–electrolyte solution [GoLYTELY]
B. Mineral oil
C. Magnesium salts (magnesium citrate)
D. Docusate sodium [Colace]

A patient has been taking docusate sodium [Colace] daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug?
A. "My doctor says that I've developed colon polyps."
B. "I've noticed that I'm having tremors now in my left hand."
C. "The dental hygienist said I was losing the enamel on my teeth."
D. "I only have a bowel movement when I take the medicine."

The patient has an order for magnesium oxide/anhydrous citric acid/sodium picosulfate [Prepopik] to be given in 2 doses. The nurse knows that this medication is used for which indication?
A. Preparation before a colonoscopy
B. Treatment of constipation
C. Preparation before an abdominal surgery
D. Prevention of constipation

The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication?
A. In the evening, before bed
B. In the afternoon, before lunch
C. In the morning, before breakfast
D. In the morning, after breakfast

The nurse is aware that laxatives are contraindicated in patients with which of the following? (Select all that apply.)
A. Abdominal pain
B. Diverticulitis
C. Constipation
D. Bowel obstruction
E. Pregnancy

The nurse expects laxatives to be ordered for which of the following patients? (Select all that apply.)
A. A patient with chronic pain
B. A patient recovering from cardiac surgery
C. A patient who recently delivered a child
D. A patient with acute food poisoning
E. A patient with no bowel sounds

What are the 4 types of gastrointestinal (GI) drugs.

Antiemetics are given to suppress

Emesis is a complex reflex brought about by activation of

Direct-acting stimuli that may induce vomiting include signals from:

Indirect-acting stimuli that may induce vomiting first activate the ______________, which in turn activates the vomiting center.

Activation of the CTZ occurs in two ways:

Once activated, the vomiting center signals the ___________; the resulting coordinated response expels gastric contents.

_______________ are the most effective drugs available for suppressing nausea and vomiting caused by cisplatin and other highly emetogenic anticancer drugs, radiation therapy, anesthesia, viral gastritis, and pregnancy.

Four serotonin antagonists are available for treating emesis:

Ondansetron was the first serotonin receptor antagonist approved for ______________. The drug is also used to prevent nausea and vomiting associated with radiotherapy and anesthesia. In addition, the drug is used off-label to treat nausea and vomiting from other causes, including childhood viral gastritis and morning sickness of pregnancy.

Benefits of ondansetron derive from blocking of _____________ located in the CTZ and on afferent vagal neurons in the upper GI tract.

Ondansetron is very effective by itself and even more effective when combined with

The most common side effects of ondansetron are:

What are the two glucocorticoids commonly used to suppress CINV, even though they are not approved for this application by the U.S. Food and Drug Administration (FDA).

What are the two substance P/neurokinin1 antagonists currently available?

Aprepitant is generally well tolerated. Compared with patients receiving ondansetron and dexamethasone, those receiving aprepitant plus ondansetron and dexamethasone experience:

Aprepitant is a substrate for, inhibitor of, and inducer of ____________, a major drug-metabolizing enzyme.

What is used in combination regimens to suppress CINV.

Lorazepam has three principal benefits:

Lorazepam may help control _________________ caused by phenothiazine antiemetics.

The phenothiazines suppress emesis by blocking _______________ receptors in the CTZ.

These drugs can reduce emesis associated with surgery, cancer chemotherapy, and toxins.

Side effects of phenothiazines include:

What phenothiazine is the most widely used antiemetic in young children, despite its dangers (respiratory depression and local tissue injury) and despite the availability of safer alternatives (e.g., ondansetron).

What two butyrophenones are used as antiemetics?

The butyrophenones suppress emesis by blocking

Butyrophenones are effective against:

Potential side effects of butyrophenones are:

What drug may pose a risk of fatal dysrhythmias owing to prolongation of the QT interval?

Metoclopramide suppresses emesis through blockade of __________ receptors in the CTZ.

What drug can suppress postoperative nausea and vomiting, as well as emesis caused by anticancer drugs, opioids, toxins, and radiation therapy.

What are the two cannabinoids approved for medical use in the United States.

Because of their psychotomimetic effects and abuse potential, the ______________ are considered second-line drugs for CINV and therefore should be reserved for patients who are unresponsive to or intolerant of preferred agents.

In addition to its use in CINV, ____________ is approved for stimulating appetite in patients with acquired immunodeficiency syndrome.

Due to their abuse potential, _____________ is classified under Schedule III and __________ under Schedule II of the Controlled Substances Act.

Many anticancer drugs cause:

Chemotherapy is associated with three types of emesis:

Antiemetics are more effective at _________ CINV than at _______________.

The antiemetic regimen for a particular patient is based on the ___________ of the chemotherapy drugs used.

The current regimen of choice for patients taking highly emetogenic drugs consists of three agents:

Nausea and vomiting of pregnancy (NVP) is extremely common, especially during

NVP can be managed with

NVP first-line drug therapy consists of a two-drug combination:

If doxylamine and vitamin B6 fail to suppress NVP, alternatives include

What drug may be tried as a last resort for NVP, but only after 10 weeks of gestation.

Motion sickness can be caused by sea, air, automobile, and space travel. Symptoms are

Drug therapy for motion sickness is most effective when given

__________, a muscarinic antagonist, is the most effective drug for preventing and treating motion sickness.

Scopolamine's benefits derive from suppression of:

The most common side effects of scopolamine are:

The antihistamines used most often for motion sickness are:

Suppression of motion sickness appears to result from blocking of ________ and ____________ receptors in the neuronal pathway that connects the inner ear to the vomiting center.

The most prominent side effect—sedation—results from blocking of ____ receptors. Other side effects—dry mouth, blurred vision, urinary retention, and constipation—result from blocking of _____ receptors.

Diarrhea is characterized by stools of:

Management of diarrhea is directed at:

Antidiarrheal drugs are divided into two major groups:

______ are the most effective antidiarrheal agents available.

By activating ________ receptors in the GI tract, these drugs reduce intestinal motility and thus slow intestinal transit, which allows more time for the absorption of fluid and electrolytes.

What are the several opioid preparations are approved for diarrhea.

What opioid preparations are the most frequently used?

________ is an opioid used only for diarrhea. It is formulated in combination with atropine. The atropine is present to discourage _______ abuse; doses of the combination that are sufficiently high to produce euphoria from the _______ would produce unpleasant side effects from the correspondingly high dose of atropine.

____________ is a structural analog of __________. The drug is used to treat diarrhea and to reduce the volume of discharge from ileostomies.

Infectious diarrhea may be produced by enteric infection with a variety of

Antibiotics should be administered for diarrhea only when clearly indicated. Indiscriminate use of antibiotics is undesirable in that

Tourists often are plagued by

In most cases, the causative organism for infectious diarrhea is

If symptoms from infectious diarrhea are especially severe, treatment with one of the __________ antibiotics is indicated; __________ is preferred for children.

Several measures can reduce the acquisition of traveler’s diarrhea. Two measures ______ and ______ are highly effective.

___________ is a gram-positive, anaerobic bacillus that infects the bowel. Injury results from the release of bacterial toxins. Symptoms range from relatively mild to very severe, even death.

__________ is the most common disorder of the GI tract.

IBS is characterized by

IBS has four major forms, characterized by:

Two groups of drugs are used for treatment of IBS:

Only three drugs are approved for IBS:

______ is a potentially dangerous drug approved for severe IBS-D in women.

IBS-D is considered severe if the patient experiences one or more of the following:

Alosetron causes selective blockade of _____ receptors, which are found primarily on neurons that innervate the viscera.

In patients with IBS-D, alosetron can:

Alosetron has _______ interactions with other drugs.

Although alosetron is generally well tolerated, it can cause severe adverse effects including:

To ensure the best possible benefit/risk ratio, the manufacturer and the FDA have established a risk management program that involves the active participation of:

Inflammatory bowel disease (IBD) has two forms:

Crohn’s disease is characterized by ___________ and usually affects ____________, but it also can affect ______________.

Ulcerative colitis is characterized by:

Both Crohn's disease and ulcerative colitis produce _____________. Ulcerative colitis may cause ___________ as well.

There is general agreement that IBD results from:

Five types of drugs are used in therapy:

The ____________ are used to treat mild or moderate ulcerative colitis and Crohn’s disease and to maintain remission after symptoms have subsided.

What four types of aminosalicylates are available:

Sulfasalazine belongs to the same chemical family as ___________. However, although similar to the ______________, sulfasalazine is not used to treat _________. Its only approved indications are ____________.

5-Aminosalicylic acid (5-ASA) is the component responsible for reducing _________; sulfapyridine is responsible for _______________.

Possible mechanisms by which 5-ASA reduces inflammation include:

Nausea, fever, rash, and arthralgia are common adverse effects of:

Hematologic disorders (e.g., agranulocytosis, hemolytic anemia, macrocytic anemia) also may occur with use of:

____________ can relieve symptoms of ulcerative colitis and Crohn’s disease. Their benefits derive from antiinflammatory actions.

Glucocorticoids are indicated primarily for___________ in ulcerative colitis and Crohn's disease, not for long-term maintenance.

Prolonged use of glucocorticoids can cause severe adverse effects, including

Immunosuppressants are used for long-term therapy of selected patients with:

Although not approved for IBD, ______ and _______ have been used with success to induce and maintain remission in patients with either ulcerative colitis or Crohn’s disease.

What three immunomodulators are inhibitors of tumor necrosis factor-alpha (TNF), and what fourth immunomodulator interferes with alpha4 integrin are

In clinical trials, _____________ reduced symptoms in 65% of patients with moderate to severe Crohn’s disease and produced clinical remission in 33%. Good responses are also seen in ulcerative colitis.

_______ drugs increase the tone and motility of the GI tract. Indications include gastroesophageal reflux disease, CINV, and diabetic gastroparesis.

Metoclopramide has two beneficial actions:

In high-dose therapy using metoclopramide, what side effects are common? What can long-term high-dose therapy cause?

__________ is the first drug to be approved for reducing oral mucositis (OM), a serious and painful complication of cancer chemoradiotherapy.

Palifermin acts through ___________ receptors (which are not found on cells of hematopoietic origin) and stimulates proliferation, differentiation, and migration of epithelial cells.

__________ is approved for reducing the incidence and duration of severe oral mucositis (OM), but only in patients with hematologic malignancies and then only in those receiving high-dose chemotherapy and whole-body irradiation.

Palifermin is generally well tolerated. The most common reactions are:

A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective?
A. Aprepitant [Emend] and ondansetron [Zofran]
B. Scopolamine [Transderm Scop] and lorazepam [Ativan]
C. Ondansetron [Zofran] and dimenhydrinate [Dramamine]
D. Prochlorperazine [Compazine] and diphenhydramine [Benadryl]

A patient going on a vacation cruise is prescribed a scopolamine transdermal patch for motion sickness. The nurse teaches the patient to recognize which side effect?
A. Irritability
B. Dry mouth
C. Urinary frequency
D. Increased heart rate

A patient is having high-volume output from a new ileostomy. A nurse develops a plan that includes teaching the patient to take which antidiarrheal agent?
A. Paregoric (camphorated opium tincture)
B. Loperamide [Imodium]
C. Bismuth subsalicylate [Pepto-Bismol]
D. Alosetron [Lotronex]

A nurse should offer which fluid choice to a patient with acute diarrhea?
A. Prune juice
B. Apple juice
C. Low-fat milk
D. Coffee with cream

A nurse administers metoclopramide [Reglan] to a patient who is having nausea and vomiting postoperatively. The nurse should expect which therapeutic action if the medication is having the desired result?
A. Blocking of serotonin and dopamine receptors
B. Inactivation of histaminergic (H1) receptors
C. Reduced motility in the small intestine
D. Activation of chloride channels in the intestine

A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine [Azulfidine]. Which statement by the patient would indicate understanding of the information?
A. "My tongue may become discolored and my taste altered."
B. "I'll report any fatigue or sore throat and fever to my doctor."
C. "I may have constipation, so I'll increase my fluid intake."
D. "I'll immediately report any chest pain or shortness of breath."

A nurse administers palifermin to reduce oral mucositis from chemotherapy in a patient with which type of malignancy?
A. Leukemia
B. Brain
C. Lung
D. Breast

A patient who has had a pancreatectomy is taking pancrelipase [Viokase]. Which finding would the nurse use to evaluate the effectiveness of this drug?
A. Decrease in abdominal distention
B. Increase in flatulence
C. Reduction in fatty stools
D. Resolution of jaundice

A nurse should teach a patient who takes alosetron [Lotronex] for diarrhea-prominent irritable bowel syndrome (IBS-D) to stop the medication immediately if the patient develops which condition?
A. Heart palpitations
B. Blurred vision
C. Constipation
D. Bruising

Why is intramuscular (IM) administration of promethazine [Phenergan] preferred over intravenous (IV) administration?
A. IM injection has a more rapid onset of action.
B. Extravasation of IV promethazine can lead to abscess formation or tissue necrosis.
C. The risk of respiratory depression is eliminated with IM injection.
D. Extrapyramidal reactions do not occur when the drug is administered IM.

An adult patient in a physician's office reports severe diarrhea after returning from a trip to Mexico. Which medication might be prescribed for this patient?
1. Ciprofloxacin [Cipro] 500 mg twice daily
2. Sulfasalazine [Azulfidine] 500 mg daily
3. Metoclopramide [Reglan] 10 mg three times daily 30 minutes before meals and at bedtime
4. Ondansetron [Zofran] 8 mg three times daily

Which medication is useful for stimulating the appetite in patients with acquired immunodeficiency syndrome (AIDS)?
1. Aprepitant [Amend]
2. Ondansetron [Zofran]
3. Dronabinol [Marinol]
4. Metoclopramide [Reglan]

Which medications are used in the treatment plan for chemotherapy-induced nausea and vomiting? (Select all that apply.)
1. Lorazepam [Ativan]
2. Meclizine [Antivert]
3. Dolasetron [Anzemet]
4. Loperamide [Imodium]
5. Dexamethasone [Decadron]

Palliative care is:

The overall goals of palliative care are to:

Palliative care includes:

Hospice is:

Hospice care is provided by:

Admission to a hospice program has two criteria:

End-of-life care (EOL care) is the term currently used for:

The goals for EOL care are to:

Certain symptoms are more prevalent at the EOL, including:

Noisy, wet-sounding respirations, termed the death rattle or terminal secretions, are caused by:

Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of:

Most terminally ill and dying people:

Grief is a normal reaction to loss. It is dynamic and includes both:

Priority interventions for grief must focus on providing:

Bereavement is:

The objective of a bereavement program is to provide:

People who are dying deserve and require:

To meet the holistic needs of the patient, collaborate with:

Spirituality is defined as:

Culture affects decision-making with regard to:

Legal issues that should be discussed prior to death are the choice for

Advance directives are:

A DNR is:

__________ and _______ need ongoing information of the disease, signs and symptoms of the dying process, and any care that will be provided.

Assessment of the terminally ill or dying patient varies with:

As death approaches, you need to respond appropriately to the patient’s psychosocial manifestations, including:

Physical care at the end of life focuses on:

It is important not to _______ pain relief measures to a terminally ill patient.

Skin integrity is difficult to maintain at the end of life because of:

The patient near death may seem to be withdrawn from the physical environment, but maintaining the ability to:

After the patient is pronounced dead, prepare or delegate preparation of the body for immediate viewing by the family with consideration for _____________ and in accord with ______ and _______ and _______.

An understanding of the grieving process as it affects both is of great importance.

Recognizing signs and behaviors among family members who may be at risk for ________ is an important nursing intervention.

Caring for dying patients is ______ and ______. It is important to consider interventions that help to ease physical and emotional stress for you.

Caring for patients and their families at the end of life is:

It is common to feel helpless and powerless when dealing with death. It is important to recognize your own:

To promote your own health when caring for patients and their families at end of life focus on strategies to decrease stress:

During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness?
A. Feelings of hopelessness
B. Anorexia and nausea
C. Frustration with pain
D. Inability to carry out activities of daily living
C. Feelings of hopelessness
Feelings of hopelessness are likely to be present in a patient with a terminal illness who has clinical depression. This can be attributed to lack of control over the disease process or outcome. The nurse should routinely assess for depression when working with patients with a terminal illness.


A patient with terminal cancer tells the nurse, “I know I am going to die pretty soon, perhaps in the next month.” What is the most appropriate response by the nurse?
A. “What are your feelings about being so sick and thinking you may die soon?”
B. “None of us know when we are going to die. Is this a particularly difficult day?”
C. “Would you like for me to call your spiritual advisor so you can talk about your feelings?”
D. “Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you.”

The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. How would the nurse interpret the general prognosis of the patient?
A. 18 months or less to live
B. 3 months or less to live
C. 12 months or less to live
D. 6 months or less to live

A patient has been receiving palliative care for the past several weeks in light of a worsening condition after a series of strokes. The caregiver has rung the call bell, stating that the patient now “stops breathing for a while, then breathes fast and hard, and then stops again.” What should the nurse document that the patient is experiencing?
A. Cheyne-Stokes respirations
B. Bradypnea
C. Apnea
D. Death rattle

A patient died after a myocardial infarction experienced while performing yard work. What would indicate that his spouse is experiencing prolonged grief disorder?
A. Crying uncontrollably and unpredictably in the weeks after the spouse’s death
B. Stating that the spouse will return on the anniversary of the death
C. Talking about the spouse extensively in year after the death
D. Initially, the spouse denied the death.

How should the nurse provide appropriate cultural and spiritual care for the patient and family to best be able to help them when nearing the end of the patient’s life?
A. Call a pastor or priest for the family to help them cope.
B. Assess the beliefs and preferences of the patient and family.
C. Assess the individual patient’s wishes.
D. Do not insult African Americans by suggesting hospice care.

When the nurse assesses the patient, what manifestation indicates to the nurse that the patient is very near death?
A. The patient responds to noises.
B. The heart rate and blood pressure increase.
C. The patient is reviewing his life with his family.
D. The patient’s skin is mottled and waxlike.

When going to the hospital, which forms should patients be taught to bring with them in case end-of-life care becomes an ethical or legal issue?
A. Euthanasia
B. Advance directives
C. Do not resuscitate (DNR)
D. Organ donor card

A dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient’s needs?
A. Assess for pain, constipation, and urinary retention.
B. Assess for spiritual distress and restrain in varying positions.
C. Encourage more physical activity.
D. Assess for quality, intensity, location, and contributing factors of discomfort.

The nurse is evaluating whether a hospice referral is appropriate for a patient with end-stage liver failure. What is one of the two criteria necessary for admission to a hospice program?
A. The hospice medical director certifies admission to the program.
B. The physician guarantees the patient has less than 6 months to live.
C. The patient has completed both advance directives and a living will.
D. The patient wants hospice care and agrees to terminate curative care.

The nurse is providing anticipatory guidance to the family of a patient who is expected to die within the next 12 to 24 hours. What physical manifestations of approaching death will the nurse discuss with the family?
A. The skin will feel cold and clammy, with mottling on the extremities.
B. The patient will be incontinent of urine after frequent seizures.
C. The gag reflex is exaggerated, and the patient will exhibit deep, rapid respirations.
D. The patient will have increased pain, and the sense of touch will be enhanced.

A patient near death from metastatic cancer becomes restless and confused. What interventions would be the most appropriate for the nursing management of these symptoms?
A. Avoid administering pain medication until the patient is calm and alert.
B. Stay physically close to the patient and use a soothing voice and soft touch.
C. Restrain the patient to prevent injury and ask family and visitors to leave the room.
D. Turn on the television to provide a distraction and contact the hospital chaplain.

A patient admitted for pneumonia informs the nurse that no one is to attempt CPR. What is important for the nurse to verify in the medical record related to the patient’s directive?
A. The living will is signed by the patient and two witnesses.
B. The physician has written and signed the DNR order.
C. The patient’s durable power of attorney agrees with the decision.
D. There is an advance directive related to artificial nutrition and hydration.

After a patient died of severe injuries from a motor vehicle crash, the nurse who provided care is feeling helpless and powerless. What intervention would be most appropriate to help this nurse deal with these emotions and the death of this patient?
A. Maintain daily contact with the adolescent’s family for the next 2 to 3 months.
B. Request a prescription for an anxiolytic to aid in dealing with the death of this patient.
C. Attend a debriefing session with interprofessional team to allow expression of feelings.
D. Avoid caring for any other patients who are terminally ill until the feelings of grief subside.

Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply.)?
A. Strong spiritual beliefs
B. Advanced age of the patient
C. Medical diagnosis of the patient
D. Acceptance of the expected death of the patient
E. Adequate time for the caregiver to prepare for the death

Sleep is a state during which:

Most adults require _____ hours of sleep within a 24-hour period.

Sleep duration equal to or less than __ hours and more than or equal to __ hours in adults is associated with higher illness rates and early death.

______ controls the cyclic changes between waking and sleeping.

Wake behavior is associated with:

Sleep behavior is regulated by:

Sleep architecture is based on _________ recordings, sleep is divided into rapid eye movement (REM) and non–rapid eye movement (NREM) sleep.

Sleep disturbances resulting in insufficient sleep are associated with:

Sleep loss alters:

Fragmented or broken sleep is common in patients with:

With respect to sleep patterns, hospitalization, especially in the intensive care unit (ICU), is associated with:

What contributes to poor sleep?

You have a critical role in creating an environment conducive to sleep, such as:

The most common sleep disorder is:

What contributes to acute and chronic insomnia?

Symptoms of insomnia include:

The diagnosis of insomnia is made based on:

Treatments for insomnia are oriented toward:

Many individuals with insomnia self-medicate with:

___________ is recommended as a first-line therapy for chronic insomnia.

_________ and _______ medications are effective for improving sleep, but the benefits for improving daytime functioning are less certain.

Nonpharmacologic therapies for sleep include:

Sleep assessment is important in helping patients to:

Specific nursing diagnoses identified as related to sleep include:

Good sleep hygiene practices provide:

The term sleep-disordered breathing (SDB) indicates:

Obstructive sleep apnea (OSA) is:

Clinical manifestations of OSA include:

Mild sleep apnea may respond to simple measures:

In patients with more severe symptoms from OSA, ______ is the treatment of choice.

When patients with OSA are hospitalized, be aware that the use of _____ and _____ may worsen OSA symptoms by depressing respiration. Patients should continue CPAP use in the hospital.

Periodic limb movement disorder (PLMD) is characterized by:

Periodic limb movement disorder (PLMD) is managed through:

Circadian rhythm disorders occur when:

Jet lag disorder occurs when:

Narcolepsy is:

Narcolepsy is diagnosed based on:

Drug therapy with _________ and _______ is the main treatment for narcolepsy.

High doses of _________ may be prescribed for the management of cataplexy.

None of the current drug therapies cure narcolepsy or allow patients to consistently maintain a full, normal state of alertness. Drug therapy is combined with:

Parasomnias are:

What are two types of arousal parasomnias?

__________ are a parasomnia characterized by recurrent awakening with recall of the frightful or disturbing dream.

All aspects of sleep, including the duration, depth, and continuity of sleep, change with:

Older adults self-report _______ problems getting to and maintaining sleep compared with younger adults.

Nurses on permanent night or rapidly rotating shifts are at increased risk of experiencing:

Chronic fatigue in nurses on permanent night or rapidly rotating shifts is associated with:

Strategies, for nurses on night shifts, such as ___________ and ___________ may help to reduce sleep symptoms associated with shift work.

Which individual most clearly exhibits the signs and symptoms of primary insomnia?
A. A patient whose corticosteroid therapy causes him to feel “edgy” and unable to fall asleep at night
B. A patient who has experienced frequent nighttime awakenings since the recent death of a spouse
C. A patient whose increased sleep latency is not clearly attributable to any particular cause
D. A patient in the habit of having a cappuccino in the late evening while watching TV

A patient is seeking care for problems related to an inability to sleep and stay asleep over the past several months. What does the nurse anticipate teaching the patient regarding?
A. Over-the-counter sleep aids
B. Benzodiazepines
C. Sleep hygiene practices
D. Melatonin

Which question is most appropriate when the nurse is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)?
A. “Are you under a lot of stress at work or at home right now?”
B. “Do you tend to awaken early in the morning?”
C. “Do you have a history of chronic obstructive pulmonary disease?”
D. “Do you smoke?”

An obese patient is scheduled to begin treatment with continuous positive airway pressure (CPAP). When developing the plan of care, what outcome would be appropriate for this patient?
A. The patient will have no airway collapse.
B. The patient will breathe through the nose rather than mouth.
C. The patient will have increased gas exchange.
D. The patient will be calm.

What principle should guide the nurse’s practice when providing care for older patients?
A. Patient teaching should focus on older adults accepting age-related changes in their sleep cycles.
B. Drug therapy should be used conservatively.
C. Older adults require less sleep than younger adults.
D. Cognitive-behavioral interventions are less effective than among younger adults.

A patient informs the nurse that he is working the night shift and has difficulty sleeping during the day. What suggestions can the nurse offer to assist him with sleeping in the daylight hours?
A. Drink warm tea at the end of the shift.
B. Use room-darkening window shades.
C. Go to the gym to work out before going home to sleep.
D. Make the bedroom warmer.

A patient informs the nurse that she is having difficulty getting to sleep and staying asleep. Which studies does the nurse anticipate educating the patient about?
A. EEG
B. Polysomnography
C. Actigraphy
D. Self-report

A patient in the intensive care unit is becoming more irritable from lack of sleep. What nursing action will best help facilitate the patient’s sleeping?
A. Cluster activities to allow longer rest periods.
B. Keep the lights on during the day.
C. Talk to the patient when waking up at night.
D. Give the patient a back rub.

The nurse is preparing a patient to have a sleep study to determine if sleep apnea is present. What should the nurse teach the patient to do until the test can be completed?
A. Use the spouse’s CPAP mask.
B. Sleep in a side-lying position.
C. Take sleep medications.
D. Do not use pillows when sleeping.

A patient diagnosed with narcolepsy wants to know what can be done to cure it. What is the best response the nurse can give this patient?
A. “Patient support groups may be able to help you feel better.”
B. “Drug therapy and behavioral strategies will be used to help treat it.”
C. “If you take your medicine and naps, you will be cured.”
D. “Safety precautions must only be when you are driving an automobile.”

A patient is experiencing insufficient sleep and having health issues as a result. What disorder does the nurse inform the patient can be related to sleep disorders?
A. Short sleep duration may result in metabolic changes that are linked to obesity.
B. Radiation for cancer treatment is associated with fragmented sleep and fatigue.
C. Inadequate sleep in people with hypertension leads to future decreases in blood pressure.
D. Insufficient sleep is linked to a decreased risk for type 2 diabetes mellitus.

The nurse providing care to a group of patients during the night sets a goal of promoting restful sleep. How would the nurse best define sleep?
A. A state during which a person lacks conscious awareness but can easily be aroused
B. A basic but unorganized behavior that is not necessary for survival
C. A state of chemical balance among acetylcholine, norepinephrine, and serotonin
D. An unconscious state in which arousal is not easily accomplished

The nurse teaches a patient with a sleep disorder about sleep hygiene. Which statement, if made by the patient, indicates understanding of the instructions?
A. “I will go to bed at the same time whether I am sleepy or not.”
B. “I can use the prescribed sleeping pills every night to help me stay asleep.”
C. “I should set the temperature in my bedroom under 70° F at night.”
D. “I must stop drinking alcoholic beverages 2 hours before I go to bed.”

The nurse is caring for a patient who is diagnosed with narcolepsy and cataplexy. What therapeutic drug regimen will the nurse educate the patient about?
A. Diphenhydramine and low dose fluoxetine
B. Valerian and diazepam
C. Modafinil and desipramine
D. Melatonin and ropinirole

Which patient is at highest risk for obstructive sleep apnea (OSA)?
A. 18-yr-old woman with cystic fibrosis who has recurrent pneumonia
B. 35-yr-old woman with a BMI of 22 kg/m2 who has seasonal allergies to pollen
C. 82-yr-old man with Parkinson’s disease who has dysphagia
D. 68-yr-old obese man who smokes one pack of cigarettes per day

A patient on the surgical unit after coronary artery bypass grafting complains of vivid nightmares. What assessment should the nurse complete to determine the most likely cause of the nightmares?
A. Ask the patient about a history of posttraumatic stress disorder.
B. Determine if the patient has a history of sleep apnea or narcolepsy.
C. Review the documentation record to determine if the patient had a fever last night.
D. Evaluate the medications the patient is receiving for possible side effects.