Nokea
Match the descriptions to the stages of sleep. Some descriptions may have more than one stage and some stages may be used more than once.
- A. Brain waves resemble wakefulness
- B. Deepest sleep, lasting 20 to 40 minutes
- C. Associated with specific EEG waveforms
- D. Most vivid dreaming occurs
Correct Answer: D
Rationale: The correct answer is D (REM). REM sleep is characterized by brain waves resembling wakefulness and vivid dreaming. The deepest sleep (B) corresponds to NREM Stage 3, while specific EEG waveforms (C) are associated with all stages.
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Which statement by a patient with diabetes indicates an understanding of the medication insulin glargine injection (Lantus)?
- A. Lantus causes weight loss.
- B. Lantus is used only at night.
- C. The duration of Lantus is six hours.
- D. There is no peak time for Lantus.
Correct Answer: D
Rationale: Lantus is a long-acting insulin with no distinct peak action.
A male client has returned to the Unit following a left femoral popliteal bypass graft. Six hours later, the client's dorsalis pedis pulse cannot be palpated and his foot is cool and dusky. The nurse should:
- A. continue to monitor the foot.
- B. immediately notify the physician.
- C. notify the head nurse.
- D. assure the client that his foot is fine.
Correct Answer: B
Rationale: The client is losing the blood supply to his left foot. Continuing to monitor will not restore the blood supply to the foot. The physician should be notified immediately because the client is losing the blood supply to his left foot and is in danger of losing his foot and/or his leg. It is the responsibility of the nurse caring for the client to notify the physician, not the head nurse. This would be giving the client false assurances, which is unethical, demeaning, and could have legal consequences.
How can a nurse foster effective coping skills?
- A. Deep breathing exercises
- B. Avoid social interactions
- C. Ignore stressors
- D. Increase workload
Correct Answer: B
Rationale: The correct answer is B because it is the most appropriate response based on physiological and medical principles.
A 35-year-old client is admitted for elective tubal ligation. During the preoperative teaching, the client states, 'The anesthesiologist said she was going to give me balanced anesthesia. What exactly is that?' The best explanation by the nurse is that balanced anesthesia:
- A. is a type of regional anesthesia.
- B. uses equal amounts of inhalation agents and liquid agents.
- C. does not depress the central nervous system.
- D. is a combination of several anesthetic agents or drugs, which produce a smooth induction with minimal complications.
Correct Answer: D
Rationale: A regional anesthesia does not produce loss of consciousness and is indicated for excision of moles, cysts, and endoscopic surgeries. Varying amounts of anesthetic agents are used when employing balanced anesthesia. The amounts used depend on the age, weight, condition of the client and the surgical procedure. General anesthesia is a drug induced depression of the central nervous system, which produces loss of consciousness and decreased muscle activity. Balanced anesthesia is a combination of a number of anesthetic agents that produce a smooth induction, appropriate depth of anesthesia, and appropriate muscle relaxation with minimal complications.
Which physical assessment finding should be reported to the physician?
- A. Pearly gray or pink tympanic membrane
- B. Dense, whitish ring at the circumference of the tympanum
- C. Bulging red or blue tympanic membrane
- D. A cone of light at the innermost part of the tympanum
Correct Answer: C
Rationale: A bulging red or blue tympanic membrane indicates acute otitis media or other serious conditions requiring medical intervention.