A nurse caring for a patient in the intensive care unit (ICU) implements strategies to create an environment conducive to sleep. Which strategy would be most effective?

Correct Answer: A

Rationale: In the intensive care unit (ICU), creating an environment conducive to sleep is essential for patient recovery. Option A, turning off the lights in the room during the night, is the most effective strategy as it helps regulate the patient's circadian rhythm and promote restful sleep. This option aligns with the principles of sleep hygiene, which emphasize a dark and quiet environment for optimal rest. By minimizing light exposure, the nurse can support the patient's natural sleep-wake cycle. On the other hand, options B, having the television on at all times for background noise, and C, silencing the alarms on the bedside monitor and infusion pumps, can both disrupt the patient's sleep patterns. Background noise and alarms can be disturbing and prevent the patient from entering deep sleep stages. Option D, administering ordered analgesics around the clock even if the patient denies pain, is not directly related to creating a sleep-conducive environment. While pain management is crucial for patient comfort, it may not be the primary factor affecting the patient's ability to sleep in this scenario. Educationally, understanding the importance of environmental factors in promoting sleep in the ICU is vital for nurses to provide holistic care. By implementing appropriate strategies like turning off lights, nurses can enhance patient outcomes and overall well-being during their hospital stay.

Correct Answer: B

Rationale: The correct answer is B) The area should be treated as a painful lesion, using gentle cleansing and dressing. In the context of an unconscious patient with a stage 2 pressure ulcer, it is crucial for the nurse to understand that even though the patient may not be able to verbalize pain, the presence of a pressure ulcer indicates tissue damage that can still elicit a pain response. Therefore, the nurse should treat the area as a painful lesion by using gentle cleansing and appropriate dressing to promote healing while minimizing discomfort for the patient. Option A is incorrect because the absence of a behavioral response does not necessarily mean the patient is not experiencing pain. Pain perception is subjective and can vary among individuals, especially in patients who are unconscious or unable to communicate. Option C is incorrect because assuming that the patient cannot perceive pain due to being unconscious is a dangerous assumption. Pain perception can still occur even in unconscious patients, and aggressive scrubbing can further damage the fragile tissue of a pressure ulcer. Option D is incorrect because not all nociceptive stimuli necessarily lead to the perception of pain. Pain is a complex phenomenon influenced by various factors beyond just the transmission of signals to the brain. This scenario highlights the importance of a comprehensive understanding of pain perception and management in patients, especially those who are unable to communicate their discomfort. Nurses must approach care with empathy, knowledge, and a patient-centered mindset to ensure optimal outcomes and comfort for all patients.

Correct Answer: C

Rationale: In this scenario, the health care provider would recommend adding transdermal fentanyl (Duragesic) to the patient's medication plan due to its potent opioid analgesic properties, making it suitable for severe cancer pain management. Fentanyl is a strong opioid that can provide effective pain relief when other medications are no longer sufficient, as in this case where the patient's pain is increasing. Option A is incorrect because adding PO oxycodone to the current regimen may not provide the necessary increase in pain relief compared to transdermal fentanyl. Option B is incorrect as propoxyphene is not recommended for use due to safety concerns and its withdrawal from the market. Option D is also incorrect as hydrocodone with acetaminophen may not be as potent as transdermal fentanyl for severe cancer pain. Educationally, it is important to understand the principles of opioid selection in pain management, especially in cancer patients. Transdermal fentanyl is often reserved for moderate to severe pain that requires around-the-clock treatment, making it a suitable choice in this situation. It is crucial for healthcare providers to have a strong knowledge of opioid pharmacology to ensure effective pain management in patients with complex needs.

Correct Answer: A

Rationale: In this scenario, the correct answer is Option A: Assess their understanding of what hospice care services are. The first step for the nurse is to gather information about the family's knowledge and beliefs regarding hospice care. This is crucial as it allows the nurse to address any misconceptions, provide accurate information, and facilitate an open discussion about end-of-life care options. Option B is incorrect because asking how they will care for the patient without hospice care assumes that the family is capable or willing to provide appropriate care, which may not always be the case in a complex situation like terminal pancreatic cancer. Option C is incorrect because while it is important to involve the patient and family in decision-making, attempting to change their minds without first understanding their perspectives can lead to conflict and resistance. Option D is incorrect and culturally inappropriate as it assumes all Hispanic families have the same preferences for caring for their loved ones. It is essential to avoid stereotyping and instead focus on individual beliefs and needs. Educationally, this question highlights the importance of cultural competence, effective communication, and patient/family-centered care in end-of-life situations. Nurses must engage in open dialogue, respect diverse beliefs, and provide accurate information to support families in making informed decisions that align with their values and preferences.

Correct Answer: C

Rationale: In this case, the correct answer is C) Advance care planning. Advance care planning is a process that involves making decisions about the medical care a person would want to receive if they become unable to make their own decisions. Directives to physicians, durable power of attorney for health care, and medical power of attorney are legal documents that are typically included in advance care planning. Option A) Natural death acts and B) Allow natural death are related to end-of-life care but do not specifically include directives to physicians or powers of attorney. Option D) Do Not Resuscitate order is a specific medical order related to resuscitation preferences but does not encompass the broader scope of medical decision-making covered by advance care planning. Understanding legal documents related to healthcare decision-making is crucial for healthcare professionals to ensure they respect patients' autonomy and provide care that aligns with their wishes. By knowing the components of advance care planning, healthcare providers can better support patients in making informed decisions about their treatment preferences and end-of-life care.