List at least three behaviors or practices that can contribute to insomnia.

Correct Answer: A

Rationale: In the context of pharmacology and medical-surgical nursing, understanding factors contributing to insomnia is crucial for patient care. The correct answer, option A, "Irregular sleep schedule," is a common behavioral factor leading to insomnia. Irregular sleep patterns disrupt the body's natural sleep-wake cycle, impacting the quality and duration of sleep. This can be exacerbated by rotating shifts or inconsistent bedtime routines. Option B, "Consumption of caffeine or alcohol," is incorrect but relevant. While caffeine and alcohol can disrupt sleep patterns, they are not the primary causes of insomnia. These substances can interfere with falling asleep but may not sustain insomnia over time unless consumed excessively or close to bedtime. Option C, "Excessive screen time before bed," is another incorrect choice. Blue light emitted from screens can impact melatonin production, making it harder to fall asleep. While excessive screen time before bed can contribute to poor sleep hygiene, it is not a direct cause of chronic insomnia. Option D, "Provide enough positive pressure in the airway to prevent airway collapse," is unrelated to behaviors contributing to insomnia. This option seems to refer to a treatment strategy for sleep apnea rather than a behavior leading to insomnia. Educationally, understanding these behavioral factors contributing to insomnia is essential for nurses to provide holistic care. Educating patients on the importance of maintaining a regular sleep schedule, avoiding stimulants close to bedtime, and practicing good sleep hygiene can help manage and prevent insomnia, improving overall patient outcomes.

Correct Answer: C

Rationale: In the context of pharmacology and medical-surgical nursing, understanding pain management is crucial. The correct answer, option C, is problematic for the nurse caring for a patient with decreased cognitive function because these patients may have difficulty expressing their pain verbally or understanding pain assessment scales. This poses a challenge for accurate pain assessment and management, as the nurse may have to rely on non-verbal cues or behavioral changes to assess pain in such patients. Option A, a patient placed on a ventilator, can still communicate pain despite being intubated, through gestures, facial expressions, or non-verbal cues. Option B, a patient with a history of opioid addiction, should not prevent the nurse from addressing their pain appropriately, as pain management is a fundamental aspect of nursing care regardless of the patient's history. Option D, a patient with pain resulting from severe trauma, would typically be able to communicate their pain even if the severity of the trauma might complicate pain management. Educationally, nurses need to be aware of different strategies for assessing and managing pain in patients with various conditions, including those with cognitive impairments. Utilizing non-verbal cues, observing behaviors, and using appropriate pain assessment tools tailored to the patient's needs are essential skills in providing holistic care to all patients, including those with cognitive limitations.

Correct Answer: D

Rationale: In understanding nociceptive processes that communicate tissue damage to the central nervous system (CNS), it is crucial to grasp the sequential order of events. The correct answer, "D) Transduction," is the initial step in this process. Transduction refers to the conversion of a noxious stimulus into an electrical signal by specialized nociceptors in response to tissue injury. Option A) Perception, is the interpretation of the pain signal by the brain, occurring after transmission and modulation. Option B) Modulation involves the amplification or dampening of pain signals within the CNS, which follows transmission. Option C) Transmission involves the relay of the pain signal from the site of injury to the spinal cord and then to the brain. Understanding the nociceptive processes is vital for healthcare professionals, especially in fields like pharmacology and nursing, as it forms the basis for pain management strategies. Having a clear grasp of the sequence helps in selecting appropriate interventions targeting different stages of pain processing, thus optimizing patient care outcomes. This knowledge is fundamental in ensuring effective pain relief and enhancing patient comfort and well-being.

Correct Answer: B

Rationale: In the case of a patient with chronic cancer-related pain using MS Contin, the correct answer is B) Constipation. Opioid medications like MS Contin commonly cause constipation as a side effect due to their action on opioid receptors in the gastrointestinal tract, leading to decreased motility. Tolerance may develop to other side effects like dizziness or nausea/vomiting, but constipation tends to persist with continued opioid use, necessitating ongoing management. Pruritus (option A) is a common side effect of opioids but tends to improve with time as the body adjusts to the medication. Dizziness (option C) is also a common side effect that may decrease as tolerance develops. Nausea and vomiting (option D) can often be managed and may improve over time as well. Educationally, understanding the side effects of opioids like MS Contin is crucial for nurses and healthcare providers to effectively manage patients' pain while minimizing adverse effects. It is essential to educate patients on potential side effects, like constipation, and the need for ongoing monitoring and interventions to ensure optimal pain control and quality of life.

Correct Answer:

Rationale: In assessing a patient approaching death, understanding the physical manifestations across various body systems is crucial for a nurse. In this scenario, the correct manifestations for each body system are as follows: A) Respiratory: Cheyne-Stokes respirations - This pattern of breathing, characterized by alternating periods of deep, rapid breathing followed by shallow, slow breathing or apnea, is commonly seen in patients nearing death due to the body's inability to regulate breathing. B) Skin: Mottling - Mottled skin, with a bluish or purplish discoloration, is a sign of poor circulation and reduced blood flow to the extremities, often observed in the final stages of life. C) Gastrointestinal: Loss of appetite - As the body's systems shut down, the desire to eat diminishes, leading to a loss of appetite, which is a common feature in the terminal phase of illness. D) Musculoskeletal: Weakness - Progressive weakness and muscle wasting are typical as the body's energy reserves deplete, contributing to impaired mobility and function. Educationally, understanding these signs helps nurses provide appropriate end-of-life care, including symptom management and emotional support. The incorrect options lack the specificity and relevance to end-of-life care seen in the correct manifestations. It is essential for nurses to recognize these signs to provide compassionate and holistic care to patients and their families during this critical phase of life.