[Music] hi guys it's me professor d and welcome back to my youtube channel on this video i'm going to be covering questions that are part of the fundamentals of nursing also known as foundations of nursing and to be more specific i'm going to be covering pain rest sleep and comfort if you haven't done so already guys please don't forget to like and subscribe below also don't forget i'm also now on tick tock and youtube my handle is still the same next is nursing i also have a podcast i'm on every major streaming platform i cover um questions for nurse practitioners and i do i cover a lot of issues for nursing students as well as my audio lessons guys i have audio lessons on my website nexus nursing institute if you are in the nursing program right now and you're struggling you're struggling with a particular subject or concept concept i actually break it down i explain to you what the textbook is trying to say and i point out to you the most important contents that you're most likely going to see on your exam so make sure you check out my audio lessons on nexusnursinginstitute.com so guys without any further ado let's get started first question the nurse understands that a patient who has difficulty sleeping may have shortened n r e m n r e m guys that's um non rapid uh and are non rapid eye movement nrem non-rapid eye movement okay so the nurse understands the patient who has difficult difficulty sleeping may have shortened nrem sleep therefore the nurse should assess the patient for one decreased pain tolerance 2 excessive sleepiness three confusion or four irritability and guys the correct answer is two if that nrem has been shortened you expect that patient be tired they're gonna be sleepy they're gonna be fatigued they're gonna want more sleep because the end uh the nrem has been shortened let's say you guys had no idea what the answer was guys look at your choices the only choice that has something to do with sleep is two excessive sleepiness okay and then the question they tell you the patient had a shortened nrem sleep let's say you didn't understand nrem you know what sleep means so you would have if you even if you didn't know what the answer was when you look at your choices you should have said to yourself well which one is the one that sticks out and the sleepiness is the only one that has to do with sleep and you should have chosen that answer by the way guys um like i said when nrem is shortened the patient's going to be tired because they're going to feel like they need more sleep they're going to be sleepy next question the nurse understands that the shortest acting pain relief method is one patient controlled analgesia that's your pca two i am sedatives three iv narcotics or four regional anesthesia and guys the correct answer is three iv narcotics now even though um iv medications the onset is the quickest because it goes directly to the bloodstream yes but guess what the duration's also the shortest when it comes to narcotics and that has to do with the bio breakdown right so even though yes the onset the quickest the duration also is the shortest the correct answer is three iv narcotics um as soon as you give that iv narcotics it starts to work immediate immediately guys within me within minutes but it also doesn't last too long now let's look at our other answer choices you have one the pca pcas intermittent remember that's the one where the patient presses the button where they feel pain that's intermittent that can last hours to days depending on the type of narcotic that's given um two i am sedatives this one can last in the when it's given intramuscularly can last in the patient last for the patient about three to four hours and then for reno reno regional anesthesia that's something like guys your epidural or your nerve block um this also can last for a couple hours maybe about one to three hours but definitely the shortest acting one is going to be the iv even though the onset is the quickest the duration is also the shortest which concept associated with sleep must the nurse understand to best plan nursing care one bedtime routines are associated with an expectation of sleep two alcohol intake interferes with one's ability to sleep three sleep needs remain consistent throughout the lifespan or four total time in bed gradually decreases as one ages guys if you've been following me for any amount of time don't worry about me i love my coffee i'm gonna sip on this while you think of the answer just press pause if you need a little bit more time okay guys so the correct answer is one bedtime routines are associated with an expectation of sleep and guys this not only goes for adults this goes for pediatric patients as well for the patient to get the best quality of sleep it you teach them to establish a bedtime routine because it trains the brain to prepare for sleep wind things down soft music low lighting reading praying have some type of routine before you go to bed and it trains your brain to just slow everything down and prepare for sleep number one is the correct answer now let's look at our wrong answer choices too alcohol intake interferes with one's ability to sleep as much as many people think that alcohol is um a stimulant because you think of people who are drunk and they're rowdy and they're all like this but alcohol is actually a depressant it slows things down but we're not going to tell patients to drink alcohol to go to sleep is that healthy no but you know that number two is correct excuse me number two is incorrect it doesn't interfere with one's ability to sleep it's a depressant it may actually make the patient sleep it is a depressant but it's not healthy so we're not going to tell the patient to do it number three sleep needs remain consistent throughout lifespan no it doesn't remain consistent you know the sleep needs depends on the patient's activity tolerance activity no activity level okay so the more active a patient is the more rest they're going to need it depends on the activity level it depends on their health it depends on the patient's age so that's incorrect and then um number four total time in bed gradually decreases as one ages that's actually false um as one ages and one goes into the older adult geriatric population this patient tends to spend more time in bed but less time sleeping okay so the correct answer is number one a patient has been in the icu for two weeks which nursing diagnosis associated with sleep deprivation is most appropriate for this patient one risk for disturbed thought process two impaired gas exchange three disuse syndrome or four powerlessness and guys the correct answer is one risk for disturbed thought process so guys this is also known as icu psychosis if a patient's been in the icu for long enough they may become out of touch with reality and that's what psychosis is out of touch with reality the great thing guys is that this is reversible the patient can be reoriented back to reality however um with the patient being in the icu and not getting enough sleep they can have icu uh psychosis and the nursing diagnosis for that would be number one your risk for disturbed thought process the patient's cognition decreases the nurse understands that the internal stimulus that most commonly interferes with sleep is one ringing in the ears two full bladder three hunger or four thirst and guys the correct answer is to full bladder so another important teaching you wanna teach the patients to get the best quality and quantity of sleep you're going to teach the patients to empty their bladder before they go to bed especially older patients number one a full bladder is going to interfere with their sleep because they're going to have to get them to go urinate and number two if it's an older patient a patient part of the geriatric community what happens when you're awakened from sleep even someone young you can be slightly confused if you're sleeping then you suddenly you're jared awake you could be confused that patient getting up from sleeping getting up to go use the restroom they could do what they can fall right so you want to teach the patient to empty their bladder before going to bed uh number two is the correct answer now choice number one three and four you're ringing in the ears the hunger thirst all of these can um [Music] interfere with sleep but the most common one is the full bladder by far a patient states the pain moves from my chest down my left arm the nurse identifies that the characteristic of pain associated with the statement is one pattern two duration three location or four constancy and the guy's the correct answer is three location go back to the question that says the pain moves from my chest to my left arm they're giving the location of the pain now let's look at our other choices one pattern guys the pattern would be the onset the duration remission those are um the pattern of pain okay the recurrence choice number two duration duration is the type of pattern choice and by the way alteration also means the the amount of time that it lasts and um choice number four constancy that's you know explaining whether it's um ongoing or intermittent okay so guys the correct answer for this question is three location the nurse is caring for a patient who is experiencing pain the nurse understands that a common psychological patient response to pain is one experiencing fear related to loss of independence two developing an increased tolerance to the drug three asking for pain medication to relieve the pain or four verbalizing the presence of nausea and guys the correct answer is one experiencing fear related to loss of independence so this is normal when the patient's in pain and if that pain has been going on for some time maybe going to chronic that patient will have fear that they won't be able to do things for themselves anymore or they're going to need to depend on somebody or they're they're going to have a loss of control okay now let's look at the answer choice number two developing an increased tolerance to the drug that's actually a physiological response not not um a psychological response choice number three asking for pain medication to relieve pain that's a behavioral response not a psychological response choice number four verbalizing the presence of nausea that's a physiological response not a psychological response a psychological response is that fear that mental thought that you know i'm not going to have any control over my body or i'm going to be dependent on others for the rest of my life so number one is the correct answer a patient has had a total abdominal hysterectomy and debulking for four-stage ovarian cancer what should the nurse do first when on the second post-op day this patient complains of abdominal pain at level five on a one to ten pain scale one reposition the patient two offer relaxing back rub three use distraction techniques or four administer the ordered pain medication and guys the correct answer is for administer the ordered pain medication so this patient had let's see what kind of surgery they had a total abdominal hysterectomy so guys this is serious manipulation of those pelvic organs okay i'm surprised that patient started feeling pain on day two i give her a lot of credit for that so this patient has pr and pain med patient says they're in pain you're not gonna be trying to distract them or give them a back rub you better give them that pain medication that they have ordered for them that's what you're going to do now um choice number one two and three um if the patient um is has pain and you've assessed the type of pain that they have um you know if you're waiting to notify the doctor that the patient has pain see what the doctor wants to order in the meantime while you see what the doctor wants to do you want to give them a back rub you want to give due distraction all that good stuff wonderful but something like this a major surgery where there was huge manipulation of those organs where we expected that patient's pain to be way more than the five and they're only at of five on the second day we're going to give them that pain medication it's ordered they have an order for it it's not like the patient doesn't have an order and you're waiting to see what the doctor wants to do they have it ordered for pain give it to them okay a patient's diagnosed with a narcolepsy the nurse's primary intervention should address the patient's one inability provide self-care two alter all turned thought processes three excessive fatigue or for risk for injury and guys the correct answers for risk for injury our priority is always going to be the patient's physiological integrity what is keeping that patient alive and safe from harm so when you look at the choices you have here for is clearly the correct answer everything else can wait we want to make sure that our patient is safe a patient is experiencing discomfort associated associated with gerd the nurse should teach a patient to sleep in which position one semi-fowler's two right lateral three prone or four sims and guys the correct answer semi foulers really guys should have been high followers but remember when it comes to nursing you're not always going to get the perfect answer so you're going to choose the best answer for the choices that are given now for the selective selection of choices by far it's going to be semi-followers why think about what gerd is this is um the stomach contents including hydrochloric acid creeping up from the stomach passing through the cardiac sphincter and going into the esophagus remember the lining of the esophagus was not created to be able to handle the acidity of hydrochloric acid so it causes a burning sensation to the patient that patient feels like they're having heartburn chest pain that's why they have to sleep with the head elevated because gravity will help keep the gastric contents in the stomach but these are the positions the right lateral the prone sims that puts pressure on the abdomen which can help force that cardiac sphincter to open which will allow all of the gastric contents and the hydrochloric acid to creep up into the esophagus where it is not supposed to be okay so guys our correct answer is number one semi followers position the patient complains of pain when caring for this patient the most important thing the nurse must recall is that one the extent of pain is directly related to the amount of tissue damage two administering opioids for pain will eventually lead to addiction three the person experiencing pain is authority of the pain or four behavioral adaptations are congruent with statements about pain and guys the correct answer is number three pain is whatever the patient says it is pain is whatever the patient says it is it is not something that's measurable it's not something that's objective it's subjective whatever the patient says it is the correct answer is number three all right next question a patient is experiencing anxiety which aspect of sleep should the nurse expect will be affected as a result of anxiety one onset two depth three stage two or four duration and guys the correct answer is number one on set if the patient has anxiety they're nervous they're anxious about something their brain is going going going going it's going to be hard for them to fall asleep so the correct answer guys is onset a patient requests pain medication what should the nurse do when first responding to the patient's request for pain medication one use distraction to minimize the patient's perception of pain two place the patient in the most comfortable position three administer pain medication to the patient quickly or four assess the various aspects of the patient's pain and guys the correct answer is number four the first thing you're going to do is what assess add pie assess diagnose plan intervention and evaluate the first thing in adpie is assess patient says let me give example patient just had surgery remember the patient with the abdominal hysterectomy let's use that patient as an example they just had surgery and it's two days later and they say they have pain what do we do first yes if there's an order for pain medication but before we give them that pain medication we're going to ask some questions where do you feel pain that patient had an abdominal hysterectomy what if they say all the pain's on my left butt cheek the left butt cheek and then you go look at the patient's left butt cheek and you realize they were sitting on a sharp object and that's what was causing the pain and the pain was not from the surgery that they just had right you would have medicated that patient for no reason so you're always going to assess first what is assessment anything that gathers information anything that garners more information whether it's a physical assessment looking at your patient whether it's going into the patient's chart and getting information whether it's asking the patient questions such as the pattern of pain the onset the duration the tar the type is it sharp is it stabbing is it shooting does it um move from one place to another anything that got get guys you know i can't talk anything that garners information is a type of assessment and that's what you're going to do first with statement by the patient to the nurse indicates a precipitating factor associated with pain one i usually feel a little dizzy and think i'm going to vomit when i have pain two i usually have pain after i get dressed in the morning three my pain usually comes and goes throughout the night four my pain feels like a knife cutting right through me and guys the correct answer is to i usually have pain after i get dressed in the morning now why is this our answer let's go back to the question the question is asking about a precipitating factor guys a precipitating factor is anything that induces or precipitates okay so with that being saying um um induces precipitates aggravates make it even worse so with that uh being said look at number two i usually have pain after i get dressed in the morning so getting dressed in the morning is that trigger what may induce what may uh precipitate that pain that is the correct answer now let's look at our other answer choices one i usually feel dizzy and think i'm going to die when i have pain not after when i have pain choice number three my pain usually comes and goes that's intermittent guys and number four my pain feels like a knife them describing that pain they're actually describing the quality of the pain okay but the question is asking what is the precipitating what induces it what aggravates it so number two is the correct answer of the options presented the most important nursing intervention that supports a patient's ability to sleep in the hospital setting is one providing an extra blanket two limiting unnecessary noise on the unit three shutting off lights in the patient's room or four pulling curtains around the bed at night and the correct answer guys is limiting unnecessary noise on the unit okay that is the correct answer why because you know nurses laughing ki king at the nurse's station doctors barking orders the phones going off fax machine family in the hallway talking that is the most disturbing thing to the patient and they will not get much sleep so you could do one three and four but if there's all this external noise in the environment happening it's going to be hard for that patient to sleep that's why number two is the correct answer and guys i can't believe we're already down to our last question so here we go a patient has a history of severe chronic pain one of the most important guidelines associated with providing nursing care to the patient is one determining the level of function that can be performed without pain two focusing on pain management intervention before pain is excessive three providing interventions that do not precipitate pain four asking what an acceptable level of pain and guys the correct answer is to focusing on pain management intervention before the pain is excessive why because if we wait until that pain is excessive we wait until then to give that patient a narcotic or whatever they need you think that's gonna touch that patient's pain absolutely not and so this is why pcas are such a wonderful tool used number one that patient feels like they have some type of control because they feel like the minute they feel pain instead of pressing the button waiting for a nurse to come their anxiety rises they know as soon as they press that button as long as it's within a lot of time they will get the pain relief okay you want to catch that pain before it becomes excessive um by the time it becomes severe you give that patient that narcotic the opioid or whatever that was ordered it's not going to help them it's not going to even blunt the effects of pain so guys number two is the correct answer guys i hope you found this video to be helpful if you want to see more questions on pain sleep comfort let me know in the comments uh please help support my channel by sharing my content if you know any nursing students or new grads who are studying for their nclex that you think could use um my teaching please share my content please don't forget guys my audio lessons are available on my website check that out check out my other social media handles and i thank you so much for spending your time with me on this video and you'll be seeing me on the next video you