Sleep, Rest, And Palliative Comfort - NCLEX Pn

Which nonpharmacologic measure can reduce dyspnea by stimulating facial airflow receptors?

Cool fan or air flow directed toward the face. Activates trigeminal nerve receptors, which can modulate the perception of shortness of breath effectively.
Which option is the best position to reduce orthopnea and improve sleep in heart failure?

High-Fowler with pillows supporting arms and head. Reduces pulmonary congestion by gravity, improving ventilation and comfort for better rest.
Which medication class is commonly used to relieve dyspnea in palliative care, even without hypoxemia?

Opioids (for example, morphine). Act on central receptors to diminish the sensation of breathlessness, providing relief independent of oxygen levels.
What sleep stage is the deepest NREM stage and is most restorative for physical recovery?

N3 (slow-wave) sleep. Features delta waves, facilitating tissue repair, immune function, and growth hormone secretion for bodily restoration.
Which nursing action best reduces aspiration risk when oral intake is poor at end of life?

Provide frequent mouth care; avoid forcing fluids. Maintains oral hygiene to prevent complications while minimizing fluid intake to avoid choking hazards.
Which symptom is most consistent with opioid-induced respiratory depression requiring urgent action?

Marked sedation with decreased respiratory rate. Indicates suppression of the respiratory center in the brainstem, signaling potential overdose needing reversal.
Which medication class is commonly used for nausea in palliative care when the cause is unclear?

Antiemetic (for example, ondansetron or metoclopramide). Blocks receptors involved in nausea pathways, offering broad relief when the underlying mechanism is uncertain.
What is the priority nursing intervention for a patient with dyspnea at end of life?

Position for comfort (often high-Fowler) and treat symptoms. Elevates the upper body to facilitate easier breathing while addressing symptoms for immediate comfort.
Which environmental modification most directly promotes sleep for an inpatient at night?

Reduce noise and light; cluster care to limit awakenings. Minimizes disruptions to preserve continuous sleep cycles, crucial for restorative rest in a hospital environment.
What is the primary nursing goal of palliative care for a patient with serious illness?

Relief of suffering and improved quality of life. Palliative care emphasizes symptom management and holistic support to enhance well-being rather than curing the disease.
Which nonpharmacologic intervention is first-line to promote sleep by supporting circadian rhythm?

Consistent sleep-wake schedule with daytime light exposure. Regulates the body's internal clock, enhancing melatonin production and improving overall sleep quality.
Which nursing intervention is priority to promote safety for a delirious patient at end of life?

Frequent reorientation and a calm, low-stimulation environment. Reduces confusion and agitation, minimizing injury risk in patients with altered mental status.
Which term means comfort-focused care for a terminal patient, typically with prognosis of $\le 6$ months?

Hospice care. Provides end-of-life support focusing on comfort and quality when curative treatments are no longer appropriate.
Identify the priority intervention for a dying patient with dry mouth and cracked lips.

Frequent oral care with swabs and water-based moisturizer. Hydrates and protects oral mucosa, alleviating discomfort without increasing aspiration risk in weakened patients.
Which assessment tool uses a $0$ – $10$ scale to rate pain intensity in an alert adult?

Numeric rating scale. Enables patients to self-report pain levels quantitatively, aiding in monitoring and tailoring interventions effectively.
Identify the best nursing response when a patient says, "I do not want more treatment."

Assess goals of care and notify the provider for plan alignment. Respects patient autonomy by evaluating preferences and ensuring care aligns with end-of-life wishes.
Which bowel regimen is typically ordered prophylactically with opioids in palliative care?

Stimulant laxative with or without stool softener. Promotes intestinal motility and eases stool passage to counteract opioid effects on the digestive system.
What sleep stage is characterized by rapid eye movement, vivid dreams, and muscle atonia?

REM sleep. This stage involves paradoxical brain activity resembling wakefulness, essential for cognitive processing and emotional regulation.
Which medication is the specific antidote for opioid-induced respiratory depression?

Naloxone. Acts as an opioid antagonist, competitively binding to receptors to rapidly restore normal respiration.
Identify the best immediate nursing action for insomnia after evening caffeine intake.

Teach avoidance of caffeine in late afternoon and evening. Promotes sleep hygiene by educating on limiting stimulants to prevent interference with natural sleep cycles.
Which beverage should be avoided in the evening because it commonly worsens insomnia?

Caffeinated drinks. Caffeine stimulates the central nervous system, blocking adenosine receptors and prolonging time to sleep onset.
Which adverse effect should the nurse anticipate and prevent when a patient starts scheduled opioids?

Constipation. Opioids reduce gastrointestinal motility, necessitating proactive management to prevent bowel complications.
Which pain scale is most appropriate for a nonverbal adult who cannot self-report pain?

Behavioral pain scale (for example, PAINAD). Evaluates observable indicators like facial expressions and body movements to infer pain in those unable to communicate.
Which medication is commonly used to treat terminal respiratory secretions ("death rattle")?

Anticholinergic (for example, glycopyrrolate or scopolamine). Inhibits acetylcholine to decrease salivary and bronchial secretions, alleviating noisy breathing without sedation.

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