Fundamentals Nursing Prep U Chapter 33 Rest and Sleep

A client comes to the clinic and states to the nurse, "I am traveling overseas for a project frequently and am having a difficult time adjusting because of jet lag. What is the best response by the nurse?

"Light therapy can be beneficial and help ease the transition to a new time schedule or zone."

The nurse is promoting bedtime rituals with a family. Which statement indicates the nurse may need to provide further instructions to the mother?

"My boys love to rough-house in their room right before bedtime."

The nurse is educating a client about restless leg syndrome. What statement made by the client indicates that further education regarding restless leg syndrome is required?

"I will try to lose weight so I can sleep better at night."

Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening?

Eat some crackers with peanut butter at bedtime.

Which activity for rest break should not be incorporated into care planning for clients to aid in healing and recovery?

drinking an 8 oz cup of a caffeinated beverage

A nurse is caring for a client with insomnia. The nurse is explaining the importance of sleep to the client. Which role is sleep supposed to play?

reduce fatigue

The nurse makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep are unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to:

use caution when driving an automobile.

The parents of a newborn ask when they can expect the baby to sleep through the night. The nurse responds that the baby will most likely sleep through the night by:

3 months of age

A nurse on the night shift notices that a client is grinding his teeth while sleeping. How should the nurse document the diagnosis for the client?

Bruxism

Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern?

Do you usually go to bed and wake up about the same time each day?

The nurse is performing an intake assessment of a 60-year-old client who admits to having a "nightcap" of 4 to 6 ounces of scotch whisky each night. What effect might this alcohol be having on the client's sleep?

decreased REM sleep

The nurse identifies that a client is in stage 3 sleep. What assessment finding by the nurse is indicative of this stage?

enuresis

While instructing young adults about the need for adequate sleep, the nurse instructs the group that to improve sleep quality, individuals should:

have a consistent time for arising.

In Stage 4 sleep, the:

pulse rate is slow

A new client in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis?

Provide an opportunity for the client to talk about concerns.

The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include?

Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap.

A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because:

they may be disoriented on awakening.

The nurse is caring for a client with narcolepsy. The client reports experiencing being unable to move upon awakening from sleep. The client's spouse states that the client makes sandwiches in the middle of the night, yet the client does not recall this behavior. How does the nurse document these concerns?

sleep paralysis and automatic behavior

When the nurse attempts to wake a client who has just closed his eyes and appears asleep, the client states he is not asleep. What stage of sleep is this client in?

Stage 1

A client begins snoring and is sleeping lightly. The stage of sleep is:

Stage 2

The nurse recognizes that sleep deprivation related to environmental concerns will apply to which clients? Select all that apply.

• a 67-year-old male who has two beers during the late night newscast • a 32-year-old male machinist, two pack a day smoker • an 84-year-old male hospitalized for prostate surgery

The nurse is educating a client about nonpharmacologic measures to alleviate restless leg syndrome (RLS). Which education points would the nurse include in the plan? Select all that apply.

• applying heat or cold to the extremity can help relieve the symptoms • Biofeedback and TENS can help relax the client and relieve symptoms • massaging the legs may relieve symptoms

The client has been in the intensive care unit for several days. The client appears to be sleeping throughout the night. The nurse records the data listed above. The nurse evaluates that rapid eye movement (REM) sleep is occurring at:

0100

The nurse is administering medications for a group of clients. Which client will the nurse administer a benzodiazipne-like medication to?

A client who is being treated for short-term insomnia

A nurse is reviewing the medication administration record. Which order does the nurse question?

A diuretic administered twice daily at 9am and 9pm.

What factor has been hypothesized by researchers regarding current thoughts on sleep?

Chronic sleep deprivation is present.

The nurse is caring for a client who reports insomnia. The client has recently moved from an area nearby a fire station in the inner city to the country. Which recommendation will the nurse make to facilitate sleep?

Find a phone app that plays sounds of the city.

Which statement about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents?

Getting the child to sleep can be difficult.

A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which condition is a manifestation of depression in an older client?

Insomnia

A nurse is explaining to an insomniac client the effect of a prescribed medication and the different phases of sleep. Which statement is true for non-rapid eye movement (NREM) sleep?

It is called slow wave sleep.

A nurse is providing community education about the importance of getting enough sleep. Which information about REM sleep is most accurate?

It plays a role in memory

The nurse is caring for a client on the acute care unit who experiences automatic behaviors associated with narcolepsy. What is the priority nursing intervention?

Keep the client safe by monitoring ambulation on the unit

When a client tells the clinic nurse that he has irresistible sleep attacks throughout the day lasting from 10 to 15 minutes, the nurse suspects that the client may be experiencing what?

Narcolepsy

The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborn's sleep patterns. Which statement is accurate about a newborn's sleep patterns?

Newborns sleep 16 to 17 hours per day.

The nurse has entered the room of a newly admitted client and observed a continuous positive airway pressure (CPAP) on the client's bedside table. The nurse would recognize that this client likely has a history of what condition?

Obstructive sleep apnea

The nurse is attempting to wake a client from sleep and is having a difficult time arousing them. What stage of sleep does the nurse identify the client is experiencing?

REM sleep

A client taking a diuretic twice daily for treatment of hypertension reports being awakened often by a full bladder. What teaching regarding the diuretic will the nurse provide?

Take before 6:00 PM at night.

The student nurse is providing an education program for preschool parents. The nursing student should include which intervention to improve the child's sleep?

The child should limit fluids after supper.

A client is worried and states, "I just know I won't be able to sleep before my surgery." What sleeping pattern would the nurse anticipate?

The client will likely not be able to sleep.

A nurse on the night shift checks on a client and suspects that the client is in REM sleep. Which client cue is indicative of this stage of sleep?

The client's eyes dart back and forth quickly

The nurse is completing a sleep history on a client who reports sleeping problems. Which of the client's regular behaviors will cause the client to have difficulty with sleep?

taking a diuretic at 9 a.m. and 5 p.m. daily

A 62-year-old woman informs the nurse that her mother has been anxious and disoriented in the morning, and that she sleeps 4 hours per night, while getting up from sleep to use the bathroom. What factor in the client's health regimen could interfere with healthy sleep?

taking diuretic medicine at 10 a.m. and 10 p.m.

An 82-year-old client is newly admitted to an assistive living facility. Which intervention promotes safety at night for the client?

using a night light in the bathroom

When evaluating a client's sleep plan success, the nurse would expect the client to:

verbalize feeling rested

The nurse is encouraging a client to begin and maintain a sleep diary. What statement made by the client indicates an understanding of the purpose of the diary?

"I will record the time I go to bed and how long it takes me to fall asleep."

A nurse is visiting the home of a first-time mother and her newborn. The nurse is teaching the mother about the newborn's sleep needs. The nurse would inform the mother that newborns sleep approximately how many hours per day?

14 to 20 hours

A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep?

14 to 20 hours each day

The nurse is instructing a parent on how to promote restful sleep for a child. What food would be the best bedtime snack for the child?

Apple slices

The nurse is discussing sleep interventions with a client. What statement made by the client indicates an understanding of sleep restruction?

limiting time in bed to actual sleep time.

When the newly admitted client with chronic obstructive pulmonary disease informs the nurse that she frequently awakens during the night, the nurse may notify the physician for which intervention?

low flow oxygen

The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is:

observe client's hours of sleep and review client's sleep diary

When a nurse notes that a sleeping client is demonstrating irregular respirations and is showing eye movement, the nurse identifies the stage of sleep the client is experiencing as:

rapid eye movement (REM)

Which factor necessitates the need for more sleep in the adolescent population?

rapid growth

A newly admitted client states to the nurse, "I average about 5.5 hours of sleep per night," What determination of this client's sleep patterns does the nurse discuss with the client?

they are sleep deprived to some degree.

A nursing student is changing the client's bed. Which action requires intervention from the nursing instructor?

tossing soiled linen on the floor

An older adult client with mild hypothermia has been admitted to the health care facility. What should the nurse do to provide an appropriate environment to an older adult client?

Ensure that the environment is warmer.

A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage?

Hypothalamus

For the last 3 weeks, a nurse in a long-term care facility has administered a sedative-hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation?

Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration.

The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects a nursing diagnosis of:

Sleep Pattern Disturbance related to acute pain

An elderly client is complaining of disturbed sleep during the night because of excessive urination. What information should the nurse address with the client as a possible cause related to the complaint?

Timing of diuretic medication

Which guideline does the nurse apply to discussion of sleep patterns with older adult clients?

Total sleep time decreases as the clients age.

The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to:

anticipate sleeping overnight at a health care center.

The client being seen in the employee wellness clinic reports difficulty sleeping for the past several months. The most important assessment the nurse could make is:

reviewing the client's sleep diary for the past 2 weeks.

The nurse is caring for a client who is having difficulty sleeping. Which medication does the nurse anticipate will be prescribed by the healthcare provider?

temazepam (Restoril)

A parent reports their 4-year-old child wakes up frequently at night screaming and occurs shortly after the child has fallen asleep. The nurse determines that the child takes a tub bath and the parent reads a story prior to bedtime at 8 p.m. What is the best response to the parent? Select all that apply.

• "It is common for this to occur in this age group." • "Comforting your child when this occurs may help." • "You may find a nightlight in his room is helpful."

A student nurse is preparing a presentation on sleep hygiene practices. What information should the nurse include? Select all that apply.

• Eliminate caffeine intake 6 hours prior to bedtime. • Do not watch television in bed. • Use blackout or other types of curtains/blinds to keep the room as dark as possible.

The nurse is teaching a client with seasonal affective disorder about proper use of a full-spectrum light. Which teaching will the nurse include?

Sit within 3 ft (1 m) of the light for approximately 2 hours soon after awakening.

A middle-age client reports to the nurse that he has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. Which instruction does the nurse provide to the client? Select all that apply.

• Avoid activities after 5 p.m that are stimulating. • Participate in a quiet activity, such as reading, prior to attempting to fall asleep.

A client reports periodic difficulty falling asleep. Which teaching will the nurse provide? (Select all that apply.)

• Go on a daily walk. • Adhere to a regular schedule for waking and going to sleep. • Decrease caffeine intake.

A student nurse is preparing a presentation regarding hypnotic medications. What information should the student nurse include? Select all that apply.

• Hypnotics may impair waking in a client. • Hypnotics may be addictive. • Tapering of doses may be required after long-term use.

The nurse is managing the environment for clients on a busy hospital unit. Which interventions would the nurse perform to facilitate a more restful environment? Select all that apply.

• Maintain a brighter room during daylight hours and dim lights in the evening. • Decrease the volume on alarms, pages, telephones, and staff conversations. • Medicate for pain if needed.

The nurse is teaching the practice of stimulus control to a patient who has insomnia. The nurse would include which teaching points in the teaching plan? (Select all that apply.)

• Recommend that the patient use the bedroom for sex and sleep only. • Instruct the patient to leave the bedroom if he or she cannot get to sleep within 15 to 20 minutes; he or she should return to the bedroom when sleepy. • Instruct the patient to get up the same time every day, no matter what time he or she fell asleep.

A client informs the nurse about difficulty getting a restful sleep. What education can the nurse provide to encourage adequate sleep and rest? Select all that apply.

• eat a small protein- and carbohydrate-containing snack about an hour before bedtime • discontinue the use of tobacco or tobacco products • Perform moderate exercise

A client has voiced concerns about her inability to fall asleep. When reviewing her history, what information would the nurse expect to find? Select all that apply.

• smokes 1 pack of cigarettes daily • drinks coffee with all meals • history of hyperthroidism

A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning the client reports overwhelming fatigue and has told the nurse, "I just can't manage to get any sleep around here." How should the nurse first respond to this client's statement?

Assess the factors that the client believes contribute to the problem.

A client reports to the nurse, "Sleep really isn't necessary." Which teaching by the nurse is appropriate? (Select all that apply.)

• "Sleep helps your blood flow to the brain." • "Sleep helps you to learn easier and remember more." • "Sleep helps your immune system to fight off infections."