Rest & Sleep
While reviewing a client's chart, the nurse notes the client has been experiencing enuresis. To assess whether this remains an ongoing problem for the client, the nurse asks which question? -"Do you have a strong desire to void?" -"Do you urinate while sleeping?" -"Does it burn when you urinate?" -"Is it painful when you urinate?"
"Do you urinate while sleeping?" Enuresis is defined as involuntary voiding during sleep. The remaining questions do not relate to this problem associated with changes in the client's voiding pattern.
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:
"I should become involved in a weight loss program." Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.
An infant's death is deemed due to sudden infant death syndrome (SIDS). The parents want to know the cause of SIDS and if they could have done something to prevent it. What explanation should the nurse provide these parents?
"Unfortunately the cause of SIDS is unknown" Unfortunately, while there are many theories as what causes SIDS, no one specific cause has been identified. SIDS is more frequent in male than female infants. Although cigarette smoke may have an association with SIDS, exposure to respiratory infection has not been proven to be correlated with an increased incidence of SIDS. Although SIDS is more common in preterm infants, it is often associated with multiple births, infants with low Apgar scores, and infants born to mothers who smoked during pregnancy. SIDS can also occur in babies who sleep face down on soft surfaces. That is why back sleeping is now recommended.
A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time, even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?
"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Sleep needs for children change according to their ages. A 6- to 8-year-old child needs 12 hours of sleep per night. The 8- to 10-year-old child needs 10 to 12 hours of sleep per night. The 10- to 12-year-old child needs between 9 and 10 hours of sleep per night. Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical intervention.
A client comes to the clinic for an evaluation of headache, fatigue, and an overall feeling of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply. -"I've been drinking about three or four more beers every night." -"I've been going out with my friends about once or twice a week." -"I'm so tired that all I ever want to do is sleep all the time." -"Most times, I feel like I'm trapped with no way out." -"I'm looking for a new job because my job is so stressful."
-"I've been drinking about three or four more beers every night." -"I'm so tired that all I ever want to do is sleep all the time." -"Most times, I feel like I'm trapped with no way out." Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.
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. -drinking a cup of coffee before bed can help relieve the tingling sensations -applying heat or cold to the extremity can help relieve the symptoms -an alcoholic drink is recommended before bed to relax the client -Biofeedback and TENS can help relax the client and relieve symptoms -massaging the legs may relieve symptoms -A mild analgesic before bed can help relieve symptoms
-applying heat or cold to the extremity can help relieve the symptoms -massaging the legs may relieve symptoms -Biofeedback and TENS can help relax the client and relieve symptoms The nurse would instruct the client that applying heat or cold to the extremity can help relieve the symptoms of restless leg syndrome (RLS). The nurse would instruct the client that biofeedback and TENS can help relax the client and relieve symptoms. The nurse would instruct the client that massaging the legs may relieve RLS symptoms. Caffeine and alcohol should be avoided by the client before bed. A mild analgesic before bed will not help relieve RLS symptoms.
A nurse is caring for a client who is 2 days postpartum. The client asks the nurse how many hours of the day she should expect her infant to sleep. What is the most appropriate answer? 8-10 hours 10-12 hours 12-14 hours 16-20 hours
16-20 hours Newborns (0-2 months) usually sleep approximately 16 to 20 hours per day.
The nurse is caring for a group of clients in the hospital. Which client is at most risk for obstructive sleep apnea?
A male client with a neck circumference of 44 having a laparoscopic cholecystectomy. Conditions that predispose to OSA include male gender, increasing age, a positive family history, and obesity. Alcohol and other drugs that depress the CNS tend to increase the severity of obstructive episodes. Most people who develop sleep apnea are obese. Large neck girth in both male and female snorers is highly predictive of sleep apnea. Neck circumferences greater than 40 cm are correlated with OSA, even more so than body mass index (BMI).
A client with difficulty sleeping is prescribed ramelteon. The client asks the nurse, "How does this medicine work?" Which information would the nurse include in the response? -Activates the receptors for the hormone melatonin -Causes a change in the circadian rhythms -Decreases impulses to the cerebral cortex -Stimulates the reticular activating system
Activates the receptors for the hormone melatonin Ramelteon is a selective melatonin receptor agonist prescribed to facilitate the onset of sleep; it is not intended for sleep maintenance. It may be used long-term and activates receptors for melatonin. Ramelteon does not cause a change in circadian rhythms, decrease impulses to the cerebral cortex, or stimulate the reticular activating system.
A nurse is caring for the following clients. Which client should the nurse evaluate first?
An 18-year-old male who appears to be sleepwalking in the hallway Sleepwalking may be dangerous, and the nurse must maintain the client's safety. The other clients are not in unsafe situations.
A nurse is caring for a client admitted for a prolonged stay on a medical-surgical unit. The client has been having difficulty sleeping and appears depressed. Applying the holistic health model, which action taken by the nurse would be most appropriate? Ask the client's family to bring some items from home, such as a blanket, pillow, or pictures Reassure the client how lucky he or she is to have family visit often and reassure the client that he or she will be going home soon Suggest the client try some meditation and contact the health care provider to request medication to help with sleep Document the observations, and encourage the client that he or she will feel better once going home
Ask the client's family to bring some items from home, such as a blanket, pillow, or pictures Holism is a theory and philosophy that focuses on connections and interactions between parts of the whole, as well as the body's interaction with the environment. Holism recognizes that a person's environment and habits are part of who the person is. The holistic model is not necessarily a counterpoint to the biomedical model. While a focus on the mind is congruent with holism, this does not preclude treatment of bodily symptoms. Reassurance and encouragement may seem necessary but are not components in holistic care and can often feel ingenuine to clients. Suggesting meditation may help the client but is not the most appropriate measure.
The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment? -Assessing the quantity and quality of the client's sleep -Assessing the client's communication skills -Assessing the quality of the client's support network -Assessing the client's vital signs
Assessing the quantity and quality of the client's sleep Intrusion almost always takes a toll on the client's sleep. Communication and social support are only peripherally related to episodes of intrusion. Intrusion will certainly affect the client's vital signs, but these changes are unlikely to be as problematic as sleep difficulties.
A G1 P1001 mother is just home after giving birth to her first child 5 days ago. Her birth was complicated by an emergency cesarean birth resulting from incomplete cervical dilation (dilatation) and hemorrhage. The nurse determines that the mother has not slept longer than 3 hours at one time. The appropriate nursing diagnosis for this client care issue is: -At risk for postpartum depression due to inadequate rest. -At risk for interruption of tissue integrity. -At risk for safety due to low hemoglobin. -At risk for inadequate healing due to decreased nutrition.
At risk for postpartum depression due to inadequate rest. This scenario refers only to the issue of sleep. Information is insufficient to suggest that the other issues are problematic at this time.
A physician is providing care for a 40-year-old client who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The client is requesting a prescription for "sleeping pills." Which statement forms a valid basis for the care provider's plan for treatment? -Sedatives and hypnotic drugs will not provide safe relief of the man's health problem. -The man is suffering from primary insomnia. -Melatonin supplements will be the safest and most effective long-term pharmacologic treatment. -Behavioral therapies, counseling, and education may be of some use for the client.
Behavioral therapies, counseling, and education may be of some use for the client.
A client is diagnosed with mild obstructive sleep apnea after having a sleep study performed. What treatment modality will be the mosteffective for this client? Surgery to remove the tonsils and adenoids Medications to assist the patient with sleep at night Continuous positive airway pressure (CPAP) Bi-level positive airway pressure (BiPAP)
Continuous positive airway pressure (CPAP) CPAP provides positive pressure to the airways throughout the respiratory cycle. Although it can be used as an adjunct to mechanical ventilation with a cuffed endotracheal tube or tracheostomy tube to open the alveoli, it is also used with a leak-proof mask to keep alveoli open, thereby preventing respiratory failure. CPAP is the most effective treatment for obstructive sleep apnea because the positive pressure acts as a splint, keeping the upper airway and trachea open during sleep. CPAP is used for clients who can breathe independently. BiPAP is most often used for clients who require ventilatory assistance at night, such as those with severe COPD or sleep apnea.
The nurse is caring for several clents with symptoms of chronic fatigue. Which manifestation does not correlate with a diagnosis of chronic fatigue syndrome (CFS)? -Joint pain without swelling -Memory loss and impaired concentration -Insomnia and night sweats -Cough with blood-tinged sputum
Cough with blood-tinged sputum The manifestations of CFS last at least 6 months and include difficulty with memory and concentration, problems with sleep, persistent muscle pain, joint paint without redness or swelling, headaches, tender lymph nodes, increased malaise following exertion, and sore throat. In addition, clients may experience irritable bowel, depression, chills and night sweats, multiple allergies, brain fog, balance problems, and visual disturbances. A cough with blood-tinged sputum could arise from tuberculosis or lung cancer but is not characteristic for CFS.
A client stops breathing during sleep as a result of repetitive upper airway obstruction. To help decrease the frequency of the apneic episodes, the nurse intervenes by informing the client to: Eliminate alcohol ingestion. Sleep on the back. Take a hypnotic medication at hours of sleep. Use nasal oxygen at night.
Eliminate alcohol ingestion. The client's symptoms are consistent with obstructive sleep apnea. Initial treatment includes avoidance of alcohol and hypnotic medications. Clients are told to not sleep on their backs. Administration of nasal oxygen may help with hypoxemia but has little effect on the frequency of apnea.
A nurse is discussing sleep hygiene with a client who reports having chronic insomnia. Which are appropriate recommendations? Select all that apply.
Establish a regular wakeup time Maintain a quiet sleep environment that is neither too cold nor too hot Avoid caffeinated beverages Sleep hygiene refers to a set of rules and information about personal and environmental activities that affect sleep. These rules include establishing a regular wakeup time to help set the circadian clock and regularity of sleep onset, maintaining a practice of sleeping only as long as needed to feel refreshed, providing a quiet environment that is neither too hot nor too cold, and avoiding the use of alcohol and caffeine before going to bed.
Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder?
Hyperactivity, dismissing meals, and sleep disturbance. Safety needs are always the first priority in care planning. A client who has not eaten or slept for several days and has been extremely hyperactive may be at risk for exhaustion and malnutrition and the implications of those states. Although thought disorder, expansive mood, and dress are important assessment information, priority interventions must center on the basic needs of hyperactivity, dismissing meals, and sleep disturbance.
The nurse has a client who appears to be sleepwalking. Which intervention would be most appropriate for the nurse? -Awaken the client and reorient the client to his surroundings. -Lead the client back to bed. -Apply a vest restraint to maintain the client's safety. -Apply a continuous positive air pressure (CPAP) mask to the client.
Lead the client back to bed. No attempt should be made to interrupt the sleepwalking event because such efforts may be frightening. Restraints and CPAP mask are not treatments for sleepwalking.
An client 81 years of age is in a long-term-care facility. His family could no longer cope with his progressing senile dementia, including wandering away and unpredictable behavior. Late one night the nurse finds the client wandering in the hall. He says he is looking for his wife. What should the nursing approach should be?
Remind him of where he is and assess why he is having difficulty sleeping. Reminding the client where he is will help orient him to his surroundings. Assessment is needed to determine any need that may be disturbing the client, such as the need to use the bathroom, feeling cold/warm, etc. The other responses do not include orienting the disoriented/confused client.
A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter? Serotonin Calcitonin Melatonin Parathyroid
Serotonin Abnormalities of serotonin are involved in mental depression and sleep disorders. Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide hormone not a neurotransmitter. Parathyroid is a gland that secretes parathyroid hormone.
The nurse is performing a physical health assessment of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What aspect of this assessment should the nurse prioritize?
Sleep assessment All of the listed components should be included in a comprehensive physical assessment. However, sleep is a major concern in clients with PTSD and is likely disrupted to a greater degree than respiratory function, bowel function, or nutrition.
An elementary school nurse is conducting a program for parents on attention deficit hyperactivity disorder (ADHD). What is the most important information for the nurse to include in the program?
Sleep disturbances are common for children with ADHD Sleep disturbances are common for children with ADHD. Although ADHD can be diagnosed prior to school age, the diagnosis is more commonly made after the child starts attending school and is unable to display attentive behavior in class. There is no difference in aggression with gender. The child will not have fatigue from the ADHD activity.
The nurse is caring for a client receiving fluvoxamine and behavior therapy for obsessive compulsive disorder. What outcome does the nurse expect of this client?
The client is able to sleep for at least 4 hours per night after 5 days The client responding effectively to treatment must be able to sleep for at least 4 hours per night. Adequate nutrition must be established within 4 to 5 days. The client is expected to identify the cause of stress and anxiety within 2 to 3 days. Individual strengths and abilities must be identified and reviewed with staff within 3 to 4 days.
A client who has been experiencing depression for 3 months was recently placed on sertraline. The client calls a nurse and reports that significantly improved mood and optimism about the future. Which piece of additional information would require a rapid nursing intervention?
The client is sleeping only 3 hours per night and does not feel fatigued in the morning. Some individuals who start on antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), may develop hypomania or mania. The client's limited sleep and lack of fatigue despite limited sleep are indications that the client may be having a hypomanic or a manic episode, which requires rapid nursing intervention and contacting the physician. Appetite may increase or decrease in depression. Craving sweets is not an immediate problem. Sexual difficulties are common for people taking SSRIs and for people who are depressed. Although these adverse effects should be addressed — especially because many individuals stop taking SSRIs because of them — they are not an immediate concern. Changes in adult relationships do not require rapid nursing intervention.
The psychiatric mental health nurse has taught some relaxation techniques to a client with obsessive-compulsive disorder (OCD). What outcome would most clearly suggest that this intervention has been successful? The client accurately describes the harmful effects of compulsions The client reports increased quality and quantity of sleep The demonstrates the ability to block negative thoughts The client accurately describes the effects of obsessions on quality of life
The client reports increased quality and quantity of sleep Relaxation techniques can reduce anxiety and improve sleep. They are less likely to enhance insight. Thought blocking focuses on stopping obsessive thoughts.
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. The worry will make the client fall asleep quickly. The client will probably not be able to stay asleep. The client will likely sleep all night.
The client will likely not be able to sleep. The expectation that the onset of sleep will be difficult increases the person's anxiety. The anxiety floods the brain with stimulating chemicals that interfere with relaxation, which is a prerequisite for natural sleep. Given the client's anxiety about the surgery, as well as the expectation that they will not sleep, it is likely that the client will not be able to sleep. Worry may cause exhaustion, but it will not cause the client to fall asleep quickly. Since the client will likely not sleep, the nurse does not anticipate patterns of wakening for the client.
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 in need of medication to aid sleep. -They are in need of a sleep clinic visit. -They are sleep deprived to some degree. -They are an efficient sleeper.
They are sleep deprived to some degree. Optimum daytime performance with minimal sleepiness and no accumulation of sleep debt in adults is related to obtaining 8 hours of sleep each night. Sleeping less than 6 hours has been linked to an increase in morbidity and early mortality.
The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking?
They put her to bed when she falls asleep If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.
A person with advanced sleep phase syndrome (ASPS) would likely display which symptoms? -Trouble staying awake and falling asleep at inappropriate times -Sleeping 10 to 12 hours per day and awakening with feelings of sadness -Difficulty falling asleep at night and awakening in the morning -Trouble staying awake in the evening and waking up early in the morning feeling rested
Trouble staying awake in the evening and waking up early in the morning feeling rested With ASPS a person has trouble staying awake in the evening, goes to bed early, and wakes up early in the morning feeling rested. Falling asleep at inappropriate times is more related to narcolepsy, and waking up feeling sad is most related to depression. Having trouble going to sleep and trouble waking in the morning is related to DSPS.
To obtain subjective data about a newly admitted client's sleep pattern, the nurse: -inspects the client's eyes for redness. -asks the client what promotes sleep. -documents the client's affect and yawning. -determines how frequently the client naps.
asks the client what promotes sleep.
The nurse is caring for a client who has been diagnosed with narcolepsy. The client reports that his muscles become extremely weak when he becomes excited. The nurse understands that the client is describing which of the following? -hypnagogic hallucinations -cataplexy -sleep paralysis -hypnopompic hallucinations
cataplexy Cataplexy is characterized by brief periods of muscle weakness brought about by emotional reactions such as laughter, anger, or fear. Sleep paralysis is a terrifying experience that occurs on falling asleep or on awakening, during which people find themselves unable to move, speak, or even breathe deeply. Hypnagogic hallucinations are vivid hallucinations that occur at the onset of sleep. Hypnopompic hallucinations are hallucinations that may occur on awakening.
A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client?
eszopiclone. Eszopiclone (Lunesta) is a newer medication commonly prescribed to treat insomnia. Phenytoin (Dilantin) is an anticonvulsive that depresses the brain's sensory areas located in the motor cortex. Loratadine (Claritin) is an antihistamine that causes the least amount of drowsiness in this class of drugs. Norepinephrine (levarterenol, Levophed) is a potent sympathetic neurotransmitter. Its primary action is to increase blood pressure as a result of vasoconstriction of peripheral blood vessels.
A depressed client in the psychiatric unit hasn't been getting adequate rest and sleep. To encourage restful sleep at night, the nurse should: -talk with the client for a long time at night to reduce anxiety. -encourage environmental stimulation during the evening. -gently but firmly set limits on how much time the client spends in bed during the day. -encourage the client to take an antianxiety agent as needed at bedtime.
gently but firmly set limits on how much time the client spends in bed during the day. Setting limits on how much time the client may spend in bed and what time the client must get up in the morning lets the client know what is expected while conveying genuine concern. Talking with the client for a long time at night would interfere with sleep and give the client attention for not sleeping. Encouraging environmental stimulation in the evening would discourage rest and sleep at night. While most antianxiety agents have sedating adverse effects, they aren't intended for use as sleep-inducing agents.
The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care? ability to perform activities of daily living (ADL) decreased joint pain increased fatigue a weight gain of 2 pounds
increased fatigue Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. The client is reporting being able to do ADLs and decreased joint pain. The client's weight gain of 2 pounds does not correlate with self-care problems.
A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam? Decreases stress Eases pain Induces sleep Improves circulation
induces sleep. Flurazepam induces sleep. Adrenergic drugs help to relieve stress. Analgesics are used to ease pain. Circulation can be improved by exercising.
A nurse is caring for a child who was involved in a bus accident on the way home from preschool. Several people were killed in the accident. When talking with the child's parents about normal reactions to a traumatic event, the nurse should tell them that -they should immediately seek psychiatric care for the child. -they should allow the child to eat and sleep when the child wants. -they should allow their child to watch television programs about the accident. -it is normal for the child to want to sleep with them at night.
it is normal for the child to want to sleep with them at night. It is normal for children involved in traumatic events to experience regression in growth and development or the ability to perform physical tasks. For example, a child who has been in an accident may wish to sleep with the parents. Children recovering from traumatic events should have a routine for school, play, meals, and sleep. The parents should not let the child watch television or other media programs about the accident. Children are very resilient; there is no reason to assume this child needs immediate psychiatric counseling.
A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?
middle insomnia The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep).
The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is: -measure neck circumference and auscultate the abdomen. -observe the client's hours of sleep and review the client's sleep diary. -auscultate the lung fields and perform neuro checks. -measure the client's weight and assess visual acuity.
observe the client's hours of sleep and review the client's sleep diary Observing the sleeping patterns and checking the client's sleep diary can lead the nurse to clues about the quality of the client's sleep. Neck circumference can be a factor in obstructive sleep apnea, but it is not routinely measured during assessment. Being overweight is a common finding in sleep disorder clients, but visual acuity issues are not. Auscultation of the lungs and abdomen are not pertinent to the potential disorder.
When discussing rest and sleep with a pregnant woman, the nurse would discuss which position to use for napping?
on her side with the weight of the uterus on the bed Resting on the side prevents pressure from the uterus against the vena cava and, therefore, allows blood to return to the uterus.
A nursing student observing newborns in the nursery is amazed that a crying infant put her fingers in her mouth, instantly stops crying, and then falls asleep. This behavior can best be explained as:
self-quieting ability Self-quieting ability refers to newborns' ability to quiet and comfort themselves. Assisting parents to identify consoling behaviors also helps. The sleep state is noted as an infant becoming drowsy and less attentive to the parents and his surroundings. Social behaviors are things such as cuddling and snuggling into the arms of the parents when the newborn is held. Motor maturity refers to posture, tone, coordination, and movements of the newborn.
The nurse is caring for a client who is having difficulty sleeping. Which medication does the nurse anticipate will be prescribed by the health care provider? -temazepam -furosemide -amlodipine -simvastatin
temazepam Benzodiazepines such as temazepam are often used to treat difficulty sleeping. Furosemide is a diuretic; amlodipine is a calcium channel blocker; and simvastatin is a HMG CoA reductase inhibitor (statin) used to treat high cholesterol.
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 nap in the afternoon, which lessens their hours of sleep at night. -they are typically prone to sleep walking. -they are the age group least likely to use prescribed sleep medications. -they may be disoriented on awakening.
they may be disoriented on awakening. The elderly sleep less soundly for less time, and have little or no Stage IV deep sleep. It is common for them to be confused upon awakening, which could lead to injury. Napping does not alter their safety. Somnambulism is commonly seen in children. Older adults commonly take prescribed or over-the-counter sleep aids.
