Sleep Patterns HESI

The client has been prescribed levofloxacin 750 mg PO daily. The nurse has received 250 mg tablets from the pharmacy. How many tablets should the nurse administer? (Enter the numerical value only. If rounding is required, round to the whole number).

3 Tablets 750 mg / 250 mg = 3 tablets

The nurse monitors the client's postoperative lab values. The nurse notes that his white blood cell count (WBC) is 15,000 mm3 (15 × 109/L). Which observation should be documented in the nurse's assessment? (Select all that apply) A. Observe for excessive drainage. B. Measure oxygen saturation. C. Determine skin turgor. D. Measure the tympanic temperature. E. Blood glucose level.

A & D -Observe for excessive drainage. Abnormal drainage could indicate the presence of infection. The nurse should evaluate the surgical wound as well. -Measure the tympanic temperature. The client's WBC count is elevated, indicating a possible infection. The client should be assessed for fever.

The nurse understands that a thorough sleep assessment and history is needed. The nurse performs a focused assessment on the client, before he sees the healthcare provider (HCP). As part of the assessment, the nurse evaluates the client for which additional symptoms that are commonly associated with sleep deprivation? (Select all that apply) A. Nocturia. B. Tachycardia. C. Euphoria. D. Paresthesia. E. Sleep apnea.

A & E -Nocturia. Urination during the night disrupts the sleep cycle and contributes to sleep deprivation. -Sleep apnea. Sleep apnea occurs when there is a lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep, resulting in sleep deprivation.

Based on the results from the assessment, the nurse formulates a plan of care for the client. Which statements reflect potential expected outcomes for the nursing problem "disturbed sleep pattern related to stress from new job"? (Select all that apply) A. Client can identify ways to relieve stress during the day and before bedtime. B. Client will report a 50% decrease in night awakenings within 1 week. C. Client establishes bedtime rituals, such as having a glass of wine before bed. D. Client ma

A, B, & E -Client can identify ways to relieve stress during the day and before bedtime. It is important for the client to be able to identify ways to relieve stress before going to bed at night. -Client will report a 50% decrease in night awakenings within 1 week. This outcome is directly related to the nursing problem, is specific and measurable, and is realistically timed. -Client reports fewer incidences of dozing off during the day. It is important for the client to report less daytime sleepiness. This outcome is directly related to the nursing problem.

The client returns to the clinic after using the CPAP machine at home for 3 months. He reports no improvement in symptoms and appears disheveled and irritable. He describes sleeping only 3 or 4 hours each night and blames it on discomfort caused by the CPAP machine. The nurse records the client's appearance and complaints in the chart. The nurse considers which information to be subjective data? (Select all that apply) A. Client states he only sleeps 3 or 4 hours per night. B. The client display

A, D, & E -Client states he only sleeps 3 or 4 hours per night. This statement by the client is subjective data. -The client reports that the CPAP apparatus is uncomfortable. The client reports this data, making it subjective. -The client's wife states he has been yawning a lot at home. Information reported by the wife is subjective data.

During the follow-up visit, the client states, "I'm a little worried about my older son. He is 16 and seems to be sleeping too much. If this keeps up, I'm afraid that I may have trouble sleeping due to the stress again!" Which initial response by the nurse is best? A. "Please tell me about your son's sleep habits." B. "Don't worry, it is normal for teenagers to sleep a lot. You are just hypersensitive about sleep." C. "Teens typically do not need as much sleep as adults, so there must be a probl

A. "Please tell me about your son's sleep habits." This information is needed to determine what is "too much." The response also invites the client to continue expressing concerns.

The client's surgery is completed without complications. After a 2-hour stay in the postanesthesia unit, he returns to his room. The next day, the nurse observes the following vital signs: The client's heart rate drops from 80 bpm to 65 bpm while asleep. Oxygen saturation remains greater than 95% with regular respirations of 16 to 20 per minute. Which action should the nurse implement? A. Document this expected finding. B. Contact the HCP about this abnormality. C. Recommend the application of

A. Document this expected finding. A decrease of up to 20 bpm during NREM sleep is considered a normal finding and a part of the body's circadian rhythm.

The HCP conducts a physical exam. While the HCP agrees that job stress is likely exacerbating the disturbed sleep pattern, the spouse's report of increased snoring episodes is concerning. Diagnostic testing is prescribed. A polysomnogram (sleep study) reveals more than 200 episodes of sleep apnea during the night. A pulse oximeter is used during the testing, and the client's oxygen saturation level drops to 82% periodically. The client is diagnosed with obstructive sleep apnea (OSA) and is pre

A. There is a lack of airflow through the nose and/or mouth for periods of 10 seconds or longer during sleep. This describes obstructive sleep apnea. Efforts by the brain and respiratory muscles continue, but airflow is obstructed.

Which interventions should the nurse add to the client's plan of care? (Select all that apply) A. Encourage an increase in carbohydrates and move the evening meal to 1 hour before bedtime to promote sleep. B. Monitor bedtime food and beverage intake, which might interfere with sleep. C. Instruct the client to keep reading material from work at the bedside to review when he awakens. D. Instruct the client to get out of bed if unable to fall back to sleep within 30 minutes and to do a quiet activ

B & D -Monitor bedtime food and beverage intake, which might interfere with sleep. Foods and drinks containing caffeine, stimulants, or alcohol can interfere with sleep patterns. -Instruct the client to get out of bed if unable to fall back to sleep within 30 minutes and to do a quiet activity until becoming sleepy. Lying in bed awake for more than 30 minutes may increase anxiety and inhibit the onset of sleep. A quiet activity such as reading or muscle relaxation can be helpful.

In managing the client's postoperative care, which task should the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply) A. Complete a focused respiratory assessment every 4 hours. B. Obtain pulse oximetry and respiratory rate every 2 hours. C. Take vital signs and complete body systems assessment every 8 hours. D. Administer prescribed throat lozenges every 2 hours as needed. E. Serve the prescribed breakfast tray to the client.

B & E -Obtain pulse oximetry and respiratory rate every 2 hours. This task may be delegated. However, the nurse must then evaluate the data after it is obtained by the UAP. -Serve the prescribed breakfast tray to the client. This task may be delegated to the UAP.

The client reports that his son sleeps sometimes until noon in the summer. He often stays up very late at night. Which response by the nurse is accurate? A. "Sleeping until noon is unhealthy for anyone no matter what age they are." B. "Many adolescents start developing this type of pattern as they develop independence." C. "I would try enforcing a strict, earlier bedtime routine so he does not sleep so late." D. "Excessive daytime sleepiness is symptomatic of the sleep disorder narcolepsy."

B. "Many adolescents start developing this type of pattern as they develop independence." This is particularly common during the summer months, if there are no school obligations to make them rise earlier.

The nurse obtains a health history that reveals the client is worried about the pressures of a growing family and a new job. The client has been unable to maintain his normal exercise routine and has gained 15 lbs. (6.8 kg) in the last 6 months. The client admits he frequently smokes when he cannot sleep. His spouse, who has accompanied on the visit to the clinic, states that her husband's snoring has worsened in both frequency and noise level over the last 3 months. The client has even resorted

B. "You should not take someone else's prescription." This response directly addresses the issue without being condemning. It can be dangerous for clients to take someone else's prescription, due to the risk of contraindications or drug interactions.

The client refuses to wear the CPAP mask while hospitalized. The night before their surgical procedure, the pulse oximeter alarms. The nurse enters the client's room and observes that the client is sleeping and that his oxygen saturation has decreased to 84%. Which priority action should the nurse implement? A. Quietly place an oxygen mask on the client without waking him. B. Gently shake the client to awaken him. C. Document the observation as an expected finding. D. Request that the HCP to ree

B. Gently shake the client to awaken him. Although the nurse wants to promote sleep, the client must be awakened to relieve the obstruction and increase oxygen saturation.

While reviewing discharge paperwork with the client, he states, "I really need to get back to work. All of this has caused a great strain on my job." How should the nurse respond to the client's statement? A. "Right now you need to concentrate on getting better." B. "I will have a social worker call you to see if you need any financial help." C. "You seem concerned about missing work and the pressures of your job." D. "I know what you mean. I couldn't afford to miss very much work either."

C. "You seem concerned about missing work and the pressures of your job." The nurse is therapeutically restating the client's feelings, which is likely to encourage the client to continue the conversation.

The nurse notifies the healthcare provider of the elevation in WBCs and receives a prescription for an oral antibiotic. The client is to receive the first dose prior to discharge. Upon entering the client's room with the medication, the nurse observes the client is asleep. The spouse asks the nurse to leave the medication at the bedside for self-administration when he awakens. Which is the most important action for the nurse to implement? A. Honor the spouse's request and leave the medication ca

C. Wake the client and administer the first dose of the antibiotic. Although the client may need sleep, his need for the antibiotic is greater.

The client reports that a few years ago he took temazepam for sleep and it worked for a while. He asks if he can have a new prescription. Which response by the nurse is most appropriate? A. "You may resume the temazepam if you still have the prescription." B. "You really don't need a medication like this, do you?" C. "You should be reevaluated by a healthcare provider before resuming this medication." D. "Absolutely not! This type of drug is very addictive and should be avoided whenever possible

C. "You should be reevaluated by a healthcare provider before resuming this medication." The client should always be reevaluated before resuming any medication. A new prescription needs to be filled if indicated. Continued evaluation is also needed if temazepam is used for more than 2 weeks or in high doses, both of which put the client at risk for tolerance and/or physical dependence.

After further examination and testing by the HCP, the client is referred to a surgeon and is scheduled for a uvulopalatopharyngoplasty (UPPP), the removal of tissue in the throat to treat the obstructive sleep apnea. The client is admitted to the hospital, and an apnea monitor is prescribed. The charge nurse should assign the client to which room? A. A semi-private room with another client. B. A designated isolation room with a double door. C. A private room near the nursing station and report r

C. A private room near the nursing station and report room. Due to the increased monitoring necessitated by the client's sleep apnea, the client's room should be near the nursing station.

The nurse knows that as clients age and health issues arise, including weight gain, that sleep patterns can change. Which statement is the best description of the sleep pattern for a normal adult? A. Sleep problems decrease in middle-aged adults. B. Most of the sleep cycle is made up of rapid eye movement (REM) sleep. C. An adult has four to six sleep cycles, each with non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, during a normal night's sleep. D. A middle-aged adult re

C. An adult has four to six sleep cycles, each with non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, during a normal night's sleep. Every 90 minutes REM sleep recurs. When a sleeper awakens at any stage of the sleep cycle it must start again at N1.

The client is seen in the surgeon's office for a follow-up evaluation 2 weeks after surgery. Which is the most effective method to evaluate improvement of the client's OSA? A. Ask the client how he has been sleeping for the last 2 weeks since surgery. B. Obtain current vital signs, including a pulse oximetry reading. C. Ask the client's spouse about the client's snoring and respiratory pattern at night. D. Assess lung sounds in the sitting and supine position.

C. Ask the client's spouse about the client's snoring and respiratory pattern at night. Speaking with the client's spouse about her observations regarding snoring, respiratory rate, and sleep pattern corroborates the nursing problem of ineffective respiratory patterns.

At 0300 the client awakes and requests a sleeping pill, stating he needs to make sure to get some sleep the night before surgery. His prescriptions include zolpidem tartrate 5 mg PO at bedtime PRN for sleep. His last respiratory rate while sleeping was 12 with an oxygen saturation level of 89%. Current vital signs are P 80 beats/min, BP 120/70 mmHg, R 22 breaths/min, T 98.9° F, and oxygen saturation 95%. How should the nurse proceed? A. Administer the PRN medication. B. Administer oxygen via fa

C. Explain the oxygen saturation level is too low and that it wouldn't be safe. The client's saturation level is too low in order to tolerate the hypnotic drug, which will likely drop the oxygen saturation level further.

The nurse facilitates care and comfort both pre- and post-surgery, centered around the sleep apnea, pain management, and post-surgical complications. To promote sleep for a hospitalized client, which intervention should the nurse implement? A. Avoid performing the prescribed assessments every 4 hours during the night. B. Withhold the client's pain medication during the day to decrease napping episodes. C. Ensure that the client's room is kept completely dark during the night with no outside ligh

D. Close the door to the client's room whenever possible to decrease the noise level and light coming into the room. Reducing the amount of light and the noise of call lights, hallway traffic, and overhead paging are important nursing interventions to facilitate sleep for a hospitalized client.