Sleep Quiz

The parent of a preschool-age child has been told the child has sleep terrors. Which statement should the nurse include when teaching the parents about sleep terrors?

"Intervention is required only if it is necessary to protect the child." Sleep terrors typically start within a few hours after the child falls asleep. The child has no memory of the dream and returns to sleep rapidly. In fact, it is difficult to keep the child awake. Sleep terrors are very common and rarely require intervention. The dreams are real to the child experiencing nightmares, not sleep terrors. Comforting to return to sleep is needed when the child experiences nightmares.

A client taking clozapine states, "I don't like feeling so sedated during the day. I can hardly keep my eyes open." Which response by the nurse would be most appropriate?

"Let's talk to your health care provider about taking most of the drug at bedtime." Sedation and drowsiness are common adverse effects of clozapine. Usually, taking the majority of the dose at bedtime is helpful. By suggesting that the client and the nurse talk to the health care provider about taking most of the drug at bedtime, the nurse addresses the client's concern and advocates for the client's needs. The other statements are inappropriate because they minimize the client's concern, possibly leading to noncompliance if the problem continues without appropriate intervention.

A 12-year-old child is sent home for pediculosis after being at camp for 1 week. The mother thinks others at camp have it. The mother asks the nurse how her son could have gotten pediculosis. How should the nurse reply?

"Children who sleep close to someone who has it get it more easily." Children at camp are at higher risk for developing pediculosis because of the close contact with others. Pediculosis is spread person to person or on other objects that are shared, such as helmets, combs, or other personal items used near the hair.Lice are not transmitted by animals or pets or during swimming.

A client receiving radiation therapy for lung cancer is having difficulty sleeping. What should the nurse do first when teaching the client about promoting sleep?

Ask the client about usual sleep patterns. Since sleeplessness is often an adverse effect of radiation therapy, the nurse should first assess the client's usual sleep patterns, hours of sleep required before treatment, and usual bedtime routine. Refraining from watching television before bedtime and avoiding caffeine intake may be helpful depending first on the client's needs. Sleeplessness is not always an effect of radiation therapy, and the nurse should develop the care plan must to the client's needs.

The parent of an 11-month-old infant reports to the nurse that the infant sleeps much less than other children. The parent asks the nurse whether the infant is getting sufficient sleep. What should be the nurse's initial response?

Ask the parent for more information about the infant's sleep patterns. The nurse needs more information about the infant's sleep patterns to rule out potential problems before determining whether the infant is getting enough sleep. The nurse shouldn't offer advice or reassurance without knowing more about the infant's specific sleep habits.

A 13-year-old male was kidnapped and held for ransom by two criminals. His parents asked to have him admitted to the adolescent psychiatric unit. He is sleep-deprived, filthy, alternating between sobbing and making threats to kill his captors, suspicious, and easily startled. He signs a no harm contract and then asks to go to sleep. What is the best initial plan for this client?

Develop trust and allow him to talk about his memories and feelings. After such a crime, talking about his memories and feelings is an early part of the emotional recovery process. Encouraging him to talk to the police and helping him prepare for the trial may be appropriate later as he reorganizes his life for a trial. It is important for him to express his anger, even fantasies of revenge, rather than repress it.

Two nurses are working the night shift on a medical unit. The first nurse completes an initial shift assessment on assigned clients. One hour later, the second nurse finds the first nurse asleep in the lounge. The first nurse remains asleep for the next 4 hours and then wakes up to do client rounds. What should the second nurse do in this situation?

Discuss the situation with the first nurse, including the safety implications of sleeping on the job. The second nurse is responsible for immediately discussing this behavior and its safety implications with the first nurse. The other options do not demonstrate behavior representative of advocating for safe and competent care.

The nurse is assessing a client who has a chronic mental illness. What early signs of relapse should the nurse monitor for? Select all that apply.

decrease in sleep and self-care increase in social isolation and withdrawal more fears and suspiciousness Early signs of relapse include a decrease in sleep and self-care, increased withdrawal or social isolation, and increased fears or suspiciousness. Obvious delusions, hallucinations, and suicidal or homicidal threats are much later indicators of relapse.

An older adult woman who is usually meticulous about her appearance and dress arrives today for her 23rd day of radiation therapy. She appears disheveled and emotionally labile, and her responses to the usual questions are a little inappropriate. Her heart rate is 124 bpm, her respirations are 32 breaths/min, and her skin is cold and clammy. Based on these findings, the nurse should further assess the client for which condition?

delirium Tachycardia, tachypnea, moist or clammy skin, and disorientation are classic symptoms of delirium. Clients with panic disorder do not exhibit disorientation. Clients with depression exhibit a flat affect, apathy, and sleep disturbances. Clients with schizophrenia have thought disorders such as hallucinations or delusions.

A mother who gave birth some three hours ago asked the nurse why her baby is so difficult to keep awake. The nurse informs the mother that this behavior indicates

normal progression into the sleep cycle. Typically, it's difficult to awaken any neonate 3 hours after birth. This finding suggests normal progression into the sleep cycle. During this period, the neonate shows minimal response to external stimuli. Hypoglycemia is characterized by irregular respirations, apnea, and tremors. Periods of neonatal reactivity are characterized by alertness and attentiveness.

The client with dual diagnoses of major depression and alcohol abuse states, "I only drink when I cannot sleep." Which outcome is important for the client to achieve first?

Verbalize the desire to stop drinking alcohol. Verbalizing the desire to stop drinking alcohol is an initial outcome that acknowledges alcohol consumption as a problem behavior and leads to further participation in treatment.Describing adaptive methods to use instead of drinking alcohol to induce sleep is an outcome to be reached later, after the client states he will stop drinking.Verbalizing the negative effects of alcohol on the body and describing the dangerous effects of using alcohol with antidepressant medication are both therapeutic behaviors, but they are not specific to helping the client sleep.

The partner of a 22-year-old client dies in a drunk-driving accident. The client complains of difficulty eating, sleeping, and working. The reaction is considered:

a crisis caused by traumatic stress. This client is in crisis as a result of the traumatic stress of losing the partner. A traumatic event can create symptoms, such as difficulty eating, sleeping, and working. These symptoms aren't a pathologic response to grief. The sudden accident isn't an anticipated event.

A nurse is providing care for a pregnant client. The client asks the nurse how she can best deal with her fatigue. The nurse should instruct her to:

try to get more rest by going to bed earlier. The client should listen to the body's way of telling her that she needs more rest and try going to bed earlier. Sleeping pills shouldn't be consumed prenatally because they can harm the fetus. Vitamins won't take away fatigue. False reassurance is inappropriate and doesn't help the client deal with fatigue now.

The health care provider (HCP) prescribes pulse assessments through the night for a school- age child with rheumatic fever who has a daytime heart rate of 120 bpm. The nurse explains to the mother that this is to evaluate if the elevated heart rate is caused by which factor?

routine activity during waking hours An above-average pulse rate that is out of proportion to the degree of activity is an early sign of heart failure in a client with rheumatic fever. The sleeping pulse is used to determine whether the mild tachycardia persists during sleep (inactivity) or whether it is a result of daytime activities. The environmental temperature would need to be quite warmer before it could influence the heart rate. Digitalis lowers the heart rate, so the rate would be decreased during the daytime.

A client is scheduled for cardiac catheterization the next morning. The physician ordered temazepam, 30 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:

sedatives reduce excitement; hypnotics induce sleep. Sedatives are drugs that act to reduce activity or excitement, calming a client. Hypnotics induce a state resembling natural sleep. Sedatives and hypnotics cause predictable responses, interact with many drugs, and can cause respiratory depression.

After administering a prescribed medication to a client who becomes restless at night and has difficulty falling asleep, which nursing action is most appropriate?

sitting quietly with the client at the bedside until the medication takes effect To promote adequate rest (6 to 8 hours per night) and to eliminate hyposomnia, the nurse should sit with the client at the bedside until the medication takes effect. The presence of a caring nurse provides the client with comfort and security and helps to decrease the client's anxiety. Engaging the client in interaction until the client falls asleep, reading to the client, or encouraging the client to watch television may be too stimulating for the client, consequently increasing rather than decreasing the client's restlessness.

A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. He has been sleeping poorly, has lost 8 lb (3.6 kg), is poorly groomed, exhibits hyperactivity, and loudly denies the need for hospitalization. Which nursing intervention takes priority for this client?

Decreasing environmental stimulation This client is at increased risk for injuring himself or others. Decreasing environmental stimulation, a measure the nurse may take independently, may reduce the client's hyperactivity. If this nursing intervention is ineffective, the nurse may administer a sedative, as ordered. Providing adequate hygiene is an appropriate nursing intervention but isn't the highest priority. Because the overall goal is to reduce the client's hyperactivity, involving him in unit activities is contraindicated.

A client diagnosed with major depression has sleep and appetite disturbances, a flat affect and is withdrawn. The client has been taking fluvoxamine 50 mg twice daily for 5 days. Which client behavior is most important to report to the next shift?

client sleeping from 2300 hours to 0600 hours The most important behavior to report to the next shift is that the client was able to sleep from 2300 to 0600. This indicates that improvement in the symptoms of depression is occurring as a result of pharmacologic therapy. The nurse would expect to observe improvement in sleep, appetite, and psychomotor behavior first before improvement in cognitive symptoms. The client's flat affect is still a symptom of depression. The fact that the client had a visitor is not as important as changes in the client's behavior. Spending the evening in her room is a continuation of the client's withdrawn behavior and is important to report but not as important as the improvement in sleep.

A nurse is caring for a client with panic disorder who has difficulty sleeping. Which nursing intervention would best help the client achieve healthy long-term sleeping habits?

encouraging the client use relaxation exercises Relaxation exercises provide the client with a healthy way to gain control over anxiety. These exercises also produce a physiologic response that counters the stress-induced response. Giving the client a sleeping pill would provide short-term relief for sleeplessness but wouldn't teach healthy sleep habits. Suggesting the client stay up and talk won't help develop healthy sleep habits or control stress and anxiety. Playing ping pong or engaging in other exercises just prior to sleep produces a physiologic response similar to that induced by stress.

A client requests medication at 9 p.m. (2100) instead of 10 p.m. (2200) so that the client can go to sleep earlier. Which type of nursing intervention is required?

independent Nursing interventions are classified as independent, interdependent, or dependent. Altering the drug schedule to coincide with the client's daily routine represents an independent intervention, whereas consulting with the physician and pharmacist to change a client's medication because of adverse reactions represents an interdependent intervention. Administering an already ordered drug on time is a dependent intervention. There's no such thing as an intradependent nursing intervention.

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

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.

After teaching the mother of a 7-month-old diagnosed with bronchiolitis, the nurse determines that the teaching has been effective when the mother states she will immediately report which sign or symptom?

longer periods of sleep than usual An infant's sleeping longer than usual can indicate that the child is expending too much energy to breathe and is tiring, suggesting that the child's condition is getting worse. This should be reported to the health care provider (HCP). Fewer than seven wet diapers a day indicates that the child is not drinking enough. A temperature of 100° F (37.8° C) for longer than 2 days should be reported. Clear nasal drainage is expected. However, yellow nasal drainage lasting longer than 24 hours should be reported.

The nurse is caring for a client with an exacerbation of ulcerative colitis. The nurse should instruct the client to:

obtain frequent rest periods. It is important for the client to have frequent rest periods. Repeated episodes of diarrhea interrupt sleep patterns, and poor nutrition may also cause the client to feel weak. If the client is experiencing a severe exacerbation of ulcerative colitis, bed rest may be prescribed. Antidiarrheal medications can be used selectively in ulcerative colitis but are not recommended for regular use as they can lead to colonic dilation.The client should maintain a low-residue, high-calorie, caffeine-free diet.It is not necessary to limit weight lifting.

During a home visit to an older adult with mild dementia, the client's daughter reports that she has one major problem with her mother. She says, "She sleeps most of the day and is up most of the night. I can't get a decent night's sleep anymore." Which suggestions should the nurse make to the daughter? Select all that apply.

Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime. Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day. Promote relaxation before bedtime with a warm bath or relaxing music. A set routine and brief exercises help decrease daytime sleeping. Decreasing caffeine and fluids and promoting relaxation at bedtime promote nighttime sleeping. A strong sleep medicine for an older adult client is contraindicated due to changes in metabolism, increased adverse effects, and the risk of falls. Using caffeinated beverages may stimulate metabolism but can also have long-lasting adverse effects and may prevent sleep at bedtime.

A 22-year-old client exhibits memory loss, confusion, and wandering behavior. Which comment by the nurse would provide the best reality orientation for the client when she first awakens in the morning?

Good morning. This is your 2nd day in Memorial Hospital, and I'm your nurse for today. My name is Rachel." To promote reality orientation, the nurse should be as specific as possible when addressing a confused and disoriented client. Such comments as indicating what day it is, where the client is, and the nurse's name can help. Asking the client questions about her environment is likely to be challenging and may decrease the client's self-esteem. The nurse needs to establish her identity to decrease confusion before explaining the plans for the day.

The nurse teaches a client with heart failure to take oral furosemide in the morning. What is the expected outcome for taking this drug in the morning? The client will:

Obtain more sleep. When diuretics are given early in the day, the client will void frequently during the daytime hours and will not need to void frequently during the night. Therefore, the client's will be able to sleep more. The client may be at risk for falling, and the nurse should instruct all clients to rise from a sitting or lying position slowly, but the primary reason for taking the drug in the morning is to limit the number of times the client would need to void during the night if the drug were taken at bedtime. Taking furosemide in the morning has no effect on concentrating the urine or preventing electrolyte imbalances.

A primigravid client at 36 weeks' gestation tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which suggestion would be most helpful?

Practice relaxation techniques before bedtime. Insomnia in the later part of pregnancy is not uncommon because the client has difficulty getting into a position of comfort. This is further compounded by frequent nocturia. The best suggestion would be to advise the client to practice relaxation techniques before bedtime. The client should avoid caffeine products such as chocolate and coffee before going to bed because caffeine is a stimulant. Alcohol consumption, regardless of the type or amount, should be avoided. Exercise is advised during the day, but it should be avoided before bedtime because exercise can stimulate the client and decrease the client's ability to fall asleep.

A girl in second grade with no remarkable medical history experiences a generalized tonic-clonic seizure in the classroom. Immediately after the seizure, the nurse arrives and notices that the child has been incontinent of urine and is difficult to arouse. Which action would be mostappropriate at this time?

Stay with the child, and allow her to sleep in a side-lying position. During the postictal period of a generalized tonic-clonic seizure, it is normal for a child to sleep and be difficult to arouse. During this time, the nurse should stay with the child, allowing sleep until she awakens. The side-lying position is best to prevent possible aspiration. Sleep and drowsiness do not follow other forms of generalized seizures.During a seizure, urinary incontinence is common. Therefore, asking the teacher about any urinary problems would be inappropriate.After a tonic-clonic seizure, children are sleepy and fussy. The child should be allowed to sleep until waking.Obtaining information about neurologic status is important, but awakening the child every 3 to 5 minutes would not be helpful.

The client, who is taking fluoxetine 20 mg at bedtime, tells the nurse the drug is interfering with his sleep. What conclusion should the nurse make?

The client should take fluoxetine in the morning. Fluoxetine should be taken as early in the day as possible so as not to interfere with nighttime sleep; it may cause nervousness in some clients. The dosage is therapeutic and not too high. There is no evidence in this situation to justify the conclusion that the client's depression is worsening or that the client is on the wrong medication.

The nurse is teaching a client with heart failure how to avoid complications and future hospitalizations. The client has understood the instruction when the client identifies which potential complications? Select all that apply.

becoming increasingly short of breath at rest weight gain of 2 lb (0.9 kg) or more in 1 day having to sleep sitting up in a reclining chair If the client will call the health care provider (HCP) when there is increasing shortness of breath, weight gain over 2 lb (0.9 kg) in 1 day, and need to sleep sitting up, this indicates an understanding of the teaching because these signs and symptoms suggest worsening of the client's heart failure. Although the client will most likely be placed on a sodium-restricted diet, the client would not need to notify the HCP if he or she had consumed a high-sodium breakfast. Instead the client would need to be alert for possible signs and symptoms of worsening heart failure and work to reduce sodium intake for the rest of that day and in the future.

When assessing a preschooler who has sustained a head trauma, the nurse notes that the child appears to be obtunded. Which finding supports this level of consciousness?

can be roused with stimulation The child is obtunded if he can be aroused with stimulation. If the child shows no motor or verbal response to noxious stimuli, he's comatose. If the child remains in a deep sleep and is responsive only to vigorous and repeated stimulation, he's stuporous. If the child has limited spontaneous movement and sluggish speech, he's lethargic.