BNS (VNSG 1323) CH. 18 "Comfort, Rest and Sleep" NCLEX-STYLE QUESTIONS

An older adult client reports that he has disturbed sleep during the night due to excessive urination. What information should the nurse provide to the client with regards to his condition? A) "Make sure that you're taking your diuretics early in the day." B) "Let me know if you have any other urinary symptoms." C) "Try to avoid drinking coffee after mid-afternoon." D) "You may use an absorbent pad at night."

A) "Make sure that you're taking your diuretics early in the day." The nurse should inform the client that the time of the administration of a diuretic can be changed to the morning after taking a physician's order. Diuretics may awaken those who take them with a need to empty the bladder. For this reason, diuretics generally are administered early in the morning so that the peak effect has diminished by bedtime. Avoiding stimulants at night may not relieve increased urination. Absorbent pads are used for incontinence and not for an increased frequency of urination. The nurse may ask about the urinary symptoms, but it is an assessment and not an implementation to resolve the problem. Coffee may increase sleep latency but is not likely to increase urination.

A nurse is reviewing the medication administration record. Which order does the nurse question? A) A diuretic administered twice daily at 9 am and 9 pm. B) A diuretic administered every other day at noon. C) A diuretic administered twice daily at 9 am and 5 pm. D) A diuretic administered once daily at 9 am.

A) A diuretic administered twice daily at 9 am and 9 pm. A diuretic should not be administered after 6 pm. This will promote sleep if a full bladder does not awaken the client. Once daily dosing and every other day dosing is not cause for question.

A nurse is caring for a client with intermittent fever. What is the best way for the nurse to maintain the appropriate room temperature for the client? A) Adjust the thermostat. B) Open doors and windows. C) Turn on the fans in the room. D) Use a humidifier in the room.

A) Adjust the thermostat. The nurse should adjust the room temperature, using the thermostat, to suit the client's condition. This would increase the client's comfort level. Opening the ventilators and windows is a fire hazard, and fans are considered a source of spreading infection. Using a humidifier in the room could be uncomfortable if the client has a fever.

A client reports periodic difficulty falling asleep. Which teaching will the nurse provide? (Select all that apply.) A) Go on a daily walk B) Take intermittent daytime naps to feel refreshed C) Adhere to a regular schedule for waking and going to sleep D) Sleep in on weekends to catch up from weekday lack of sleep E) Decrease caffeine intake

A) Go on a daily walk C) Adhere to a regular schedule for waking and going to sleep E) Decrease caffeine intake The nurse will educate the client about sleep-promoting nursing measures, such as maintaining sleep rituals, reducing the intake of stimulating chemicals, promoting daytime exercise, and adhering to a regular schedule for retiring and awakening. Catching up on sleep and taking intermittent nap do not help in maintaining consistent sleep rituals.

The nurse is caring for a client who must receive medication overnight. As the nurse prepares to administer the medication, the client is noted to have relaxed muscle tone, is not moving, snores, and is difficult to arose. How will the nurse document this stage of sleep? A) Stage 3 B) REM C) NREM D) Stage 2

A) Stage 3 Clients in Stage 3 sleep phase have entered the early phase of deep sleep. They may snore, and will exhibit relaxed muscle tone with little or no physical movement. They are difficult to arouse. Clients in other sleep stages do not exhibit these characteristics.

During the initial interview at the health care center, the client informs the nurse that for the last few months he has been experiencing increased sleep. He also notes an increase in his appetite and craving for sweets, which has led to weight gain. He also notices that these symptoms decrease when daylight increases. How should the nurse document the client's condition based on the information provided during the initial interview? A) Insomnia B) Seasonal affective disorder C) Restless legs syndrome D) Narcolepsy

B) Seasonal affective disorder Based on the data provided by the client during the interview, the nurse should document the client's condition as seasonal effective disorder. The nurse should document the condition as seasonal affective disorder because the client's condition varies with the intensity of light and is associated with hypersomnolence, increased appetitie, and weight gain. Narcolepsy is characterized by the sudden onset of daytime sleep, short NREM periods before the first REM phase, and pathologic manifestations of REM sleep. Restless leg syndrome is the movement, typically in the legs, to relieve disturbing skin sensations. Insomnia refers to the difficulty in falling asleep, awakening frequently during the night, or awakening early.

An elderly female client report disturbed sleep during the night due to frequent urges to urinate. What information should the nurse provide to the client with regards to her condition? A) "Let me know if you have any other urinary symptoms." B) "You may use an absorbent pad at night." C) "Let's see about changing the timing of your diuretics to morning." D) "Make sure to avoid drinking fluids after lunchtime."

C) "Let's see about changing the timing of your diuretics to morning." The nurse should inform the client that the time of the administration of a diuretic can be changed to the morning after taking a physician's order. Diuretics may awaken those who take them with a need to empty the bladder. For this reason, diuretics generally are administered early in the morning so that the peak effect has diminished by bedtime. Avoiding fluids after lunch may lead to dehydration. Absorbent pads are used for incontinence and not for an increased frequency of urination. The nurse may ask about the the urinary symptoms, but it is an assessment and not an implementation to resolve the problem.

A client has sought advice from the nurse about overcoming insomnia, a problem that has begun to adversely affect quality of life and productivity. What client education should the nurse provide? A) "Have a glass of red wine or brandy around 30 minutes before you plan to go to bed." B) "Limit the amount of exercise you get during the day to avoid stimulating your nervous system." C) "Try your best to go to bed and get up at the same time every day." D) "If your schedule allows it, take a short nap after lunch to reduce the pressure to get all your sleep during the night."

C) "Try your best to go to bed and get up at the same time every day." Clients who are experiencing insomnia should avoid alcohol and napping. Exercise is generally beneficial, but should be limited to daytime hours. Clients should be encouraged to go to bed and awaken at consistent times every day.

A client who works night shift is struggling with sleeping during the day after working all night. What actions by the client are sleep promoting factors? (Select all that apply.) A) Sleeping in a different location for day sleeping. B) Having an alcoholic drink before trying to sleep. C) Eating breakfast before going to sleep. D) Leaving the television on while attempting sleep. E) Sleeping in a room with curtains that block the light. F) Reading and drinking coffee before going to bed.

C) Eating breakfast before going to sleep. E) Sleeping in a room with curtains that block the light. Sleeping in darkness or dim light as well as satiation helps to promote sleep. Hunger or thirst can suppress sleep. Varied sleep locations and drinking alcohol or stimulants like caffeine in coffee can also suppress sleep. Leaving the television on creates noise and a quiet environment is a sleep-promoting factor.

A nurse provides a back massage to a client before bedtime to promote relaxation. What is the most important intervention to consider when giving a back massage to a client? A) Place the client in a comfortable position. B) Explain the procedure to the client. C) Omit stimulating strokes on the client. D) Massage in a circular manner.

C) Omit stimulating strokes on the client. The nurse should omit stimulating strokes in the client because is may interfere with sleep. As a part of the procedure, the nurse may explain the procedure to the client and place the client in a comfortable position. The nurse may or may not use the circular motion to perform the massage on the client. However, neither of these actions may affect the client's sleep nor stimulate the client in anyway.

An 80-year-old client with a long history of insomnia was prescribed a hypnotic by her primary care provider. The client's husband states that she displayed unusual behavior after taking the drug and appeared stimulated, rather than sedated. How should the nurse best interpret this series of events? A) The drug likely reacted adversely with another drug that the client is taking. B) The client may require a higher dose of the drug. C) The client may have experienced a paradoxical response to the drug. D) The client may lack the enzymes required for normal metabolism of the drug.

C) The client may have experienced a paradoxical response to the drug. Some sedatives and hypnotics have a paradoxical effect when administered to older adults: they tend to produce restlessness and wakefulness instead of sleep. A higher dose will exacerbate rather than resolve this problem. An adverse drug reaction is possible, but the client's experience is more likely attributable to age-related physiological changes. A lack of enzymes account for this drug response.

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? A) simvastatin (Zocor) B) furosemide (Lasix) C) temazepam (Restoril) D) amlodipine (Norvasc)

C) temazepam (Restoril) Benzodiazepines such as temazepam (restoril) are often used to treat difficulty sleeping. Furosemid (Lasix) is a diuretic; amlodipine (Norvasc) is a calcium-channel blocker; and simvastatin (Zocor) is HMG CoA reductase inhibitor ("Statin") used to treat high cholesterol

A client has told the nurse that the client has one or two glasses of red wine each night to help fall asleep. What should the nurse teach the client about this practice? A) "It is widely believed that alcohol helps you fall asleep, but research has shown that this isn't actually the case." B) "It's important that you avoid mixing alcohol with a caffeinated beverage like cola." C) "Even though it's effective, having a drink every night can result in liver disease over time." D) "Alcohol does indeed bring on sleep, but many people find that it causes them to awaken early in the morning."

D) "Alcohol does indeed bring on sleep, but many people find that it causes them to awaken early in the morning." Alcohol promotes sleep. However, as alcohol is metabolized, stimulating chemicals that were blocked by the sedative effects of the alcohol surge forth from neurons, causing early awakening. Heavy alcohol use causes liver disease, but this does not necessarily mean that an individual who uses moderate amounts of alcohol to aid sleep is at risk of liver disease.

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? A) Use a bright light at night for safety. B) Raise the side rails of the bed. C) Keep an attendant with the client. D) Ensure that the environment is warmer.

D) Ensure that the environment is warmer. Ensuring that the environment is warmer than normal is the most appropriate activity to deal with hypothermia because older adult clients tend to prefer warmer room temperature because of decreased subcutaneous fat deposits. Raising the side rails may become a safety hazard in the case of older adult clients. Keeping an attendant with the client may not be feasible at all times. Using a bright light at night provides safety but interferes with client's sleep.

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? A) Somnambulism B) Nightmares C) Nocturnal enuresis D) Insomnia

D) Insomnia Insomnia and hypersomnia are often manifestations of depression in older clients. Nightmares, somnambulism (Sleepwalking), and nocturnal enuresis are examples of parasomnias. These are conditions associated with activities that cause arousal, or partial arousal, usually during transitions in NREM periods of sleep. However, these are not manifestations of depression in an older adult client.

Which assessment data would cause the nurse to suspect sundown syndrome in a client? A) Onset of increased heart rate when the sun sets. B) Oriented to person only during the day. C) Wandering through the unit each morning. D) Repeating the same phrase in the evening.

D) Repeating the same phrase in the evening. Sundown Syndrome is an onset of disorientation when the sun sets. Being oriented to person and wandering the unit during the day does not indicate Sundown syndrome. Evening perseveration or ruminating over the same phrase or thought is a characteristic of sundown syndrome.

A nurse is creating a comprehensive plan of care for client who has been admitted to the hospital. In the care plan, the nurse has specified the appropriate use of side rails. What principle should guide the use of side rails in institutional care settings? A) Side rails should be lowered except for clients who have cognitive deficits. B) Side rails should be raised for all clients except those with mobility challenges. C) Side rails should be kept in the raised position at all times. D) Side rails can sometimes be a safety risk rather than a benefit.

D) Side rails can sometimes be a safety risk rather than a benefit. There is controversy as to whether raised side rails are a risk or benefit because some clients climb over them rather than seeking nursing assistance. This is especially true of clients with cognitive deficits, though it is inaccurate to state that they should be raised for all clients who are cognitively healthy. Side rails are considered a form of physical restraint in long-term care facilities, and their use must be justified.

A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client? A) Risk for Injury B) Relocation Stress Syndrome C) Impaired Bed Mobility D) Sleep Deprivation

D) Sleep Deprivation Sleep deprivation is the most appropriate nursing diagnosis for this client because the symptoms of restless legs syndrome keep the person awake and prevent continuous sleep. Eventually, sleep deprivation affects the person's life, damaging work productivity and personal relationships. Relocation Stress Syndrome would not be an appropriate diagnosis because the symptoms are not due to relocation to a new place. Impaired Bed Mobility is an inappropriate diagnosis because the client is not confined to a bed. The client does not have a risk for injury; therefore, the diagnosis of Risk of Injury would be incorrect.

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? A) The client will probably not be able to stay asleep. B) The worry will make the client fall asleep quickly. C) The client will likely sleep all night. D) The client will likely not be able to sleep.

D) 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.

Which beverage does the nurse recommend to a client with insomnia that may promote the ability to sleep? A) alcohol B) cola C) hot chocolate D) milk

D) milk Milk contains L-tryptophan, a chemical that is known to facilitate sleep. Hot chocolate and cola contain caffeine. The nurse should never recommend alcohol, which is a depressive drug.