Sleep and Rest Prep U Chaper 34

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. Although most sedative hypnotic drugs provide several nights of excellent sleep, the medication often loses its effects after 1 or 2 weeks. Alcohol and diphenhydramine should not be administered with a sedative hypnotic drug, as this can intensify the medication. Increased activity assists the client in sleeping. Carbohydrates have been shown to help a client sleep.

Which group of terms best describes sleep?

altered consciousness, relative inactivity

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

rapid growth The growth spurt that occurs during adolescence may necessitate the need for more sleep. However, the stresses of school, activities, and part-time employment may cause adolescents to have restless sleep, and many adolescents do not get enough sleep.

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

tossing soiled linen on the floor

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." Abstaining from alcohol consumption and using a heating pad on the affected area at night can help decrease the symptoms of restless leg syndrome (RLS). RLS may be related to diabetic neuropathy. Being overweight is not a risk factor for RLS.

The client, who is a male, states his wife complains that his snoring awakens her at night. The spouse is present. To obtain further data, the nurse asks the spouse:

"Is there silence after snoring that then is followed with a snort?" A nurse should ask the client's spouse more about the snoring for a better assessment. Snoring that is followed by silence and then a snort may be a sign of obstructive apnea. Snoring is not considered a sleeping disorder and is often more disturbing to the sleep partner. Asking how long and how loud does not assist with identifying the type of snoring. It is clear that the client is disturbed by the noise, so asking the how often is not appropriate.

A client with insomnia is prescribed a hypnotic. When educating the client about using the medication, which statement would the nurse be least likely to include?

"Start with the largest dose and work your way down to a smaller dose." Hypnotics are most appropriately used for insomnia of recent origin, such as after a situational crisis. Clients should take the smallest effective dose, and then only for a few nights or intermittently as required. Hypnotics may be useful as a short-term intervention for insomnia. Individuals should take safety precautions in the home or hospital when they have taken a hypnotic and need to get to the bathroom at night. Hypnotics require judicious use because they do not induce normal sleep and they are not without side effects.

A new mother is discussing her 6-month-old infant's sleep habits and expresses concern about the infant obtaining too much sleep. The mother reports the infant's circadian cycle as listed above. The best statement by the nurse is:

"Your infant is obtaining the average hours of sleep per day for an infant." Infants usually require 14 to 20 hours of sleep per day. This infant is obtaining 14 hours of sleep each day. There is no need for the nurse to suggest waking the infant or suggesting that the infant is sleeping too little.

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 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 working the night shift assesses a client's vital signs at 4 a.m. (0400). What would be the expected findings, based on knowledge of NREM sleep?

Decreased TPR and BP Throughout the stages of NREM sleep, the parasympathetic nervous system dominates. There is a decrease in temperature, pulse, respirations, and blood pressure. This is very predictive and occurs regularly with most people. The sympathetic nervous system dominates the daytime rhythm and there is a decrease of temperature, pulse, respirations, and blood pressure.

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 best interview question for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern would be to ask if the client usually goes to bed and wakes up about the same time each day. The other questions are possible to ask the client, but are not related to recent changes in the client's sleep-wakefulness pattern.

A middle-age adult man has just started an exercise program. What would the nurse teach him about timing of exercise and sleep?

Exercising within 2 hours of bedtime can hinder ability to sleep. Moderate exercise is a healthy way to promote sleep, but exercise that occurs within a 2-hour interval before normal bedtime can hinder sleep. Exercise causes fatigue, which is helpful for sleep to occur. If a client exercises right before sleep, they may not be able to fall asleep immediately.

The nurse is caring for a client who reports insomnia. The client has recently moved from an area near 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. Clients tend to adapt to the unique sounds where they live, such as traffic, trains, and the hum of appliance motors or furnaces. Unfamiliar sounds tend to interfere with the ability to fall or stay asleep. The nurse will recommend that the client find an app that plays sounds of the city, which mimics the sounds with which the client is most familiar. Ignoring the problem by telling the client to adapt to the new environment does not address the problem. Avoiding eating before bedtime could cause the client to wake up hungry in the middle of the night. The nurse does not recommend alcohol, a depressive drug, to clients.

A nurse is caring for a client who is sleeping for abnormally long periods of time. This condition may be caused by injury to which body structure?

Hypothalamus The hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleeping and waking. Injury to the hypothalamus may cause a person to sleep for abnormally long periods. The thyroid is a large ductless gland in the neck that secretes hormones regulating growth and development through the rate of metabolism. Pancreas is a large gland behind the stomach that secretes digestive enzymes into the duodenum, the hormones insulin and glucagon. Spinal cord connects nearly all parts of the body to the brain, with which it forms the central nervous system.

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. The nurse would include the education point that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. It is normal for infants to have eye movements, groaning, or grimacing during sleep periods. School-age children become aware of the concept of death, not preschool children. Waking from nightmares or night terrors is common during the preschooler stage.

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. Safety is the priority factor in the client's care. Activity should be monitored in case sleep paralysis or sleep should occur while walking in or out of the client's room. A stimulant drug may be ordered but would not be the priority in the care of the client. Antidepressants may exacerbate the disorder by increasing sleepiness.

A nurse is caring for a client who has been diagnosed with insomnia. Which nursing intervention would help the nurse relieve the client's condition?

Maintain a calm and quiet environment free from noise. Maintaining a calm and quiet environment is the most appropriate nursing activity to relieve insomnia. Motivating the client to sleep by telling the client that it may affect health may cause anxiety in the client. Engaging the client in diversional activities at bedtime may increase sleeplessness. Sedatives can be administered as prescribed, but they should be used as last resort. These other activities may not relieve insomnia in the client.

What is the rationale for using CPAP to treat sleep apnea?

Positive air pressure holds the airway open. Continuous positive airway pressure (CPAP) is used to treat sleep apnea. The device, worn at night, delivers positive air pressure through a facemask to hold the airway open. CPAP does not always use oxygen but pressure. The CPAP does not alternate waves but uses continuous positive pressure.

A nurse is caring for a client with sleep apnea. Which nursing intervention would be most appropriate to prevent hypoxia in the client?

Provide relief for nasal congestion. The nurse should provide relief for nasal congestion in the client to prevent hypoxia. Physical exercise may have an indirect beneficial effect on sleep apnea by reducing the client's weight. Providing milk before sleep helps to promote sleep but is not helpful in cases of sleep apnea. Providing a back massage before sleep does not have any effect on sleep apnea.

A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client?

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 for Injury would be incorrect.

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. The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain he is experiencing. Anxiety may be present, but that is a symptom of his problem rather than the nursing diagnosis. He may have impaired mobility, but it is not due to RLS. Also, his role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.

What name is given to the rhythmic biologic clock that exists in humans?

circadian rhythm Rhythmic biologic clocks are known to exist in plants, animals, and humans. Circadian rhythms complete a full cycle every 24 hours and in humans affect heart rate, blood pressure, body temperature, hormone secretions, and metabolism, as well as performance and mood. The sleep-wake cycle is controlled by the body's circadian rhythm and sleep homeostasis (the amount of accumulated sleep need that builds during time spent awake). Alert-unaware process and yo-yo theory are not associated with the biologic clocks.

A group of nursing students is reviewing polysomnography and the measures used. The students demonstrate a need for additional study when they identify which as a component?

electrocardiogram The components of a polysomnogram are electroencephalogram, electrooculogram, and electromyogram. Electrocardiogram is not a component.

What independent nursing action can be used to facilitate sleep in hospitalized clients who are on bed rest?

giving a back massage Simple interventions, such as offering a back massage, can promote comfort and sleep in hospitalized clients on bed rest. Changing the bed linens should be completed with a.m. care. Sleep medications must be prescribed by a physician and administered by a nurse. Encouraging naps during the day will not promote sleep at night.

A client reports that her naps after lunch often stretch to 3 hours in length and that she has great difficulty arousing herself after a nap. This condition is best termed as which of the following?

hypersomnia Hypersomnia is a condition characterized by excessive sleep, particularly during the day. Insomnia is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep. Parasomnias are patterns of waking behavior that appear during sleep. Sleep apnea is a condition in which a person experiences the absence of breathing, or diminished breathing efforts, during sleep (between snoring intervals).

Which expected outcome demonstrates the effectiveness of a plan of care to promote rest and sleep?

identifies factors that interfere with normal sleep pattern The nurse evaluates the effectiveness of the plan of care to promote rest and sleep by evaluating if the client has met the expected outcomes of the plan. If the client is able to identify factors that interfere with normal sleep patterns, this illustrates achievement of one expected outcome. The factors may be the need for medications or reading in bed for long periods. Another outcome is that the client reports improvement in quality of rest and sleep.

A client is undergoing a sleep study and appears to be in the stage of rapid eye movement sleep. When assessing the client, which finding would the nurse correlate with this stage of sleep? Select all that apply.

increased temperature increased respiratory rate During REM sleep, the pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase, whereas general skeletal muscle tone and deep tendon reflexes are depressed.

Which natural chemical does the body produce at night to decrease wakefulness and promote sleep?

melatonin Melatonin is a natural chemical produced at night that decreases wakefulness and promotes sleep. Serotonin and dopamine are neurotransmitters that affect mood. Endorphins are peptides that activate the body's opiate receptors, causing an analgesic effect.

A nurse working in a health clinic assesses sleep patterns during each health assessment. Based upon the nurse's knowledge regarding sleep needs, the nurse recognizes which age group as generally needing the least amount of sleep?

older adults As people age, the number of hours of needed sleep decreases. An average of 5 to 7 hours of sleep is usually adequate for the older adult age group. Infants sleep an average of 12-15 hours. Adolescents sleep an average of 9-10 hours. Young adults average about 7.5-8 hours.

A nurse is caring for a client who has been diagnosed with a disturbed sleep pattern. What measures should be undertaken by the nurse to promote sleep? Select all that apply.

providing a back massage promoting daytime exercise assisting with progressive relaxation

A nurse is reviewing the medical record of a client who reports difficulty sleeping. What would the nurse identify as a subjective finding related to the client's sleep assessment?

report of sleeping 2 hours per night

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?

seasonal affective disorder Based on the data provided by the client during the interview, the nurse should document the client's condition as seasonal affective 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 appetite, 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.

A nurse is obtaining a sleep history from a client. The client states that he goes to bed at 11:15 pm and is usually asleep by 11:30 pm. The nurse documents this information as reflecting:

sleep latency. Most people take approximately 7 to 10 minutes to fall asleep after they turn out the light; this period is called sleep latency. Parasomnia refers to activities that are normal during time awake but abnormal during sleep, such as sleepwalking (somnambulism), talking, night terrors, and bed-wetting (enuresis). Hypopnea refers to periods of very shallow breathing.

A nurse is reviewing the results of a polysomnogram for a client who is experiencing difficulty sleeping. When looking at the encephalogram component, which wave characteristic would the nurse identify as indicating rapid eye movement sleep?

waves similar to wake state Rapid eye movement sleep is characterized by waves similar to wakefulness on the electroencephalogram, except for very low muscle tone, indicated by a reduction in amplitude of the electromyogram. Fast theta waves on the electroencephalogram are found in stage 3 of nonrapid eye movement sleep. Sleep spindles appear on the electroencephalogram in stage 2 of nonrapid eye movement sleep. Delta sleep waves on the electroencephalogram are seen in stages 3 and 4 of nonrapid eye movement sleep.

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 Sleep paralysis occurs when the person cannot move for a few minutes just before falling asleep or awakening. Cataplexy occurs with a sudden loss of muscle tone triggered by an emotional change such as laughing or anger. Hypnogogic hallucinations are dream-like auditory or visual experiences while dozing or falling asleep. Automatic behavior is the performance of routine tasks without full awareness, or later memory, of having done them. This client experiences sleep paralysis and automatic behavior.

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 arouse. How will the nurse document this stage of sleep?

stage 3 Clients in the 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.

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. 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 client is diagnosed with narcolepsy. What is a characteristic of this disorder?

uncontrollable desire to sleep Narcolepsy is a condition characterized by an uncontrollable desire to sleep. Narcolepsy is considered a neurologic disorder. Restless sleep is a decrease in the amount or quality of sleep. Clients with insomnia not only have trouble falling asleep, but they also tend to have more awakenings throughout the night. Restless leg syndrome is a disorder characterized by an unpleasant tickling or twitching sensation in the leg muscles when sitting or lying down, which is relieved only by moving the legs.