ch.34 rest and sleep

The nurse is attempting to wake a client from sleep and is having a difficult time arousing them. What stage of sleep does the nurse identify the client is experiencing?

REM sleep

Which factor has the most influence on an individual's sleep-wake patterns?

the inner biologic clock

An 82-year-old client is newly admitted to an assisted living facility. Which intervention promotes safety at night for the client?

using a night light in the bathroom

A nurse is working with an older adult client who has been diagnosed with onset insomnia and informs the nurse about waking at least once during the night. What actions by the nurse can help promote adequate sleep? Select all that apply.

The nurse advises the client to exercise no closer than 6 hours to bedtime. The nurse encourages the client to remove the television from the bedroom. The nurse encourages the client to minimize caffeine intake several hours prior to bedtime. The nurse helps the client come up with a bedtime routine that can be implemented each

A nurse is instructing her students on the role of hormones in sleep patterns. Which statement would indicate to the nursing instructor that the student needs additional education?

"A hyperactive thyroid can make the client sleepy all the time."

A school nurse is speaking to a group of parents regarding the sleep needs of adolescents. Which statement by a parent indicates a need for further education?

"Academic performance in adolescents is good when they sleep about 7 hours per night."

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

The nurse awakens a client while the client is experiencing rapid eye movement sleep. What statement made by the client indicates they were awakened during REM sleep?

"I was having a great dream and I remember all of it."

The nurse is encouraging a client to begin and maintain a sleep diary. What statement made by the client indicates an understanding of the purpose of the diary?

"I will record the time I go to bed and how long it takes me to fall asleep."

A parent reports their 4-year-old child wakes up frequently at night screaming and roccurs shortly after the child has fallen asleep. The nurse determines that the child takes a tub bath and the parent reads a story prior to bedtime at 8 p.m. What is the best response to the parent? Select all that apply.

"It is common for this to occur in this age group." "Comforting your child when this occurs may help." "You may find a nightlight in his room is helpful."

A client comes to the clinic and states to the nurse, "I am traveling overseas for a project frequently and am having a difficult time adjusting because of jet lag. What is the best response by the nurse?

"Light therapy can be beneficial and help ease the transition to a new time schedule or zone."

A nurse explains cognitive behavioral therapy (CBT) to a client who is experiencing chronic insomnia. Which statements by the nurse best describe this therapy? Select all that apply.

"You will meet with a therapist to work through any maladaptive sleep beliefs." "Used with other complementary therapies, CBT is very successful." "CBT may include progressive muscle relaxation measures, stimulus control, and sleep restriction therapy."

The caregiver of a preschool-age child tells the nurse, "I am afraid my child sleeps too much," and reports that the child takes a daily 2-hour nap in addition to sleeping 12 hours at night. What is the appropriate nursing response?

"Your child should get 10-13 total hours of sleep time in a 24-hour period."

The nurse is instructing a parent on how to promote restful sleep for a child. What food would be the best bedtime snack for the child?

Apple slices

A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning, the client reports overwhelming fatigue and has told the nurse, "I just can't manage to get any sleep around here." How should the nurse first respond to this client's statement?

Assess the factors that the client believes contribute to the problem.

A middle-age client reports to the nurse that he has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. Which instruction does the nurse provide to the client? Select all that apply.

Avoid activities after 5 p.m that are stimulating. Participate in a quiet activity, such as reading, prior to attempting to fall asleep.

Which is not a lifespan consideration for sleep cycles?

By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases.

Which activity would be appropriate to suggest to the client who states that she has difficulty falling asleep every evening?

Drink a glass of warm milk before bed.

Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening?

Eat some crackers with peanut butter at bedtime.

A middle-aged client reports to the nurse that the client has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. What should the nurse instruct the client to try? Select all that apply.

Establish a set time to go to sleep each night. Perform moderate exercise three or four times each week. Participate in an enjoyable activity each day.

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.

Which statement about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents?

Getting the child to sleep can be difficult.

A client reports periodic difficulty falling asleep. Which teaching will the nurse provide? Select all that apply.

Go on a daily walk. Adhere to a regular schedule for waking and going to sleep. Decrease caffeine intake.

A student nurse is preparing a presentation regarding hypnotic medications. What information should the student nurse include? Select all that apply.

Hypnotics may impair waking in a client. Hypnotics may be addictive. Tapering of doses may be required after long-term use.

A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage?

Hypothalamus

The client is sleeping, and arousal is easy. Occasionally, the client exhibits involuntary muscle jerking, which appears to startle the client. Vital signs are unchanged from 1 hour ago. The nurse assesses the stage of nonrapid eye movement (NREM) sleep, which the client exhibits as Stage:

I.

A nurse is caring for a client diagnosed with sleep apnea. Which nursing diagnosis should the nurse include in her nursing care plan?

Impaired Gas Exchange

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.

A nurse is explaining to an insomniac client the effect of a prescribed medication and the different phases of sleep. Which statement is true for nonrapid eye movement (NREM) sleep?

It is called slow wave sleep.

A nurse is providing community education about the importance of getting enough sleep. Which information about REM sleep is most accurate?

It plays a role in memory.

When the newly admitted client with chronic obstructive pulmonary disease informs the nurse that she frequently awakens during the night, the nurse may notify the physician for which intervention?

Low-flow oxygen

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.

The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborn's sleep patterns. Which statement is accurate about a newborn's sleep patterns?

Newborns sleep 16 to 17 hours per day.

The nurse is admitting a client that has obesity and is diagnosed with obstructive sleep apnea (OSA). The client states, "I just wake up a lot and don't feel rested but it's not a big deal." What eductation should the nurse provide about the complications related to OSA?

OSA contributes to hypertension and heart disease.

The nurse is implementing comfort measures to promote sleep for a client. Which intervention is the best choice for the client?

Offer client a small carbohydrate and protein snack before bedtime.

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

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.

A nurse attempts to wake a client who is scheduled for tests and is easily aroused from sleep. Which stage of sleep is this client most likely experiencing?

Stage II

A maternity nurse is instructing new parents on the proper sleeping position for their newborn child. In what position does the nurse instruct the parents to place the infant?

Supine position

The student nurse is providing an education program for preschool parents. The nursing student should include which intervention to improve the child's sleep?

The child should limit fluids after supper.

The nurse is creating a plan of care for a client that is reporting an inability to sleep and rest. What outcome criterion will the nurse address for a goal that the client will demonstrate physical signs of being rested?

The client has decreases in circles under the eyes and excessive yawning by 1 week.

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.

A nurse on the night shift checks on a client and suspects that the client is in REM sleep. Which client cue is indicative of this stage of sleep?

The client's eyes dart back and forth quickly

The nurse is assessing a client and determines that they are in rapid eye movement (REM) sleep. What finding indicates to the nurse that the client is in this stage?

There is rapid eye movement under the eyelids.

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 sleep deprived to some degree.

The nurse recognizes that sleep deprivation related to environmental concerns will apply to which clients? Select all that apply.

a 67-year-old male who has two beers during the late night newscast a 32-year-old male machinist, two-pack-a-day smoker an 84-year-old male hospitalized for prostate surgery

A nurse is reviewing the medication administration record. Which order does the nurse question?

a diuretic administered twice daily at 9 a.m. and 9 p.m.

A client tells the nurse that the client often has a difficult time falling asleep at night. What suggestion offered by the nurse may assist the client in achieving sleep?

a snack containing carbohydrates and protein

The nurse should obtain a sleep history on which clients as a protocol?

all clients admitted to a health care agency

The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to:

anticipate sleeping overnight at a health care center.

Which physiologic change occurs during non-rapid eye movement (NREM) sleep?

decreased brain activity from wakefulness

The nurse is planning care for clients to aid in healing and recovery. Which activity is best to incorporate into a rest break?

drinking an 8-oz cup of a caffeinated beverage

The nurse identifies that a client is in stage 3 sleep. What assessment finding by the nurse is indicative of this stage?

enuresis

While instructing young adults about the need for adequate sleep, the nurse instructs the group that to improve sleep quality, individuals should:

have a consistent time for arising.

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?

insomnia

The nurse is discussing sleep interventions with a client. What statement made by the client indicates an understanding of sleep restriction?

limiting time in bed to actual sleep time

The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is:

observe the client's hours of sleep and review the client's sleep diary.

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

In Stage 4 sleep, the:

pulse rate is slow

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

rapid growth

The client being seen in the employee wellness clinic reports difficulty sleeping for the past several months. The most important assessment the nurse could make is:

reviewing the client's sleep diary for the past 2 weeks.

Which problem is associated with obesity, heavy snoring, and shallow breathing?

sleep apnea

A client states to the nurse during a sleep assessment that it takes her more than 60 minutes to fall asleep. The nurse documents this time period as the client's:

sleep latency.

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

A client who works night shift is struggling with sleeping during the day after working all night. What actions can the nurse suggest to help promote sleep? Select all that apply.

sleeping in a room with curtains that block the light eating breakfast before going to sleep

A client has voiced concerns about her inability to fall asleep. When reviewing her history, what information would the nurse expect to find? Select all that apply.

smokes 1 pack of cigarettes daily drinks coffee with all meals history of hyperthyroidism

A client begins snoring and is sleeping lightly. The stage of sleep is:

stage 2.

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 may be disoriented on awakening.

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 makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep is unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to:

use caution when driving an automobile.

A client describes difficulty falling asleep and difficulty maintaining sleep, and reports daytime fatigue and inability to concentrate. The nurse suggests which noninvasive techniques that may help promote restful sleep? Select all that apply.

waking at the same time every morning removing bedtime distractions such as watching television in bed practicing relaxation techniques

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."

A client reports to the nurse, "Sleep really isn't necessary." Which teaching by the nurse is appropriate? Select all that apply.

"Sleep helps your blood flow to the brain." "Sleep helps you to learn easier and remember more." "Sleep helps your immune system to fight off infections."

The nurse is educating a client and spouse about sudden jerking that occurs during sleep. What is the most appropriate nursing response?

"Sudden twitches that occur during the early phases of sleep are common."

Parents tell the nurse that their 5-year-old is only sleeping 10 hours now and is refusing to take an afternoon nap. The nurse should teach the parents:

"This is normal development for children in this age group."

The nurse is providing client education for the parents of an obese child diagnosed with obstructive sleep apnea. What treatment measures would the nurse explain during the education session? Select all that apply.

a weight loss plan use of a continuous passive airway pressure (CPAP) machine use of a mandibular advancement device (MAD)

Which client could be diagnosed with insomnia?

A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m.

A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep?

14 to 20 hours each day

The parents of a newborn ask when they can expect the baby to sleep through the night. The nurse responds that the baby will most likely sleep through the night by:

3 months of age

What factor has been hypothesized by researchers regarding current thoughts on sleep?

Chronic sleep deprivation is present.

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 nurse is assessing an older adult client that reports feeling fatigued and tired throughout the day. What intervention by the nurse will assist with the client's report of fatigue?

Have the client further evaluated for depression

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.

applying heat or cold to the extremity can help relieve the symptoms Biofeedback and TENS can help relax the client and relieve symptoms massaging the legs may relieve symptoms

A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest?

decrease in awareness of environment

The nurse is performing an intake assessment of a 60-year-old client who admits to having a nightcap of 4 to 6 ounces of scotch whisky each night. What effect might this alcohol be having on the client's sleep?

decreased REM sleep

Which beverage does the nurse recommend to a client with insomnia that may promote the ability to sleep?

milk

When a client tells the clinic nurse that he has irresistible sleep attacks throughout the day lasting from 10 to 15 minutes, the nurse suspects that the client may be experiencing what?

narcolepsy

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

The nurse is completing a sleep history on a client who reports sleeping problems. Which of the client's regular behaviors will cause the client to have difficulty with sleep?

taking a diuretic at 9 a.m. and 5 p.m. daily

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