Chapter 34: Rest and Sleep

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." Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow-wave sleep.

A client asks the nurse if hot chocolate at bedtime will improve the client's sleep. Which is the best response by the nurse?

"Milk is a better option to help you sleep." Milk contains L-tryptophan, a chemical that is known to facilitate sleep. Although hot chocolate may contain milk, most hot chocolate, tea and cola drinks contain caffeine. Caffeine is a stimulant and will not help to facilitate sleep.

The nurse is promoting bedtime rituals with a family. Which statement indicates the nurse may need to provide further instructions to the mother?

"My boys love to rough-house in their room right before bedtime." Bedtime rituals such as reading stories, having a healthy carbohydrate snack, holding a favorite stuffed toy, and use of a nightlight promote a healthy sleep routine for children. Most studies show that exercise right before going to bed impedes the person's ability to fall asleep quickly.

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." In addition to promoting emotional well-being, sleep enhances various physiologic processes. Sleep is believed to play a role in the following: reducing fatigue, stabilizing mood, improving blood flow to the brain, increasing protein synthesis, maintaining the disease-fighting mechanisms of the immune system, promoting cellular growth and repair, and improving the capacity for learning and memory storage. It is not appropriate, nor accurate, to teach the client that sleep can be stressful or that sleep can cause mood fluctuations

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." Nonrapid eye movement (NREM) is quiet sleep. NREM 1 sleep, which occurs at the onset of sleep and lasts about 10 minutes, is characterized as drowsiness and light sleep. Sudden twitches, called hypnogogic jerks, are common. During this early stage of sleep, a person may be aware of sounds and conversations, but avoids arousal. Sudden jerking movements do not indicate vivid dreams and do not occur during REM sleep. A decreased oxygen level does not cause hypnogogic jerks.

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." Preschoolers typically sleep 10-16 hours, but become less dependent on napping as they approach school age. By 5 years, they usually do not need routine naps. Telling them to call their pediatrician is passing off responsibility. Sweets are not recommended before bedtime, and this child has normal sleep habits.

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." Preschoolers, age 3-5, should get 10-13 total hours of sleep time in a 24-hour period. Newborns (0-3 months) require 14-17 total hours of sleep time in a 24-hour period. Infants (4-11 months) require 12-15 total hours of sleep time in a 24-hour period. School-agers (6-13 years old) require 9-11 total hours of sleep time in a 24-hour period.

The client has been in the intensive care unit for several days. The client appears to be sleeping throughout the night. The nurse records the data listed above. The nurse evaluates that rapid eye movement (REM) sleep is occurring at:

0100. During REM sleep, the client's temperature, pulse, blood pressure, and respirations increase. The client may experience small muscle twitching, such as facial muscles twitching, and irregular pulse rate and respirations. During non-eye movement sleep, the client will exhibit a decrease in body temperature, pulse, blood pressure, and respirations.

A nurse is visiting the home of a first-time mother and her newborn. The nurse is teaching the mother about the newborn's sleep needs. The nurse would inform the mother that newborns sleep approximately how many hours per day?

14 to 20 hours On average, infants require 14 to 20 hours of sleep each day.

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 pediatric nurse informs the new parent that on average, infants require 14 to 20 hours of sleep 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 Most infants sleep through the night by 3 months of age, but nocturnal awakenings continue to be frequent during the latter half of the first year.

REM sleep in a toddler is about:

30% REM sleep in the toddler and preschooler drops to about 30%, which is still higher than adults.

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. The 50-year-old woman appears to be suffering from early awakening insomnia. Because it has been longer than 1 month, it is considered a chronic insomnia. The 45-year-old woman appears to be suffering from insufficient sleep syndrome. She does not have an adequate amount of time for sleep each night, as seen with insomnia, but it is a self-imposed restriction of sleep. The 40-year-old man is not getting enough sleep because he has some form of sleep-disordered breathing (SDB). Although he might think he is allowing enough time for sleep, his quality of sleep is disrupted by these periods of apnea. The 20-year-old man appears to be suffering from narcolepsy. Along with the two episodes of cataplexy, he is excessively sleepy throughout the day and falls asleep at inappropriate times.

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

A diuretic administered twice daily at 9am and 9pm. A diuretic should not be administered after 6pm. 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.

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 Carbohydrates promote sleep by making tryptophan available to the brain. Simple carbohydrates such as fruit slices or juice are effective. Chocolate provides high sugar content and possibly caffeine exposure which will promote wakefulness. Tuna salad and almonds are protein, not carbohydrates.

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. Assessment is the first step in the nursing process. Consequently, the nurse should determine the factors contributing to the client's problem before performing interventions.

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

Chronic sleep deprivation is present. Most recently, researchers have hypothesized that much of the population in industrialized nations may be chronically sleep deprived.

The nurse is preparing a care plan for a client recently diagnosed with obstructive sleep apnea. The client reports daytime sleepiness, fatigue, and excessive snoring that "wakes me up." What nursing diagnosis would be appropriate for this client?

Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring is the correct nursing diagnosis. The medical diagnosis of obstructive sleep apnea should not be used in the nursing diagnosis.

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 nurse is explaining the use of sleep hygiene to a client experiencing insomnia. Which statement accurately describes recommended guidelines for the use of this technique? Select all that apply.

Eat a light meal before bedtime. Take a warm bath before bedtime. Sleep hygiene involves the following: restricting the intake of caffeine, nicotine, and alcohol, especially later in the day; avoiding activities after 5 p.m. that are stimulating; avoiding naps; eating a light meal before bedtime; sleeping in a cool, dark room; eliminating use of a bedroom clock; taking a warm bath before bedtime; and trying to keep the sleep environment as quiet as possible (Gevirtz, 2007).

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. Carbohydrates make tryptophan more available to the brain, thereby promoting sleep. Therefore, a small protein- and carbohydrate-containing snack such as peanut butter on toast or cheese and crackers are effective. Nicotine contained in cigarettes has a stimulating effect, and smokers usually have a more difficult time falling asleep. The client must be encouraged to quit smoking or to eliminate cigarette smoking after the evening meal. Exercise that occurs within a 3-hour interval before normal bedtime can hinder sleep. Caffeinated products, such as chocolate, coffee, and tea are considered stimulants and can interfere with sleep.

An older adult client reports insomnia. Which interventions can the nurse implement to promote quality sleep for the client?

Encourage the client to empty the bladder at bedtime Encouraging the client to empty the bladder at bedtime and dimming the lights may help to promote relaxation and sleep. Keeping the lights on in the room is not appropriate, as lights are stimulants. Suggesting music at bedtime is avoided, as the noise is a source of stimulation. Light exercise such as walking 10 minutes before bed may promote rest; however, strenuous exercise, such as walking for 60 minutes before bed, stimulates the client.

The nurse is caring for a client who reports insomnia. The client has recently moved from an area nearby 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.

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. Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.

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. 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.

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 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 medulla and midbrain are part of the reticular activating system (RAS), which plays a part in the cyclic nature of sleep. The cerebral cortex does not have any role in the sleep process.

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. Easy arousal from sleep and involuntary muscle jerking that may awaken the client are signs of Stage I NREM. In the other stages, the client becomes increasingly more difficult to arouse and does not exhibit involuntary muscle jerking. In Stage IV NREM, the client's pulse, respirations, and blood pressure decrease, and muscles are relaxed.

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.

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. Nonrapid eye movement sleep, which progresses through four stages, is also called slow wave sleep because during this phase, electroencephalographic (EEG) waves appear as progressively slower oscillations. The REM phase of sleep is referred to as paradoxical sleep because the EEG waves appear similar to those produced during periods of wakefulness, but it is the deepest stage of sleep. NREM sleep is characterized as quiet sleep and REM sleep as active 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. REM sleep is believed to play a role in learning, memory, and adaptation. It is more difficult to arouse a person during REM sleep than during NREM sleep. 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.

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.

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 The pattern of frequent arousals seen in people with chronic obstructive pulmonary disease may result from the body's adaptation to maintain adequate oxygenation. Usually, these clients require low doses of oxygen at night.

The nurse is managing the environment for clients on a busy hospital ward. Which interventions would the nurse perform to facilitate a more restful environment? Select all that apply.

Maintain a brighter room during daylight hours and dim lights in the evening. Decrease the volume on alarms, pages, telephones, and staff conversations. Medicate for pain if needed. The nurse could perform several of the interventions listed to facilitate a more restful environment. First, the nurse could maintain a brighter room during daylight hours and dim lights in the evening. Opening the curtains in the room during the day is an excellent way to carry out this intervention. The nurse would decrease the volume on alarms, pages, telephones, and staff conversations. The nurse would medicate the client for pain if needed. The nurse would not keep the room warm, but cool to aid in sleep. Procedures should be scheduled together if at all possible to decrease the amount of time the client is involved in procedures and promote rest. The nurse should keep the door to the client's room closed if possible to facilitate a more restful environment.

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. Increased activity assists the client in sleeping. Foods such as protein and carbohydrates have been shown to help a client sleep.

The client reports to the sleep clinic for a study following reports of sleepwalking and enuresis. Which sleep stage of non-rapid eye movement (NREM) sleep is affected based on the client's reports?

NREM delta The client who experiences sleepwalking (somnambulating) and enuresis (urinary incontinence) is likely in NREM stages 3 and 4, in which delta waves occur. NREM alpha, or stage 1, is the transition between drowsiness and sleep. NREM theta comprises 40% to 50% of total sleep time with rolling eye movements occurring. NREM kappa is not a sleep stage.

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 patters?

Newborns sleep 16 to 17 hours per day. Newborns sleep an average of 16 to 17 hours per 24 hours a day, divided into about seven sleep periods distributed fairly evenly throughout the day and night.

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 education should the nurse provide about the complications related to OSA?

OSA contributes to hypertension and heart disease. In healthy people, OSA may impair cardiac function over time and lead to the development of heart failure. If heart failure has already been diagnosed, OSA may result in progression of this condition. OSA is not directly associated with depression, respiratory acidosis, or seizure activity.

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.

Perform moderate exercise three or four times each week. Participate in an enjoyable activity each day. Establish a set time to go to sleep each night. Behaviors that will promote sleep include establishing a regular routine, such as time, for bedtime, exercising three to four times each week, and participating in an activity that is enjoyable each day. The client should avoid alcohol and eat a small carbohydrate snack prior to bedtime.

A new client in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis?

Provide an opportunity for the client to talk about concerns. Stress and anxiety interfere with a person's ability to relax, rest, and sleep. The client is scheduled for a surgical procedure in the morning. The nursing diagnosis addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other options are incorrect because the options do not address the situation at hand, or the nursing diagnosis that is noted.

The nurse is teaching a client with seasonal affective disorder about proper use of a full-spectrum light. Which teaching will the nurse include?

Sit within 3 ft (1 m) of the light for approximately 2 hours soon after awakening. The client should sit within 3 ft (1 m) of the artificial light for approximately 2 hours soon after awakening from sleep. Light exposure should begin in October or November, not April or May. Eyeglasses and contact lenses with ultraviolet filters should be removed before using the light. Other activities may take place, such as reading or handiwork, while periodically glancing at the light.

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.

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

Stage 2 Stage 2 is relatively light sleep from which the client is easily awakened. Rolling eye movements continue, and snoring may occur.

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. Parents and other caregivers can assist children in establishing the habit of voiding as part of preparing for bedtime. Drinking milk at bedtime, keeping the child up until 10 PM and sleeping with the parents will not improve the child's sleep.

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. 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.

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

The nurse should obtain a sleep history on which clients as a protocol? Interview questions help identify the client's sleep-wakefulness patterns, the effect of these patterns on everyday functioning, the client's use of sleep aids, and the presence of sleep disturbances and contributing factors. If the client's sleep is adequate and poses no problems, the sleep history may be brief but should still be conducted. As issues or concerns are identified in the general assessment, more detailed questions can be asked to gather more information.

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. Optimum daytime performance with minimal sleepiness and no accumulation of sleep debt in adults is related to obtaining 8 hours of sleep each night. Sleeping less than 6 hours has been linked to an increase in morbidity and early mortality.

Which guideline does the nurse apply to discussion of sleep patterns with older adult clients?

Total sleep time decreases as the clients age. As people age, the amount of stage 4 sleep decreases significantly. Sleeping patterns may become polyphasic, with a shorter nocturnal period plus daytime naps.

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 A small snack containing protein and carbohydrates may be effective in promoting calmness and relaxation prior to bedtime.

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

an inner biological clock The inner biologic clock is the regulating mechanism for the body's sleep-wake patterns. No formula exists for the duration of sleep such as 8 hours. Although light and dark appear to be powerful regulators of the sleep-wake pattern, they do not exert primary control. Bedtime rituals are helpful to assist with going to sleep but not the sleep-wake pattern.

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. Polysomnography is a sleep study. The client will be scheduled for the study at a health care center and sleep overnight as part of the study. The client should avoid sedatives as this will aggravate OSA. Interventions for OSA include inserting an oral appliance or applying a facial mask for continuous positive airway pressure.

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 There is a decrease in the awareness of the environment in sleep; this does not happen during rest. Motor and cognitive response to stimuli may be decreased in both sleep and rest. Sleep is a whole body phenomenon, whereas rest may involve the whole body system or only a part.

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 Alcohol is known to decrease the amount of REM and delta sleep an individual experiences. Alcohol does not typically shorten sleep cycles or increase the total amount of sleep.

Which activity for rest break should not be incorporated into care planning for clients to aid in healing and recovery? drinking an 8 oz cup of a caffeinated beverage taking a short 15- to 30-minute nap stretching exercises focusing thoughts on a pleasant scene away from work going for a short walk

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 Stages 3 and 4 are the stages during which snoring, sleepwalking (somnambulism), and bedwetting (enuresis) are most likely to occur.

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 regular time of rising is one of the most effective means of improving sleep quality and synchronizing circadian rhythms with clock time.

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 Sleep restriction is the concept of limiting time in bed so that sleep does not become fragmented. Shortening sleep time on purpose will promote sleep deprivation. Never sleeping in a new environment is unrealistic. Stimulants may be used to treat narcolepsy, but that is not related to sleep restriction.

In Stage 4 sleep, the:

pulse rate is slow During slow-wave sleep, the muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle all decrease.

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 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 range of normality with respect to sleep patterns is broad. Most people require 10 to 30 minutes to fall asleep; this period is called 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 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 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 Various factors may affect sleep. Taking a diuretic, particularly late in the day, is a common cause for sleep problems. The diuretic may still affect the client at hours of sleep. The other behaviors are acceptable in promoting sleep: exercising more than 2 hours before sleep, ingesting caffeine early in the day, and using a white noise machine to keep the environment quiet.

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?

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 a HMG CoA reductase inhibitor ("statin") used to treat high cholesterol.

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. The elderly sleep less soundly for less time, and have little or no Stage IV deep sleep. It is common for them to be confused upon awakening, which could lead to injury. Napping does not alter their safety. Somnabulism is commonly seen in children. Older adults commonly take prescribed or over-the-counter sleep aids.

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 are 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. The client is describing hypersomnia and is at increased risk for a motor vehicle accident when drowsy while driving an automobile. The client is to avoid alcohol, caffeine, and late night activities.

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.

use of a mandibular advancement device (MAD) use of a continuous passive airway pressure (CPAP) machine a weight loss plan A weight loss plan, use of a continuous passive airway pressure (CPAP) machine, and the use of a mandibular advancement device (MAD) are treatment measures that the nurse would explain during the education session on obstructive sleep apnea. The use of antibiotics and sleeping pills would not be included. Counseling for depression is not necessary as the question is written.

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

using a night light in the bathroom Using night lights rather than bright room lights is preferred if an older adult arises during the night. Bright lights stimulate the brain and interfere with efforts to resume sleep. Administering a diuretic at night will cause nocturnal diuresis causing the client to be up more at night. Leaving the door open to the nursing hallway does not promote safety.