Chapter 35: REST AND SLEEP
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." EXPLANATION: Light therapy helps ease the transition to a new schedule or time zone. It involves exposing the client's eyes to an artificial bright light that simulates sunlight for a specific and regular amount of time during the time the person should be awake. Sleeping pills may exacerbate the jet lag and cause difficulty regulating sleep patterns. The client should attempt to nap while on the plane and not try and stay awake to be able to adjust to the new time zone. Jet lag not only occurs once, it can be a repeated experience each time transition to a new time zone occurs.
A nurse is caring for a client newly diagnosed with sleep apnea. Which should the nurse teach the client about the most important reason why the continuous positive air pressure (CPAP) device should be used during sleep? - "The CPAP assures you get enough oxygen throughout the night." - "By maintaining the oxygen in your body during sleep other health problems can be avoided." - "Using the CPAP will increase your energy during the day by allowing you to sleep at night." - "The CPAP
"The CPAP assures you get enough oxygen throughout the night." Explanation: The nurse can explain that during the apneic or hypopneic periods, ventilation decreases and blood oxygenation drops. The accumulation of carbon dioxide and the fall in oxygen cause brief periods of awakening throughout the night. Sleep apnea occurs in conjunction with snoring which can be difficult for a spouse but less urgent than a lack of oxygen in the body. By getting more oxygen during sleep the client may have more daytime energy, and associated health problems can be avoided when the body has proper oxygen balance. These outcomes, however, are not guaranteed and should be considered less urgent than the lack of oxygen.
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." EXPLANATION: Cognitive behavior therapy (CBT) requires a therapist to work through any maladaptive sleep beliefs. CBT can be very successful is used with other complementary therapies. CBT can include progressive muscle relaxation measures, stimulus control, and sleep restriction therapy. Sedatives and hypnotics would not be used in conjunction with CBT. Pharmacologic approaches do not have to be attempted prior to CBT initiation. A client undergoing CBT is not asked to stay in bed during normal sleep hours if the client is not able to sleep.
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." EXPLANATION: 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 nurse is teaching a first-time parent about the newborn's sleep needs. The nurse would inform the parent that newborns sleep approximately how many hours in a 24 hour period? - 18 to 20 hours - 8 to 10 hours - 10 to 12 hours - 14 to 18 hours
14 to 18 hours Explanation: Newborns sleep an average of 16 hours in a 24-hour period.
An older adult client tells the home care nurse that he doesn't seem to sleep as well as he used to. The nurse will teach the client about what age-related change to sleep patterns in older adults? - A decrease in stage I of the sleep cycle. - A change in the normal progression of the sleep cycle. - A decrease in the deep sleep stage of the sleep cycle. - An increase in stage II of the sleep cycle.
A decrease in the deep sleep stage of the sleep cycle. Explanation: The changes to the sleep cycle that usually occur in the older adult are an increase in stage I (not II) and a decrease in deep sleep. These changes lead to a less restful sleep and more frequent awakenings during the night.
The nurse observes the sleep pattern of an obese client with cardiac disease and notes occasional periods of apnea. Which initial action should the nurse take? - Review the client's health record for factors contributing to sleep disturbances. - Administer bronchodilators - Ask a colleague to come and observe the sleep pattern. - Assess the client's vital signs and pulse oximetry.
Assess the client's vital signs and pulse oximetry. Explanation: Considering the client's sleep pattern, including periods of apnea; obesity; and cardiovascular disease, the client is likely experiencing sleep apnea. As such, the nurse should assess the client before providing interventions. Asking a peer to observe the sleep pattern is inappropriate, as the nurse should assess the client's well-being. Reviewing the medical record is inappropriate, as attention should be on the client's well-being.
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. - Facilitate a change in the client's diet to ensure more carbohydrates at dinner. - Educate the client on
Assess the factors that the client believes contribute to the problem. Explanation: 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 such as obtaining an order for a sedative hypnotic medication, changing the client's diet, or educating the client on relaxation techniques.
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. EXPLANTION: 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 such as obtaining an order for a sedative hypnotic medication, changing the client's diet, or educating the client on relaxation techniques.
The nurse is caring for a client with a diagnosis of insomnia who is returning to share the success of their sleep plan. Which statement by the client indicates that the plan was successful? - Client can explain the direct actions of the hypnotic prescribed. - Client verbalizes feeling rested. - Client describes the dreams experienced. - Client identifies how many NREM cycles progressed through nightly
Client verbalizes feeling rested. Explanation: An effective sleep plan should produce restful sleep and a feeling of well-being in the client. To assess that the goal has been reached, the client should be able to verbalize feeling rested. Remembering dreams does not signify that the client had healthy sleep. Sleep cycles experienced and the chemical actions of hypnotic medications are not necessary pieces of information that the client needs to understand to have an effective sleep plan.
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 Explanation: 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 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. Explanation: 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 newly admitted client with chronic obstructive pulmonary disease informs the nurse that they frequently awakens during the night. The nurse should advocate for what intervention? - Hypnotic medication - Portable room heater - Opioid analgesic - Low-flow oxygen
Low-flow oxygen Explanation: 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. A cool room generally promotes sleep so a heater may exacerbate sleep disturbances. Hypnotics are not a first-line treatment for most clients.
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? - The client's daily activity is interfering with the drug. - The nurse needs to administer another drug such as diphenhydramine for effectiveness. - Most sedative hypnotics lose their effect after 1 or 2 two weeks of administration. - The c
Most sedative hypnotics lose their effect after 1 or 2 two weeks of administration. Explanation: 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.
The nurse is caring for a client who has been increasingly fatigued and irritable. The provider has ordered for an assessment for possible sleep disorders. Which step will the nurse perform first in the sleep assessment? - Measure the client's weight and assess visual acuity. - Observe the client's hours of sleep and review the client's sleep diary. - Measure neck circumference and auscultate the abdomen. - Auscultate the lung fields and perform neurologic checks.
Observe the client's hours of sleep and review the client's sleep diary. Explanation: Observing the sleeping patterns and checking the client's sleep diary can lead the nurse to clues about the quality of the client's sleep. Neck circumference can be a factor in obstructive sleep apnea, but it is not routinely measured during a sleep assessment. Being overweight is a common finding in clients with a sleep disorder, but visual acuity issues are not. Auscultation of the lungs and abdomen is not pertinent to the potential disorder.
A new client in the medical-surgical unit reports difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nurse identifies the nursing concern of altered sleep pattern with insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this this client's nursing concern? - Bring the client a warm glass of milk at bedtime. - Help the client maintain normal bedtime routine and time for sleep. - Use tactile relaxation techniques,
Provide an opportunity for the client to talk about concerns. Explanation: 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 identified nursing concern addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other interventions do not address the situation at hand, or the nursing concern that the nurse noted.
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 Explanation: Parents and other caregivers can assist children in establishing the habit of voiding as part of preparing for bedtime; limiting evening fluids may be necessary to prevnet enuresis and reduce awakenings. Drinking milk at bedtime may undermine this. Sleeping in the same room as the parents does not promote sleep sufficiency and a later bedtime may exerbate the sleep deficit.
The nurse is providing education for parents on the four month-old infant's sleep patterns. Which education will the nurse provide?
The infant should generally sleep 12 - 16 hours per day Explanation: Sleep recommendations include 12-16 hours of sleep per day for infants 4-12 months old, Infants experience REM sleep and naps are often numerous at this age. There is no need to limit infants' sleep.
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? - The individual is transitioning from wakefulness to sleep. - There is rapid eye movement under the eyelids. - There is muscle jerking that may awaken the individual. - Respirations are regular.
There is rapid eye movement under the eyelids. Explanation: REM is a deep stage of normal sleep. The body and brain go through several changes, including rapid movement of the eyes, fast and irregular breathing, increased heart rate (to near waking levels), changes in body temperature, increased blood pressure, and brain activity similar to that seen while awake. Muscular jerking, regular respiration, and transitioning to wakefulness are not indicative of REM sleep.
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 diuretic administered once daily at 9 a.m. - a diuretic administered twice daily at 9 a.m. and 5 p.m. - a diuretic administered every other day at noon
a diuretic administered twice daily at 9 a.m. and 9 p.m. Explanation: A diuretic should not be administered after 6 p.m. 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 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 which primary nursing concern?
altered sleep pattern related to acute pain Explanation: The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain. Anxiety may be present, but that is a symptom of the client's physical issue rather than the primary nursing complication. The client may have impaired mobility, but it would not be due to restless leg syndrome. Also, the client's role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.
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 which primary nursing concern? - altered physical mobility related to restless leg syndrome - anxiety related to hospitalization - altered role performance related to inability to work at occupation - altered sleep pattern
altered sleep pattern related to acute pain Explanation: The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain. Anxiety may be present, but that is a symptom of the client's physical issue rather than the primary nursing complication. The client may have impaired mobility, but it would not be due to restless leg syndrome. Also, the client's role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.
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 which primary nursing concern? - altered role performance related to inability to work at occupation - altered physical mobility related to restless leg syndrome - altered sleep pattern related to acute pain - anxiety relat
altered sleep pattern related to acute pain Explanation: The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain. Anxiety may be present, but that is a symptom of the client's physical issue rather than the primary nursing complication. The client may have impaired mobility, but it would not be due to restless leg syndrome. Also, the client's role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.
The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to: - insert an oral appliance prior to attempting sleep. - apply a facial mask that will deliver positive air pressure. - take a prescribed sedative before trying to sleep. - anticipate sleeping overnight at a health care center.
anticipate sleeping overnight at a health care center. Explanation: 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.
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? - chocolate bar - grapes with honey - cheese and crackers - tuna salad
cheese and crackers Explanation: Combining foods that are high in tryptophan with healthy, complex carbohydrates improves sleep. A small protein- and carbohydrate-containing snack such as cheese and crackers about an hour before bed may be effective in promoting restful sleep for the child. A chocolate bar contains caffeine, which is central nervous system stimulant. Grapes with honey contain a high quantity of fructose, a form of processed sugar which can interfere with sleep if ingested too close to bedtime. Tuna salad contains protein but also contain high amount of fat, which can disrupt the sleep cycle.
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: - change bedtime to later in the evening. - use caution when driving an automobil
use caution when driving an automobile. Explanation: 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 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: - drink at least 1 cup of coffee with the evening meal. - use caution when drivin
use caution when driving an automobile. Explanation: 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.
