CoursePoint Topic 6: Rest, Sleep, Comfort, and Pain Management

An older adult client asks about over-the-counter sleeping aids. Which response is the most appropriate for the nurse to make to this client?

"Avoid sleeping aids that contain diphenhydramine."

An older adult client lives with an adult child and family, including an infant. The client reports frequently waking up during the night because of the infant. What is the nurse's best suggestion?

"Having the family use an infant monitor is better than leaving the nursery door open."

A single older adult uses earplugs at home to diminish street noise at night. Which statement by the nurse is appropriate?

"I suggest a smoke alarm with blinking lights."

An older adult client states that the client has lately been taking up to 2 hours to fall asleep at night, despite avoiding caffeine during the day and going for a brisk walk after lunch each day. Which statement by the nurse is appropriate?

"It will benefit you to get up at the same time each morning, even if you are tired."

A client reports having difficulty sleeping and is interested in using a sleep aid. Which response by the nurse is best?

"Tell me more about your bedtime routine."

After measuring vital signs the nurse asks the client "what do you need to be more comfortable?" The client response is "nothing will help me." Which action will the nurse take next?

Inquire as to why the client is feeling this way.

A client is newly diagnosed with restless legs syndrome. Which recommendation will the nurse make to help the client manage this condition?

Keep your legs warm at night.

An older adult woman had a total knee replacement yesterday; the client has rung the call light to report pain. What consideration should the nurse prioritize when choosing an appropriate intervention?

The need to provide prompt, adequate relief of the client's pain.

The nurse manager in a nursing home should make what changes when making nightly rounds?

Turn off televisions

The nurse is preparing an older adult client for sleep. Which action(s) should the nurse take after administering a prescribed sedative to the client? Select all that apply.

Turn on a night light Place call light within reach Raise side rails as appropriate Place the bed in the lowest position

The nurse suspects that an older adult client is experiencing the effects of a sleep disturbance. What finding(s) did the nurse use to come to this conclusion? Select all that apply.

Weakness Frequent yawning Disturbance in cognition Dark circles under the eyes

A nurse is responsible for the care of a group of older adults on an acute medical unit. Which client should the nurse monitor closely at night for worsening symptomatology?

a client with a diagnosis of chronic obstructive pulmonary disease (COPD)

An older adult admitted with back pain reports being "tired of taking medication" and wants to learn how to manage pain in other ways. Which nonpharmacologic recommendation will the nurse include in the teaching plan?

chiropractic therapy

An older adult client explains that the abdominal pain is so severe at times that she just wants to vomit. What herbal remedy might be appropriate for the nurse to suggest to this client?

ginger

An older adult client with ulcerative colitis asks if there are any natural supplements that reduce inflammation. Possible use of which herbal supplement(s) will the nurse incorporate in the client teaching plan? Select all that apply.

ginger fish oil turmeric bromelain

A client reports a reduction in arthritis pain when abstaining from meat and dairy products. What should the nurse explain as the reason this is occurring in the client?

low levels of arachidonic acid

An older adult client suffers from obesity. The client becomes agitated when admitted to the hospital for treatment of heart failure secondary to alcohol use disorder. For which negative consequence should the nurse assess?

obstructive sleep apnea

The nurse is caring for an older adult client with a diagnosis of osteoarthritis. On which assessment(s) will the nurse focus for the client? Select all that apply.

pain assessment mobility assessment ability to perform activities of daily living (ADLs)

A nurse plans care for an older adult with insomnia. The client's medication list includes zolpidem, potassium, and omeprazole. Which diagnosis should the nurse include in the plan of care?

risk for falls

The spouse is concerned because an older adult client always snores and falls asleep easily during the day. For which health problem should the nurse assess this client?

sleep apnea

An older adult client asks what can be done for the burning pain that occurs in both feet at the end of the day. For which type of pain should the nurse plan care for this client?

Neuropathic

An older adult client is prescribed a statin drug to decrease cholesterol level. The nurse should teach the client to look for which associated change in sleep pattern?

Nightmares

An older adult client who takes tricyclic antidepressants reports waking frequently during the night with spontaneous leg movements. Which condition does the nurse suspect this client is suffering from?

Nocturnal myoclonus

Guided imagery and massage have proven ineffective in providing pain relief for an older adult suffering from back pain. The nurse should talk to the health care provider about which next potential treatment?

Nonsteroidal anti-inflammatory drug

The nurse notes that a client with a severely infected leg wound never reports experiencing pain. Which action will the nurse take?

Observe the client for signs of pain.

A nurse assesses an older adult client following the repair of an abdominal hernia. The older adult client states, "I really hate to take pain medication." Which response by the nurse is best?

"Tell me more about your dislike of taking pain medication."

An older adult client reports aching muscles when waking up after taking a sedative to help with sleep. What should the nurse explain as a possible reason for this client's discomfort?

"The sedative decreases your body movements during sleep and you become stiff."

A nurse in a postoperative unit educates peers to overcome myths about pain in older adults. Which statement by a peer most clearly warrants further teaching?

"We have to be more conservative in the treatment of the older adults' pain than the younger clients'."

An older adult client reports difficulty sleeping since an extended family member has moved into the home. Which question will the nurse ask the client to identify additional factors that might be affecting the client's sleep?

"What is it like living with someone new?"

An older adult client asks for suggestions to naturally improve sleep during the night. What should the nurse suggest to this client? Select all that apply.

Obtain regular exercise during the day Spend time in direct sunlight during the day Drink a cup of caffeine-free herbal tea at bedtime Eat a high-protein, high-carbohydrate snack at bedtime

An adult daughter tells the nurse that the hospitalized parent is in pain yet does not report this when asked. Which intervention will the nurse take next?

Offer pain control options, as prescribed.

A client is diagnosed with increased sleep deficiency. Which action will the nurse take first to address this client's needs?

Access and determine sleep patterns

A client taking melatonin is experiencing excessive drowsiness. Which step would the nurse take first to determine cause?

Access current medications for interactions

An older adult client tells the nurse that pain is a 7 on a scale from 1 to 10. Which action will the nurse take next?

Administer pain medication, as prescribed.

A nurse in a long-term care facility has noticed that many residents of the facility spend a large amount of time in bed yet frequently report fatigue and sleep deprivation. What change in the facility's environment is most conducive with helping residents achieve adequate amounts of restful sleep?

Allowing residents to awake/sleep according to their own routines.

An older adult client suffering from shingles reports sharp, stabbing, burning pain that suddenly occurs from the back around to the sides. Which action will the nurse take to support this client?

Apply cool, wet compresses.

A client reports deep abdominal pain generating from a surgical wound. To determine a plan of care for pain management, which step would the nurse take first?

Ask the client to describe and rate the pain.

An older adult client who does not engage in routine physical activity reports severe pain with movement that occurs most days of the week. Which action will the nurse take first?

Assess for symptoms of immobility.

The nurse prepares teaching for a client diagnosed with sleep apnea. What should the nurse emphasize during this teaching? Select all that apply.

Avoid sleeping in a supine position Avoid alcohol and depressant medications Use machinery carefully during the day if sleepy

The nurse is caring for an older adult client who was recently diagnosed with sleep apnea. Which topic will the nurse include in the teaching plan for this client?

Avoid the supine position when sleeping.

The nurse is caring for an older adult client diagnosed with restless legs syndrome. Which recommendation will the nurse include in the teaching plan?

Begin and end the day with stretching.

The health care provider has recommended that an older adult client increase intake of flavonoids. Which food examples should the nurse suggest?

Blueberries, green tea, chocolate

The nurse prepares a plan of care for an older adult client with a sleep disturbance. Which outcome should the nurse identify as the best outcome for this client?

Client will sleep 7 to 8 hours per night

A 68-year-old client is recovering from knee replacement surgery. The nurse should include which well-written goal in the client's plan of care?

Client will verbalize decreased pain level of less than 5 within 3 days.

An older client reports being easily awakened during the night. Which recommendation will the nurse make to promote sleep with fewer disruptions?

Close the window coverings at night.

An older hospitalized client reports waking up several times during the night due to frequent interruptions by the nurses. What is the nurse's best action to promote rest and sleep for this client?

Cluster treatments when developing the plan of care

The nurse suspects that an older adult client is experiencing an adverse effect from a sedative provided to aid with sleep. What did the nurse assess to make this clinical determination?

Confusion

The nurse notes that an older adult client sitting in the lounge is nodding off to sleep. In which stage of sleep is this client most likely entering?

I

An older adult woman minimizes pain in the joints and back as "normal aging." Which action by the nurse is most appropriate?

Offer warm packs for joints.

An older adult client reports waking up a few times a night causing sleep to be less restful. Which recommendation will the nurse make to improve sleep?

Create a sleeping space that is dark, quiet and cool.

A nurse comes into contact with older adults from a wide variety of cultural groups. How is culture most likely to influence the assessment and management of pain?

Culture can dictate the appropriate expression of pain.

The gerontological nurse is making hourly rounds on the unit and observes an older adult client who has been sleeping for about 2 hours. The client's respiratory rate is 10 breaths/min. What is the nurse's best action?

Document the assessment findings in the client's medical record

An older adult client has been prescribed cyclobenzaprine for back spasms. Which information will the nurse include in the teaching plan for this client? Select all that apply.

Drink plenty of water to offset dry mouth. Observe for dizziness. Monitor your urinary output.

While assessing an older adult inpatient diagnosed with hyponatremia, the client reports leg cramps when falling asleep. Which intervention will the nurse add to the plan of care?

Encourage increased fluid intake throughout the day.

An older adult reports that stress is interfering with sleep and asks the nurse about coping strategies. Which technique is the nurse's best recommendation?

Exercise and time management

A client is diagnosed with a vitamin B-complex deficiency that is believed to contribute to severe nerve pain. Which food should the nurse encourage that the client adds to the daily diet?

Green leafy vegetables

The nurse teaches an older adult client suffering from osteoarthritis. Which foods should the client increase in the diet?

Green, leafy vegetables

An older adult client who is hospitalized wakes up during the night every time someone enters the room. Which intervention will the nurse implement to help the client get more rest?

Group nursing tasks to enter to the room fewer times during the night.

An older adult client diagnosed with postherpetic neuralgia suffers from chronic pain and difficulty sleeping. What is the nurse's best initial suggestion to improve this client's sleep pattern?

Guided imagery

An older adult client reports the inability to remember the last time dreaming occurred when sleeping. Which phase of sleep is being affected in this client?

REM

A nurse administers intravenous pain medication to an older adult in the hospital. Which action by the nurse is the priority?

Reassess the pain level.

An older adult client diagnosed with renal failure reports leg movements that occur while asleep. Which action will the nurse take?

Recommend a warm bath before bed.

The health care provider recommends that a client with nerve pain caused by herpes zoster apply capsaicin topical ointment over the area. What should the nurse explain to the client about this herbal remedy?

Relief should occur within a few days

A client reports drowsiness over the past month. Upon review of the client's current medications the nurse notes the client is taking warfarin, fluoxetine, diphenhydramine, prednisone and melatonin. Which action will the nurse take for this client?

Report a possible interaction between melatonin and diphenhydramine.

An older male client is grimacing and guarding the left side while hospitalized for kidney stones. The client's family is present in the room, and the client is denying pain. What is the nurse's best action?

Request that family leave the room and return after assessment is complete.

A ambulatory resident who is an assisted living facility sits in a chair at the bedside for most of the day. Which intervention will the nurse implement to improve this client's quality of sleep?

Request the client take a walk in the courtyard.

Opioids have been prescribed for an older adult client who is suffering from chronic cancer pain. What is the nurse's priority assessment when administering opioids to this client?

Respiratory rate

The nurse is educating a client newly diagnosed with rheumatoid arthritis on how to management discomfort and pain. Which topic(s) will the nurse include in the client teaching? Select all that apply.

Rest when needed. Apply ice or heat. Elevate the joint.

The nurse observes a client move the legs involuntarily several times while sleeping. Which step would the nurse take first?

Review client's current medications.

A client rates pain as a 7 on a scale of 1 to 10, 30 minutes after receiving pain medication. Which action is best for the nurse perform?

Sit at the client's bedside and talk.

An older adult client states that sleeping has improved considerably since losing 30 lb (13.5 kg). over the past 6 months. This weigh loss likely affected which health problem?

Sleep apnea

An older adult client is not sleeping through the night and asks how to improve sleep. Which is the recommendation will the nurse make?

Sleep in dark, cool location.

An older adult client reports nodding off during the nightly poker game with friends. Which recommendation will the nurse make to address this concern?

Take a brief daytime nap.

An older adult client who experiences chronic arthritic pain asks the nurse for help in getting adequate rest and sleep. What is the nurse's best recommendation?

Take pain medication at bedtime

An older adult with dementia is exhibiting increased pacing, grimacing, and agitation. What is the nurse's best action?

Take the client's vital signs.

An older adult client reports that spending more hours out of doors during the day has not improved phase advancement. What should the nurse suggest to the client at this time?

Take the daily walk after dinner instead of in the morning

The nurse notes that a client who self-reports insomnia is asleep every time the nurse enters the room during the night to provide care. What should this client's self-report indicate to the nurse?

The client has a different definition of insomnia

A nurse assesses an older adult client with confusion related to hyponatremia who reports pain. Which data should the nurse use as a guide for choosing interventions?

The client rates the pain at 8 out of 10.

A nurse assesses the pain of an older adult. Which finding indicates the presence of persistent pain?

The client rubs the shoulder