PrepU - Ch 34 - Rest and Sleep

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

the inner biologic 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 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." >> Keeping notes of times of sleep and waking are important details to record in a sleep diary. The notes are usually maintained for 14 days and include specifics such as all wakeful activities and sleep patterns in strange environments.

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 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 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.

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. Fat does not assist with digestion or rest.

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 >> Insomnia and hypersomnia are often manifestations of depression in older clients. Nightmares, somnambulism (sleepwalking), and nocturnal enuresis are examples of parasomnias. These are conditions associated with activities that cause arousal, or partial arousal, usually during transitions in NREM periods of sleep. However, these are not manifestations of depression in an older adult client.

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.

A factory worker has a work schedule involving rotating work hours between days, evenings, and nights. The client tells the nurse he is a "morning" person and is not sleeping well when he has to work nights. The nurse recommends:

modifying the sleep environment to simulate quiet and darkness. >> The factory worker needs interventions that will promote natural, restful sleep. Caffeine and stimulant medications will exacerbate the problem. Applying for a different job may be possible, but is more of a long-term solution.

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. >> 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 assessment. Being overweight is a common finding in sleep disorder clients, but visual acuity issues are not. Auscultation of the lungs and abdomen are not pertinent to the potential disorder.

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

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

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 is not a lifespan consideration for sleep cycles?

By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases. >> By middle age, the frequency of nocturnal awakenings increases, and satisfaction with sleep quality decreases. Situational variables such as job-related stress, pregnancy, parenting, family caregiving responsibilities, and illness may explain these changes in sleep patterns.

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 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." >> 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.

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 roughhouse 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 night light 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.

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.

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." >> The description is a preschooler experiencing nightmares or night terrors, which is common in this age group. Nursing interventions include teaching the parents to comfort the child and provide a nightlight. The preschooler should not be placed in the parents' bed when this occurs as this will become a regular routine. The preschooler's bedtime routine appears satisfactory, and this should be continued.

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

*Adhere to a regular schedule for waking and going to sleep. *Go on a daily walk. *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 naps do not help in maintaining consistent sleep rituals.

A nurse caring for a client with hypersomnia assesses the possible cause of the sleep disorder. What possible causes should the nurse consider? SELECT ALL THAT APPLY.

*Another sleep disorder, such as sleep apnea *Depression *Alcohol use *Some medications >> The possible causes to hypersomnia could include another sleep disorder (such as sleep apnea), depression, alcohol use, or the effect of some medications. Malnourishment and eating disorders would not be a cause of hypersomnia.

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. >> 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.

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 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 such as obtaining an order for a sedative hypnotic medication, changing the client's diet, or educating the client on relaxation techniques.

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.

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.

The nurse is caring for a client who reports insomnia. The client has recently moved from an area near a fire station in the inner city to the country. Which recommendation will the nurse make to facilitate sleep?

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

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 >> Depression often goes undiagnosed in the older adult client and one of the symptoms is polysomnia. The nurse should make a referral for further investigation into this possibility. Decreasing the intake of caffeine can be beneficial for restful sleep. The client should avoid taking naps during the day so that sleep will be easier to achieve in the evening. Decreasing fluid intake and not increasing will help the client sleep so that rising to go to the bathroom is not as often.

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 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.

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.

For the last 3 weeks, a nurse in a long-term care facility has administered a sedative hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation?

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

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. >> 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.

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 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 >> The NREM arousal threshold is usually greatest in stage 4 NREM, but it is harder to arouse a person who is in REM sleep than NREM sleep. REM rebound is the term for accumulating REM sleep in balance over time.

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 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 nurse will teach the parents to position the infant on the back (supine). Sleeping in the prone position increases the risk for sudden infant death syndrome (SIDS). In a high Fowler's position, the client is placed with the head of the bed elevated as high as possible. The side-lying position is a position for breast-feeding but not for sleeping.

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 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. >> 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 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.

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

all clients admitted to a health care agency >> 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.

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 sleep. Alcohol does not typically shorten sleep cycles or increase the total amount of sleep. Delta sleep is decreased by alcohol consumption, not increased.

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

decreased brain activity from wakefulness >> Brain activity decreases from wakefulness. During slow wave sleep (SWS), muscles are relaxed, but muscle tone is maintained during NREM. Sympathetic nerve activity decreases from wakefulness, and body temperature is regulated at a lower level from wakefulness.

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

sleep apnea >> Sleep apnea refers to recurrent periods of absence of breathing for 10 seconds or longer, occurring at least five times per hour.

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 who is having difficulty sleeping. Which medication does the nurse anticipate will be prescribed by the health care provider?

temazepam >> Benzodiazepines such as temazepam are often used to treat difficulty sleeping. Furosemide is a diuretic; amlodipine is a calcium channel blocker; and simvastatin is a HMG CoA reductase inhibitor (statin) used to treat high cholesterol.

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.

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 >> Insomnia is associated with the consumption of stimulants (e.g., caffeine, nicotine, methamphetamine, and other drugs of abuse). Insomnia is also a side effect of hyperthyroidism. Exercising 30 to 60 minutes daily can help a client fall asleep faster.

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 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.

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 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. >> 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.

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 >> 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.

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

*Promoting daytime exercises *Providing a back massage *Assisting with progressive relaxation >> In order to promote sleep in a client, the nurse could use the following measures: promoting daytime exercise, providing a back massage, and assisting the client with progressive relaxation. However, the nurse should reduce the intake of stimulating chemicals to promote sleep in a client. Diuretics may awaken those who take them with a need to empty the bladder. For this reason, diuretics generally are administered early in the morning so that the peak effect has diminished by bedtime.

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. As children grow, less sleep is needed. Toddlers, ages 1-2 years, sleeps an average of 11 to 14 hours. Preschoolers, ages 3-5 years, sleep on average 10 to 13 hours. School-aged children, aged 6-13 years, sleep from 9 to 12 hours. Teenagers, ages 14-17 years, sleep an average of 8 to 10 hours.

A client with difficulty sleeping is prescribed ramelteon. The client asks the nurse, "How does this medicine work?" Which information would the nurse include in the response?

Activates the receptors for the hormone melatonin >> Ramelteon is a selective melatonin receptor agonist prescribed to facilitate the onset of sleep; it is not intended for sleep maintenance. It may be used long-term and activates receptors for melatonin. Ramelteon does not cause a change in circadian rhythms, decrease impulses to the cerebral cortex, or stimulate the reticular activating system.