Chapter 34: Rest and Sleep
A hospitalized client informs the evening shift nurse about not being able to sleep without a shot of whiskey each night before bed and asks if the spouse can bring in a bottle. Which is the best response by the nurse? "Let's discuss that with your health care provider." "It will be difficult for you to continue that routine in the hospital." "Go ahead and ask your spouse to bring a bottle." "Do you really think that is a good habit?"
"Let's discuss that with your health care provider."
A nurse is conducting an assessment of a middle-aged client who reports difficulties with sleeping at night. Which information would the nurse correlate with the client's sleep-wakefulness pattern? Select all that apply. "I usually go to bed around 9 and get up at about 7." "I usually get up two to three times a night to urinate." "I'm always tired and feel like I don't have much energy anymore." "I like to keep a dim light on during the night in case I need to get up." "I have never tried using any medicine to fall asleep."
"I usually go to bed around 9 and get up at about 7." "I usually get up two to three times a night to urinate."
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 describes the dreams experienced. Client verbalizes feeling rested. Client identifies how many NREM cycles progressed through nightly. Client can explain the direct actions of the hypnotic prescribed.
Client verbalizes feeling rested.
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 keep track of my sleep information for 2 months." "I will record the time I go to bed and how long it takes me to fall asleep." "I will write down all my morning activities." "I will only keep track of my sleep habits at home, not when I am traveling out of town."
"I will record the time I go to bed and how long it takes me to fall asleep."
An older adult client reports insomnia. Which interventions can the nurse implement to promote quality sleep for the client? Keep lights on in the room to help prevent falls at night. Encourage the client to empty the bladder at bedtime. Suggest that the client listen to music at bedtime to promote sleep. Advise the client to briskly ambulate in the hall for 60 minutes before bed.
Encourage the client to empty the bladder at bedtime.
The home health nurse is visiting an older adult client whose caregiver reports that the client has been anxious and disoriented in the morning. The caregiver also informs the nurse that the client gets up frequently to use the bathroom during the night. The client's current medications include hydralazine 75 mg by mouth daily, furosemide 40 mg by mouth daily, and potassium chloride 20 mEq by mouth daily. Which recommendation will the nurse provide the caregiver to decrease the disruption of sleep? Have the client take a diuretic in the morning. Offer the client iced tea before bed. Suggest the client sleep without socks. Encourage the client to take frequent naps during the day.
Have the client take a diuretic in the morning.
The nurse is preparing to educate a client with restless legs syndrome who reports sleeplessness and prefers to use nonpharmacologic methods to promote sleep. Which recommendation will the nurse include in the teaching? Massage the legs before bed. Have a glass of wine before bed. Sleep in a warm environment. Go to bed whenever you feel tired.
Massage the legs before bed.
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 have shorter periods of REM sleep. Newborns are inactive when awake. Newborns will nap two times per day. Newborns sleep 16 to 17 hours per day.
Newborns sleep 16 to 17 hours per day.
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 neck circumference and auscultate the abdomen. Observe the client's hours of sleep and review the client's sleep diary. Auscultate the lung fields and perform neurologic checks. Measure the client's weight and assess visual acuity.
Observe the client's hours of sleep and review the client's sleep diary.
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 worry will make the client fall asleep quickly. The client will probably not be able to stay asleep. The client will likely sleep all night.
The client will likely not be able to 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? There is rapid eye movement under the eyelids. There is muscle jerking that may awaken the individual. Respirations are regular. The individual is transitioning from wakefulness to sleep.
There is rapid eye movement under the eyelids.
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 anxiety related to hospitalization altered physical mobility related to restless leg syndrome altered role performance related to inability to work at occupation
altered sleep pattern related to acute pain
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 hypnogogic hallucinations cataplexy and hypnogogic hallucinations hypnogogic hallucinations and sleep paralysis sleep paralysis and automatic behavior
sleep paralysis and automatic behavior
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: ingest a small amount of alcohol prior to bedtime. use caution when driving an automobile. drink at least 1 cup of coffee with the evening meal. change bedtime to later in the evening.
use caution when driving an automobile.
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? Enjoy the peace and quiet of the country. Find a phone app that plays sounds of the city. Avoid eating right before bedtime. Ingest 1 ounce of liquor before going to sleep.
Find a phone app that plays sounds of the city.
Which statement about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents? Getting the child to sleep can be difficult. Most toddlers fall asleep easily. Nightmares are rare in toddlers. Slow-wave sleep occurs less in toddlers than in adults.
Getting the child to sleep can be difficult.
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 health care provider for which intervention? A hypnotic medication An opioid medication Low-flow oxygen Warm milk
Low-flow oxygen
The nurse is managing the environment for clients on a busy hospital unit. 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. Keep the room warm and provide earplugs and eye masks if requested. Decrease the volume on alarms, pages, telephones, and staff conversations. Schedule procedures separately to avoid tiring out the clients. Medicate for pain if needed. Keep the doors to the clients' rooms open.
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.
A client diagnosed with hypothyroidism is suffering from fatigue, lethargy, depression, and difficulty executing the tasks of everyday living. What type of sleep deprivation would the nurse suspect is affecting this client? REM deprivation NREM deprivation Total sleep deprivation Insomnia
NREM deprivation
When a nurse notes that the client appears to be sleeping, is demonstrating irregular respirations, and is showing eye movement, the nurse identifies the stage of sleep the client is experiencing as Transitional Rapid eye movement (REM) Light sleep Slow wave
Rapid eye movement (REM)
The student nurse is providing an education program for preschool parents. The nursing student should include which intervention to improve the child's sleep? The child should limit fluids after supper. The child should drink milk at bedtime. The parents should keep the child up until 10 PM. The child should sleep with the parents.
The child should limit fluids after supper.
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 exercises 30 to 60 minutes daily works 30 hours per week
smokes 1 pack of cigarettes daily drinks coffee with all meals history of hyperthyroidism
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? "If you have jet lag once, you shouldn't have any further problems on your next trip overseas." "You should take sleeping pills when you board so that you will sleep until you arrive at your destination. "Light therapy can be beneficial and help ease the transition to a new time schedule or zone." "Try to stay awake for the duration of the flight and sleep when you arrive."
"Light therapy can be beneficial and help ease the transition to a new time schedule or zone."
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? 8 to 10 hours 10 to 12 hours 14 to 18 hours 18 to 20 hours
14 to 18 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 Causes a change in the circadian rhythms Decreases impulses to the cerebral cortex Stimulates the reticular activating system
Activates the receptors for the hormone melatonin
The nurse observes the sleep pattern of an obese client with cardiac disease and notes occasional periods of apnea. Which action should the nurse take? Assess the client's vital signs and pulse oximetry. Call a code blue, as the client is not breathing. Ask a peer to come and observe the sleep pattern. Review the client's medical record for sleep disturbances.
Assess the client's vital signs and pulse oximetry.
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. Obtain a PRN order for a sedative hypnotic from the client's health care provider. Educate the client on relaxation techniques and reduce noise levels on the unit. Facilitate a change in the client's diet to ensure more carbohydrates at dinner.
Assess the factors that the client believes contribute to the problem.
What factor has been hypothesized by researchers regarding current thoughts on sleep? The current population requires less sleep. More sleep is obtained through napping. The population is healthier due to sleep. Chronic sleep deprivation is present.
Chronic sleep deprivation is present.
Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern? In what way does the sleep you get each day affect your everyday living? How much sleep do you think you need to feel rested? What do you usually do to help yourself fall asleep? Do you usually go to bed and wake up about the same time each day?
Do you usually go to bed and wake up about the same time each day?
A perimenopausal woman reports insomnia. Which intervention(s) will the nurse suggest to the client? Select all that apply. Nap frequently during the day to make up for the lost sleep at night. Eliminate caffeine and alcohol in the evening because both are associated with disturbances in the normal sleep cycle. Exercise vigorously before bedtime to promote drowsiness. Eat a small snack of protein and carbohydrate before bedtime. Discuss the use of a sleep aid with the health care provider.
Eliminate caffeine and alcohol in the evening because both are associated with disturbances in the normal sleep cycle. Eat a small snack of protein and carbohydrate before bedtime. Discuss the use of a sleep aid with the health care provider.
A student nurse is preparing a presentation on sleep hygiene practices. What information should the nurse include? Select all that apply. Eliminate caffeine intake 6 hours prior to bedtime. Do not watch television in bed. Use blackout or other types of curtains/blinds to keep the room as dark as possible. Take a hot bath prior to bedtime. Do 15 to 30 minutes of exercise prior to bedtime.
Eliminate caffeine intake 6 hours prior to bedtime. Do not watch television in bed. Use blackout or other types of curtains/blinds to keep the room as dark as possible.
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? Encourage the client to increase the amount of fluids during the evening hours Inform the client that taking frequent naps during the day will help Have the client further evaluated for depression Encourage the client to drink or eat more foods with caffeine during the day
Have the client further evaluated for depression
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? Cerebral cortex Hypothalamus Medulla Midbrain
Hypothalamus
The nurse is implementing comfort measures to promote sleep for a client. Which intervention is the best choice for the client? Encourage the client to take a shower prior to bedtime. Have the client set an alarm clock so they are not worried about getting up. Create a warm, dark environment in the clients' rooms. Offer client a small carbohydrate and protein snack before bedtime.
Offer client a small carbohydrate and protein snack before bedtime.
The nurse is creating a plan of care for a client that is reporting an inability to sleep and rest. What outcome criterion will the nurse address for a goal that the client will demonstrate physical signs of being rested? The client reports a decrease in sleep latency to 10-15 minutes. The client has decreases both in under-eye circles and in excessive yawning by 1 week. The client reports less anxiety regarding falling asleep. The client reports drinking only one cup of coffee a day.
The client has decreases both in under-eye circles and in excessive yawning by 1 week.
An older adult client tells his home care nurse that he doesn't seem to sleep as well as he used to. The nurse is aware that the sleep changes that occur in the older adult client which cause a less restful sleep include: a decrease in stage I of the sleep cycle. a decrease in the deep sleep stage of the sleep cycle. a change in the normal progression of the sleep cycle. an increase in stage II of the sleep cycle.
a decrease in the deep sleep stage of the sleep cycle.
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.
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 snack containing carbohydrates and fat a snack containing protein and fat it is best to avoid a snack prior to bedtime
a snack containing carbohydrates and protein
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? cheese and crackers chocolate bar grapes with honey tuna salad
cheese and crackers
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 purposefully shortening sleep time over several nights to reach a point when lengthy sleep is necessary never allowing sleep in a new environment taking prescribed stimulant medication to counteract narcolepsy
limiting time in bed to actual sleep time
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 nap in the afternoon, which lessens their hours of sleep at night. they are typically prone to sleep walking. they are the age group least likely to use prescribed sleep medications. they may be disoriented on awakening.
they may be disoriented on awakening.
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. Teach parents of infants to report any eye movements, groaning, or grimacing by their infant during sleep periods. Advise parents that waking from nightmares or night terrors is common during the adolescent stage. Inform parents about the preschool child's awareness of the concept of death possibly occurring and encourage parents to help alleviate the child's fears.
Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap.
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? Help the client maintain normal bedtime routine and time for sleep. Provide an opportunity for the client to talk about concerns. Use tactile relaxation techniques, such as a back massage. Bring the client a warm glass of milk at bedtime.
Provide an opportunity for the client to talk about concerns.
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. take a prescribed sedative before trying to sleep. insert an oral appliance prior to attempting sleep. apply a facial mask that will deliver positive air pressure.
anticipate sleeping overnight at a health care center.
The client being seen in the employee wellness clinic reports difficulty sleeping for the past several months. The most important assessment the nurse could make is: reviewing the client's sleep diary for the past 2 weeks. identifying specific foods that negatively impact sleep. having the client recall the number of sleep hours each night for the past week. asking the client's bed partner to describe the sleep problem.
reviewing the client's sleep diary for the past 2 weeks.
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 infants adolescents young adults
older adults
In Stage 4 sleep, the: blood pressure is elevated pulse rate is slow respirations are irregular temperature increases
pulse rate is slow
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? "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 assures you get enough oxygen throughout the night." "The CPAP prevents you from snoring so your spouse can sleep."
"The CPAP assures you get enough oxygen throughout the 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. The nurse needs to administer another drug such as diphenhydramine for effectiveness. The client's daily activity is interfering with the drug. The client is eating protein prior to bedtime.
Most sedative hypnotics lose their effect after 1 or 2 two weeks of administration.
A nurse is working with an older adult client who has been diagnosed with onset insomnia and informs the nurse about waking at least once during the night. What actions by the nurse can help promote adequate sleep? Select all that apply. The nurse advises the client to exercise no closer than 6 hours to bedtime. The nurse encourages the client to remove the television from the bedroom. The nurse encourages the client to minimize caffeine intake several hours prior to bedtime. The nurse helps the client come up with a bedtime routine that can be implemented each night. The nurse teaches the client that shorter, unbroken sleep periods are not normal.
The nurse advises the client to exercise no closer than 6 hours to bedtime. The nurse encourages the client to remove the television from the bedroom. The nurse encourages the client to minimize caffeine intake several hours prior to bedtime. The nurse helps the client come up with a bedtime routine that can be implemented each night.
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 in need of medication to aid sleep. They may be sleep deprived to some degree. They are an efficient sleeper. They are in need of a sleep clinic visit.
They may be sleep deprived to some degree.
