CH 34 - REST AND 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 9-11 total hours of sleep time in a 24-hour period." "Your child should get 14-17 total hours of sleep time in a 24-hour period." "Your child should get 12-15 total hours of sleep time in a 24-hour period." "Your child should get 10-13 total hours of sleep time in a 24-hour period."
"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.
A middle-age client reports to the nurse that he has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. Which instruction does the nurse provide to the client? Select all that apply.
Avoid activities after 5 p.m. that are stimulating. Participate in a quiet activity, such as reading, prior to attempting to fall asleep. Explanation: To promote good sleep hygiene, the client should avoid any stimulating behaviors after 5 p.m. Quiet activities, such as reading, are acceptable. The client should avoid taking naps and ingesting caffeine. Chocolate has caffeine. Bed should be used for sex and sleep only, not watching television.
What factor has been hypothesized by researchers regarding current thoughts on sleep? More sleep is obtained through napping. Chronic sleep deprivation is present. The population is healthier due to sleep. The current population requires less sleep.
Chronic sleep deprivation is present. Explanation: Most recently, researchers have hypothesized that much of the population in industrialized nations may be chronically sleep deprived.
Which statement about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents? Nightmares are rare in toddlers. Most toddlers fall asleep easily. Slow-wave sleep occurs less in toddlers than in adults. Getting the child to sleep can be difficult.
Getting the child to sleep can be difficult. Explanation: Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.
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 drink or eat more foods with caffeine during the day 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
Have the client further evaluated for depression Explanation: 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? Medulla Cerebral cortex Midbrain Hypothalamus
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.
A nurse is providing community education about the importance of getting enough sleep. Which information about REM sleep is most accurate? The blood pressure decreases. Muscle tone is enhanced. The person is easily arousable. It plays a role in memory.
It plays a role in memory. Explanation: REM sleep is believed to play a role in learning, memory, and adaptation. It is more difficult to arouse a person during REM sleep than during NREM sleep. During REM sleep, the pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase, whereas general skeletal muscle tone and deep tendon reflexes are depressed.
The nurse is caring for a client on the acute care unit who experiences automatic behaviors associated with narcolepsy. What is the priority nursing intervention? Educate the client about other symptoms that may be experienced, such as sleep paralysis. Ask the client about willingness to explore taking an antidepressant to reduce symptoms associated with atypical REM sleep. Keep the client safe by monitoring ambulation on the unit. Contact the health care provider to consider prescribing a stimulant drug.
Keep the client safe by monitoring ambulation on the unit. Explanation: Safety is the priority factor in the client's care. Activity should be monitored in case sleep paralysis or sleep should occur while walking in or out of the client's room. A stimulant drug may be ordered but would not be the priority in the care of the client. Antidepressants may exacerbate the disorder by increasing sleepiness.
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: Anxiety related to hospitalization. Sleep Pattern Disturbance related to acute pain. Role Performance, Ineffective related to inability to work at occupation. Mobility, Impaired Physical related to Restless Leg Syndrome (RLS).
Sleep Pattern Disturbance related to acute pain. Explanation: 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.
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 muscle jerking that may awaken the individual. There is rapid eye movement under the eyelids. 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.
Which guideline does the nurse apply to discussion of sleep patterns with older adult clients? The amount of stage 4 sleep increases as clients age. Total sleep time decreases as the clients age. Circadian rhythms become more prominent as clients age. Older clients fall asleep more quickly than younger ones.
Total sleep time decreases as the clients age. Explanation: As people age, the amount of stage 4 sleep decreases significantly. Sleeping patterns may become polyphasic, with a shorter nocturnal period plus daytime naps.
A 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 twice daily at 9 a.m. and 5 p.m. a diuretic administered every other day at noon a diuretic administered once daily at 9 a.m.
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 providing care to a group of clients in an acute care facility. The client most likely to prefer a room that is warm as well as wearing thermal blankets is the client who is: aged 74 years. going through menopause. a teenager. 6 months' pregnant.
aged 74 years. Explanation: Older clients, such as the one aged 74 years, may prefer to have a room that is warm and being provided with thermal blankets.
A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest? decrease in cognitive response to stimuli decrease in awareness of environment decrease in motor response to stimuli involves all the body systems
decrease in awareness of environment Explanation: 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.
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. history of hyperthyroidism drinks coffee with all meals works 30 hours per week exercises 30 to 60 minutes daily smokes 1 pack of cigarettes daily
smokes 1 pack of cigarettes daily drinks coffee with all meals history of hyperthyroidism Explanation: 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.
Which factor has the most influence on an individual's sleep-wake patterns? bedtime rituals the body's need for 8 hours of sleep daylight and darkness the inner biologic clock
the inner biologic clock Explanation: 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 awakens a client while the client is experiencing rapid eye movement sleep. What statement made by the client indicates they were awakened during REM sleep? "I feel really cold." "I heard you immediately when you came in my room." "I was having a great dream and I remember all of it." "It feels like I just went to sleep."
"I was having a great dream and I remember all of it." Explanation: People who are awakened during the REM state almost always report that they have been dreaming. They can usually vividly recall their dreams even if they were absurd or have no sensible meaning for them. During REM sleep the body temperature rises and does not decrease so the client shouldn't feel cold. Sleeping lightly and hearing the nurse walk in the room is not indicative of REM sleep.
A parent reports their 4-year-old child wakes up at night screaming and this occurs 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. "Put the child in your bed to sleep when this occurs." "Comforting your child when this occurs may help." "You may find a nightlight in his room is helpful." "It is common for this to occur in this age group." "You will need to change your child's bedtime routine."
"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." Explanation: 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 nurse is instructing her students on the role of hormones in sleep patterns. Which statement would indicate to the nursing instructor that the student needs additional education? "Estrogen has been shown to decrease sleep latency." "A hyperactive thyroid can make the client sleepy all the time." "Women often experience fatigue due to loss of estrogen." Hypothyroidism may contribute to a lack of slow-wave sleep."
"A hyperactive thyroid can make the client sleepy all the time." Explanation: Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow-wave sleep.
The nurse makes the following assessment: A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night even though the number of hours of sleep are unchanged, and continues to feel tired and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. The nurse further assesses by asking: "Are you euphoric at other times during the day?" "Has there been a recent weight loss?" "Do you find your speech is quicker now?" "Have you had any recent head injury?"
"Have you had any recent head injury?" Explanation: The client is experiencing sleep difficulties, and these symptoms may be hypersomnia. The nurse assesses for a cause for hypersomnia. Head trauma or other injury to the central nervous system may cause this. Other causes include obesity and depression. When experiencing hypersomnia, the client may exhibit slower speech.
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? "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." "You should take sleeping pills when you board so that you will sleep until you arrive at your destination. "If you have jet lag once, you shouldn't have any further problems on your next trip overseas."
"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.
The nurse is educating a client and spouse about sudden jerking that occurs during sleep. What is the most appropriate nursing response? "Those are hypnogogic twitches that happen during REM sleep." "When oxygen levels drop during sleep, muscles will jerk suddenly." "Sudden jerking movements can indicate vivid dreaming." "Sudden twitches that occur during the early phases of sleep are common."
"Sudden twitches that occur during the early phases of sleep are common." Explanation: Nonrapid eye movement (NREM) is quiet sleep. NREM 1 sleep, which occurs at the onset of sleep and lasts about 10 minutes, is characterized as drowsiness and light sleep. Sudden twitches, called hypnogogic jerks, are common. During this early stage of sleep, a person may be aware of sounds and conversations, but avoids arousal. Sudden jerking movements do not indicate vivid dreams and do not occur during REM sleep. A decreased oxygen level does not cause hypnogogic jerks.
Which is not a lifespan consideration for sleep cycles? Getting the toddler and preschooler to fall asleep is a common problem. Newborns can sleep up to 16 to 18 hours per day. In adolescents, there is a shift to later evening bedtime. By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases.
By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases. Explanation: 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.
The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include? Advise parents that waking from nightmares or night terrors is common during the adolescent stage. Teach parents of infants to report any eye movements, groaning, or grimacing by their infant during sleep periods. 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.
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.
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? Warm milk Low-flow oxygen A hypnotic medication An opioid medication
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 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. Assisting with progressive relaxation Promoting daytime exercises Providing a back massage Increasing the intake of stimulating chemicals Administration of diuretics
Promoting daytime exercises Providing a back massage Assisting with progressive relaxation
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? Bring the client a warm glass of milk at bedtime. Use tactile relaxation techniques, such as a back massage. Provide an opportunity for the client to talk about concerns. Help the client maintain normal bedtime routine and time for sleep.
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 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? stage 4 NREM sleep REM sleep stage 1 NREM sleep REM rebound period
REM sleep Explanation: 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.
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? it is best to avoid a snack prior to bedtime a snack containing protein and fat a snack containing carbohydrates and protein a snack containing carbohydrates and fat
a snack containing carbohydrates and protein Explanation: 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. Reference:
The nurse is discussing sleep interventions with a client. What statement made by the client indicates an understanding of sleep restriction? purposefully shortening sleep time over several nights to reach a point when lengthy sleep is necessary limiting time in bed to actual sleep time never allowing sleep in a new environment taking prescribed stimulant medication to counteract narcolepsy
limiting time in bed to actual sleep time Explanation: 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.
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? cataplexy and hypnogogic hallucinations hypnogogic hallucinations and sleep paralysis sleep paralysis and automatic behavior sleep paralysis and hypnogogic hallucinations
sleep paralysis and automatic behavior Explanation: Sleep paralysis occurs when the person cannot move for a few minutes just before falling asleep or awakening. Cataplexy occurs with a sudden loss of muscle tone triggered by an emotional change such as laughing or anger. Hypnogogic hallucinations are dream-like auditory or visual experiences while dozing or falling asleep. Automatic behavior is the performance of routine tasks without full awareness, or later memory, of having done them. This client experiences sleep paralysis and automatic behavior.
The nurse 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. ingest a small amount of alcohol prior to bedtime. use caution when driving an automobile. change bedtime to later in the evening.
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 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. Decrease the volume on alarms, pages, telephones, and staff conversations. Keep the doors to the clients' rooms open. Maintain a brighter room during daylight hours and dim lights in the evening. Schedule procedures separately to avoid tiring out the clients. Medicate for pain if needed. Keep the room warm and provide earplugs and eye masks if requested.
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. Explanation: The nurse could perform several of the interventions listed to facilitate a more restful environment. First, the nurse could maintain a brighter room during daylight hours and dim lights in the evening. Opening the curtains in the room during the day is an excellent way to carry out this intervention. The nurse would decrease the volume on alarms, pages, telephones, and staff conversations. The nurse would medicate the client for pain if needed. The nurse would not keep the room warm, but cool to aid in sleep. Procedures should be scheduled together if at all possible to decrease the amount of time the client is involved in procedures and promote rest. The nurse should keep the door to the client's room closed if possible to facilitate a more restful environment.
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 worry will make the client fall asleep quickly. The client will likely not be able to sleep. The client will likely sleep all night. The client will probably not be able to stay asleep.
The client will likely not be able to sleep. Explanation: 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 preparing a care plan for a client with insomnia. Which would be an appropriate outcome criterion for the goal of having the client report fewer problems falling asleep? The client will report a decrease in sleep latency to 10 to 15 minutes within 30 days. The client will fall asleep faster. The nurse will administer the client's hypnotic at bedtime each night. The nurse will give the client a backrub at bedtime each night.
The client will report a decrease in sleep latency to 10 to 15 minutes within 30 days. Explanation: Outcome criteria for the goal should be client focused, measurable, and with a specific time frame.
A client reports to the nurse, "Sleep really isn't necessary." Which teaching by the nurse is appropriate? Select all that apply. "Sleep helps your immune system to fight off infections." "Sleep helps you to learn easier and remember more." "Sleep can make your moods fluctuate over time." "Sleep helps your blood flow to the brain." "Sleep takes time, which can be stressful for some people."
"Sleep helps your blood flow to the brain." "Sleep helps you to learn easier and remember more." "Sleep helps your immune system to fight off infections." Explanation: In addition to promoting emotional well-being, sleep enhances various physiologic processes. Sleep is believed to play a role in the following: reducing fatigue, stabilizing mood, improving blood flow to the brain, increasing protein synthesis, maintaining the disease-fighting mechanisms of the immune system, promoting cellular growth and repair, and improving the capacity for learning and memory storage. It is not appropriate, nor accurate, to teach the client that sleep can be stressful or that sleep can cause mood fluctuations.
The 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: 0400. 0300. 0200. 0100.
0100. Explanation: 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 middle-aged client reports to the nurse that the client has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. What should the nurse instruct the client to try? Select all that apply. Perform moderate exercise three or four times each week. Participate in an enjoyable activity each day. Eat a snack that contains a small amount of fat. Establish a set time to go to sleep each night. Drink one or two ounces of alcohol before bedtime.
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. Explanation: Behaviors that will promote sleep include establishing a regular routine, such as time, for bedtime, exercising three to four times each week, and participating in an activity that is enjoyable each day. The client should avoid alcohol and eat a small carbohydrate snack prior to bedtime.
A 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? somnambulism nocturnal enuresis nightmares insomnia
insomnia Explanation: 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.
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 young adults infants adolescents
older adults Explanation: 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: blood pressure is elevated pulse rate is slow temperature increases respirations are irregular
pulse rate is slow Explanation: 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.
A client begins snoring and is sleeping lightly. The stage of sleep is: stage 1. stage 2. stage 4. stage 3.
stage 2. Explanation: Stage 2 is relatively light sleep from which the client is easily awakened. Rolling eye movements continue, and snoring may occur.
An 82-year-old client is newly admitted to an assisted living facility. Which intervention promotes safety at night for the client? leaving a bright light on in the bathroom administering diuretics at bedtime leaving the door open to the nursing hallway using a night light in the bathroom
using a night light in the bathroom Explanation: 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.
Which client could be diagnosed with insomnia? A 40-year-old obese man who is reporting fatigue. He states that he goes to bed around 9 p.m. every night and wakes up between 5 and 6 in the morning. He feels like he gets a good night's sleep, but his wife says that she constantly has to poke him throughout the night because he "stops breathing." A 45-year-old woman who has been reporting fatigue for the last year. When asked about her sleep schedule, she states that she usually goes to bed around 1 a.m. and gets up at 7 a.m. when her 5-year-old daughter gets up. She describes herself as a night owl. A 20-year-old man who is reporting excessive drowsiness at work to the point that he falls asleep while at his computer. He goes to bed at 11 p.m. and wakes up at 7 a.m. without difficulty. Twice in the last year he passed out after getting extremely angry. 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.
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. Explanation: 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.
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? Do you usually go to bed and wake up about the same time each day? What do you usually do to help yourself fall asleep? How much sleep do you think you need to feel rested?
Do you usually go to bed and wake up about the same time each day? Explanation: The best interview question for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern would be to ask if the client usually goes to bed and wakes up about the same time each day. The other questions are possible to ask the client, but are not related to recent changes in the client's sleep-wakefulness pattern.
A client informs the nurse about difficulty getting a restful sleep. What education can the nurse provide to encourage adequate sleep and rest? Select all that apply. Eat chocolate before bed. Eat a small protein- and carbohydrate-containing snack about an hour before bedtime. Perform moderate exercise. Drink an alcoholic drink 1 hour prior to bed to assist with staying asleep. Discontinue the use of tobacco or tobacco products.
Eat a small protein- and carbohydrate-containing snack about an hour before bedtime. Discontinue the use of tobacco or tobacco products. Perform moderate exercise. Explanation: A small protein-containing snack (a source of tryptophan) before bedtime has been recommended for patients with insomnia. However, as nutritionists have studied the effects of various foods on mood, new information has emerged. Carbohydrates make tryptophan more available to the brain. This explains why meals heavy in carbohydrate content tend to cause drowsiness. Combining foods that are high in tryptophan with healthy, complex carbohydrates improves sleep. Therefore, a small protein- and carbohydrate-containing snack such as peanut butter on toast or cheese and crackers about an hour before bed may be more effective. Initially, alcohol consumption may help to induce sleep, but once the alcohol is cleared from the body, sleep is fragmented and disrupted often. Alcohol also interferes with entering deeper stages of sleep, which may result in feelings of fatigue upon wakening despite having spent an adequate amount of time in bed. Moderate amounts of exercise can help induce sleep. Initially, sleep may be disrupted when stopping smoking, but then sleep will be better.
Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening? Smoke a cigarette to relax and calm down at bedtime. Eat a bar of a favorite chocolate before bedtime. Eat some crackers with peanut butter at bedtime. Exercise vigorously for 30 minutes before bedtime.
Eat some crackers with peanut butter at bedtime. Explanation: Carbohydrates make tryptophan more available to the brain, thereby promoting sleep. Therefore, a small snack containing protein and carbohydrates (such as peanut butter on toast or cheese and crackers) is effective. Nicotine contained in cigarettes has a stimulating effect, and smokers usually have a more difficult time falling asleep. The client must be encouraged to quit smoking or to eliminate cigarette smoking after the evening meal. Exercise that occurs within a 3-hour interval before normal bedtime can hinder sleep. Caffeinated products, such as chocolate, coffee, and tea are considered stimulants and can interfere with sleep.
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? Ingest 1 ounce of liquor before going to sleep. Find a phone app that plays sounds of the city. Enjoy the peace and quiet of the country. Avoid eating right before bedtime.
Find a phone app that plays sounds of the city. Explanation: 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 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." "I will write down all my morning activities." "I will keep track of my sleep information for 2 months." "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." Explanation: 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.
The nurse should obtain a sleep history on which clients as a protocol? only clients who suffer from a sleep disorder or have been unconscious clients who suffer from a sleep disorder or who are spending time in the CCU all clients admitted to a health care agency only clients who have been suffering from a sleep disorder
all clients admitted to a health care agency Explanation: Interview questions help identify the client's sleep-wakefulness patterns, the effect of these patterns on everyday functioning, the client's use of sleep aids, and the presence of sleep disturbances and contributing factors. If the client's sleep is adequate and poses no problems, the sleep history may be brief but should still be conducted. As issues or concerns are identified in the general assessment, more detailed questions can be asked to gather more information.
A nursing instructor is speaking to a group of students regarding the effects of shift work on sleep patterns. Which pattern of work shifts has been shown to enhance work production? rotating between day and night shifts each week. working multiple night shifts in a row working one week of day shifts then one week of night shifts clockwise rotation of shifts
clockwise rotation of shifts Explanation: Research has shown that clockwise rotation of shifts is preferable and that short naps during breaks enhance work performance. Recent studies have shown a negative relation between the number of consecutive night shifts worked and urinary levels of melatonin metabolites.
A nurse working night shift understands the importance of enhancing the sleep patterns of his clients. In order to do so, he should: evaluate the sleep response of the client with polysomnogram. only wake them for the 12:00 AM and 4:00 AM vital signs. allow the client time to sit at the desk to enhance better rest. cluster activities to allow 90 to 120 minutes of sleep.
cluster activities to allow 90 to 120 minutes of sleep. Explanation: When possible, the nurse should cluster activities at night to provide periods of 90 to 120 minutes of uninterrupted sleep.
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? shorter sleep cycles increased amount of total sleep increased stage IV NREM sleep (delta sleep) decreased REM sleep
decreased REM sleep Explanation: 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.
The nurse has completed an assessment of a client who has had difficulty sleeping for more than 3 months. The nurse has diagnosed the client as having the nursing diagnosis Insomnia. What data supports this diagnosis? Select all that apply. rapid speech when asked questions about sleep history 10 lb (4.5 kg) overweight; an increase of weight noted in the past 3 months swelling of the client's eyelids yawning during the assessment interview report of increased energy in the afternoon
swelling of the client's eyelids 10 lb (4.5 kg) overweight; an increase of weight noted in the past 3 months yawning during the assessment interview Explanation: Physical assessment data that supports the nursing diagnosis Insomnia include swelling of the client's eyelids, being overweight and an increase in weight, and yawning. Other physical assessment data that would support the nursing diagnosis Insomnia include decreased (not increased) energy and slow (not rapid) speech.
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 using a white noise machine to mask outside noise drinking 2 cups of coffee every morning exercising immediately after getting off work at 5 p.m.
taking a diuretic at 9 a.m. and 5 p.m. daily Explanation: 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 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. Explanation: 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. Somnambulism is commonly seen in children. Older adults commonly take prescribed or over-the-counter sleep aids.