Chapter 34: Rest and Sleep
A client asks the nurse if hot chocolate at bedtime will improve the client's sleep. Which is the best response by the nurse?
"Milk is a better option to help you sleep." Explanation: Milk contains L-tryptophan, a chemical that is known to facilitate sleep. Although hot chocolate may contain milk, most hot chocolate, tea and cola drinks contain caffeine. Caffeine is a stimulant and will not help to facilitate sleep.
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 Explanation: 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.
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 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.
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 Explanation: 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.
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. Explanation: Assessment is the first step in the nursing process. Consequently, the nurse should determine the factors contributing to the client's problem before performing interventions such as obtaining an order for a sedative hypnotic medication, changing the client's diet, or educating the client on relaxation techniques.
A client is prescribed escitalopram, diuretics, and pseudoephedrine. The client states, "I'm tired all the time." What does the nurse understand may be happening to this client?
Decrease in R.E.M. sleep due to prescribed medications Explanation: Pseudoephedrine is a powerful stimulant and diuretics can prompt nighttime awakenings to void. Both of these effects can produce insomnia. Some clients with mental illness experience insomnia, but a direct effect of medications is more likely. There is no indication of napping or exercise.
The nurse is preparing a care plan for a client recently diagnosed with obstructive sleep apnea. The client reports daytime sleepiness, fatigue, and excessive snoring that "wakes me up." What nursing diagnosis would be appropriate for this client?
Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring Explanation: Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring is the correct nursing diagnosis. The medical diagnosis of obstructive sleep apnea should not be used in the nursing diagnosis.
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? 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 nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage?
Hypothalamus Explanation: The hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleeping and waking. Injury to the hypothalamus may cause a person to sleep for abnormally long periods. The medulla and midbrain are part of the reticular activating system (RAS), which plays a part in the cyclic nature of sleep. The cerebral cortex does not have any role in the sleep process.
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 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.
When a nurse notes that the patient appears to be sleeping, is demonstrating irregular respirations, and is showing eye movement, the nurse identifies the stage of sleep the patient is experiencing as
Rapid eye movement (REM) Explanation: In REM sleep, respirations are irregular and oxygen consumption increases.
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 the deep sleep stage of the sleep cycle. Explanation: The changes to the sleep cycle that usually occur in the older adult are an increase in stage I and a decrease in deep sleep. These changes lead to a less restful sleep and more frequent awakenings during the night.
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. Explanation: Polysomnography is a sleep study. The client will be scheduled for the study at a health care center and sleep overnight as part of the study. The client should avoid sedatives, as this will aggravate OSA. Interventions for OSA include inserting an oral appliance or applying a facial mask for continuous positive airway pressure.
The 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. Explanation: A sleep diary kept for 2 weeks will provide a more detailed history of the client's sleep-wakefulness pattern than having the client identify foods that impact sleep, or having the client recall the number of hours of sleep each day for the past week. Client recall may be inaccurate. The client should describe the sleep problem, not the client's bed partner.
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 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.
A client who works night shift is struggling with sleeping during the day after working all night. What actions can the nurse suggest to help promote sleep? Select all that apply.
sleeping in a room with curtains that block the light eating breakfast before going to sleep Explanation: Sleeping in darkness or dim light as well as satiation helps to promote sleep. Hunger or thirst can suppress sleep. Varied sleep locations and drinking alcohol or stimulants like caffeine in coffee can also suppress sleep. Leaving the television on creates noise, and a quiet environment is a sleep-promoting factor.
In Stage 4 sleep, the:
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 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." Explanation: To promote relaxation and sleep, the nurse should be alert to the client's bedtime rituals and observe them as much as possible. To prevent interference with medical care, the nurse and client should consult with the health care provider before adding alcohol to the bedtime routine. Questioning the client about the habit may cause the client to become defensive.
What factor has been hypothesized by researchers regarding current thoughts on 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 factor has the most influence on an individual's sleep-wake patterns?
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 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 has decreases both in under-eye circles and in excessive yawning by 1 week. Explanation: This outcome criterion addresses the goal by stating physical, objective signs that the person is better rested. It also mentions a time frame, which makes it measurable and easier to evaluate.
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. Explanation: 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 caring for a client with insomnia. Which teaching will the nurse provide to help the client improve sleep?
"Create a bedtime routine." Explanation: Sleep is believed to play an important role in reducing fatigue, stabilizing mood, and improving blood flow to the brain, among other things. Creating a bedtime routine helps the client's mind and body know when it is time to sleep. The bed should not be used to watch television as this will confuse the bedtime routine. Insomnia is not known to be related to fluid intake in the evening, unless those fluids contain caffeine.
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. Explanation: 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.
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:
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 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 Explanation: 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 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. 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.
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?
14 to 18 hours Explanation: Newborns sleep an average of 16 hours in a 24-hour period.
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. 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 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." Explanation: 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.
Which is not a lifespan consideration for sleep cycles?
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 nurse is caring for a client on the acute care unit who experiences automatic behaviors associated with narcolepsy. What is the priority nursing intervention?
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.
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. Explanation: Although most sedative hypnotic drugs provide several nights of excellent sleep, the medication often loses its effects after 1 or 2 weeks. Alcohol and diphenhydramine should not be administered with a sedative hypnotic drug, as this can intensify the medication. Increased activity assists the client in sleeping. Carbohydrates have been shown to help a client sleep.
The nurse is 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. 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.
A client taking a diuretic twice daily for treatment of hypertension reports being awakened often by a full bladder. What teaching regarding the diuretic will the nurse provide?
Take it before 6:00 p.m. at night. Explanation: The client taking a diuretic may awaken at night with a full bladder. The nurse will teach the client to take the second dose of the medication before 6:00 p.m. at night so that urination is accomplished before going to sleep. The other options are not appropriate for the nurse to teach the client.
The student nurse is providing an education program for preschool parents. The nursing student should include which intervention to improve the child's sleep?
The child should limit fluids after supper. Explanation: Parents and other caregivers can assist children in establishing the habit of voiding as part of preparing for bedtime. Drinking milk at bedtime, keeping the child up until 10 PM and sleeping with the parents will not improve the child's sleep.
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 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 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 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.
A client begins snoring and is sleeping lightly. The stage of sleep is:
stage 2. Explanation: Stage 2 is relatively light sleep from which the client is easily awakened. Rolling eye movements continue, and snoring may 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. Explanation: A diuretic should not be administered after 6 p.m. This will promote sleep if a full bladder does not awaken the client. Once daily dosing and every-other-day dosing is not cause for question.
The nurse is completing 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 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.
The nurse is assessing a client with a history of sleep apnea who is noncompliant regarding wearing the continuous positive airway pressure (CPAP) apparatus. Which statement made by the client indicates understanding of risks related to noncompliance?
"I know if I do not wear the CPAP the oxygen in my blood may drop and damage my heart." Explanation: Understanding of risks of noncompliance are revealed in the statement, "I know if I do not wear the CPAP, the oxygen in my blood may drop and damage my heart." Complications of sleep apnea are related to chronic hypoxemia. Noncompliance with CPAP may result in hypertension, not hypotension. The statement, ""There is no reason why I should wear the mask other than because the doctor says I should" indicates the client is in denial regarding risks. Weaning the CPAP mask will not cause weight gain. The client is likely not to have excessive daytime sleepiness if resting well at night by wearing the CPAP mask.
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 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.
A nurse is caring for a client newly diagnosed with sleep apnea. Which should the nurse teach the client about the most important reason why the continuous positive air pressure (CPAP) device should be used during sleep?
"The CPAP assures you get enough oxygen throughout the night." Explanation: The nurse can explain that during the apneic or hypopneic periods, ventilation decreases and blood oxygenation drops. The accumulation of carbon dioxide and the fall in oxygen cause brief periods of awakening throughout the night. Sleep apnea occurs in conjunction with snoring which can be difficult for a spouse but less urgent than a lack of oxygen in the body. By getting more oxygen during sleep the client may have more daytime energy, and associated health problems can be avoided when the body has proper oxygen balance. These outcomes, however, are not guaranteed and should be considered less urgent than the lack of oxygen.
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?
Apple slices Explanation: Carbohydrates promote sleep by making tryptophan available to the brain. Simple carbohydrates such as fruit slices or juice are effective. Chocolate provides high sugar content and possibly caffeine exposure which will promote wakefulness. Tuna salad and almonds are protein, not carbohydrates.
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. Explanation: Considering the client's sleep pattern, including periods of apnea; obesity; and cardiovascular disease, the client is likely experiencing sleep apnea. Sleep apnea may result in periods of life-threatening apnea, hypoxia, and bradycardia. As such, the nurse should awaken the client, obtain and record vital signs, and notify the health care provider of the sleep pattern and vital sign results. Calling a code blue is inappropriate, as the client is experiencing periods of apnea that are consistent with a sleep disorder and there is no indication that the client does not have a pulse. Asking a peer to observe the sleep pattern is inappropriate, as the nurse should assess the client's well-being. Reviewing the medical record is inappropriate, as attention should be on the client's well-being.
A client calls a sleep clinic helpline and describes the spouse's sleep patterns of snoring loudly then becoming startled and waking up five or six times a night. The client is asking how to improve the spouse's sleep patterns. Which Information will the nurse include in teaching about healthy sleep patterns?
Discuss the sleep pattern with the health care provider. Explanation: The description of the client's snoring is suggestive of sleep apnea. The treatment plan should be to attempt detection of this disorder rather than disguising it by lowering the spouse's sensitivity to it. The client's spouse should discuss the symptoms with the health care provider. Advising the spouse that partners often sleep in separate rooms is not therapeutic and is masking potential sleep apnea. Snacks do not affect sleep apnea.
A nurse is explaining the use of sleep hygiene to a client experiencing insomnia. Which statement accurately describes recommended guidelines for the use of this technique? Select all that apply.
Eat a light meal before bedtime. Take a warm bath before bedtime. Explanation: Sleep hygiene involves the following: restricting the intake of caffeine, nicotine, and alcohol, especially later in the day; avoiding activities after 5 p.m. that are stimulating; avoiding naps; eating a light meal before bedtime; sleeping in a cool, dark room; eliminating use of a bedroom clock; taking a warm bath before bedtime; and trying to keep the sleep environment as quiet as possible (Gevirtz, 2007).
Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening?
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.
An older adult client reports insomnia. Which interventions can the nurse implement to promote quality sleep for the client?
Encourage the client to empty the bladder at bedtime. Explanation: Encouraging the client to empty the bladder at bedtime and dimming the lights may help to promote relaxation and sleep. Keeping the lights on in the room is not appropriate, as lights are stimulants. Suggesting music at bedtime is avoided, as the noise is a source of stimulation. Light exercise such as walking 10 minutes before bed may promote rest; however, strenuous exercise, such as walking for 60 minutes before bed, stimulates the client.
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. 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.
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. 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 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 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 62-year-old client informs the nurse that the parent has been anxious and disoriented in the morning. The client also informs the nurse that the parent gets up frequently to use the bathroom. Which nursing intervention can decrease the disruption of sleep?
Have your parent take diuretic medicine in the morning. Explanation: Taking a diuretic will promote the need for voiding within a few hours, interrupting the sleep cycle if taken at night. Taking the diuretic during the morning can lessen voiding effects later in the day. Tea is a weak stimulant but should be avoided close to bedtime. Older adults can have difficulty sleeping if they feel cold, so wearing socks to bed can promote restful sleep. Taking naps during the day can interfere with sufficient sleep at night.
The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include?
Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. Explanation: The nurse would include the education point that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. It is normal for infants to have eye movements, groaning, or grimacing during sleep periods. School-age children become aware of the concept of death, not preschool children. Waking from nightmares or night terrors is common during the preschooler stage.
A 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?
NREM deprivation Explanation: Hypothyroidism tends to decrease the amount of NREM sleep, especially stages II and IV, while hyperthyroidism may result in difficulty falling asleep.
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. Explanation: 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. 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.
A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client?
Sleep Deprivation Explanation: Sleep deprivation is the most appropriate nursing diagnosis for this client because the symptoms of restless legs syndrome keep the person awake and prevent continuous sleep. Eventually, sleep deprivation affects the person's life, damaging work productivity and personal relationships. Relocation Stress Syndrome would not be an appropriate diagnosis because the symptoms are not due to relocation to a new place. Impaired Bed Mobility is an inappropriate diagnosis because the client is not confined to a bed. The client does not have a risk for injury; therefore, the diagnosis of Risk for Injury would be incorrect.
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. 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 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. 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.
