PrepU Sleep

The history of a female client who has just been admitted to the unit and is very depressed reveals a weight loss of 10 lb (4.5 kg) in 2 weeks, sleeping 3 hours a night, and poor hygiene. The client states, "I am no good to anyone. Everyone would be better off without me." Which question should the nurse ask first?

"Are you thinking of hurting yourself?" On hearing the client's statement, the nurse must ask the client directly if she plans to kill herself. It is erroneous to think that talking to the client about suicide will drive her to it. Asking directly about suicidal intent is absolutely necessary. Commonly, doing so provides the client with a sense of relief. In addition, the nurse conveys concern for and a sense of worth to the client, thus enabling appropriate planning for care. Asking, "What do you mean?" is an indirect method of inquiry that provides the client with the opportunity to evade the nurse's intent. Asking, "Does your family not care about you?" shows poor judgment on the nurse's part and is demeaning to the client. Asking, "What happened to make you think that?" conveys a lack of knowledge of psychopathology.

Parents of a preschooler tell the nurse that their child often refuses to go to sleep at night. Which suggestion by the nurse would be helpful? Select all that apply.

"Try using a night light in the child's room." "Set up some familiar bedtime rituals for your child." "Avoid having your child watch frightening shows on TV before bedtime." "Try reading a favorite story before bedtime."

A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep?

14-20 Hours The pediatric nurse informs the new parent that on average, infants require 14 to 20 hours of sleep each day. As children grow, less sleep is needed. Toddlers, ages 1-2 years, sleeps on average of 11 to 14 hours. Preschoolers, ages 3-5 years, sleep on average 10 to 13 hours. School-aged children, aged 6-13 years, sleeps from 9 to 12 hours. Teenagers, ages 14-17 years, sleep an average of 8 to 10 hours.

A nurse is caring for a client who has had difficulty sleeping. What nursing intervention may facilitate the client's rest?

A back rub is used after a bath or as a nursing intervention for the following: assessment of skin, improving circulation, decreasing pain, decreasing anxiety, improving sleep, and providing a means of communication between the nurse and the client. Stimulating the environment through conversation or multiple stimuli will only increase the level of alertness of the client.

A female patient with obstructive sleep apnea (OSA) has been recommended a continuous positive airway pressure (CPAP) machine for the treatment of her health problem. The nurse's priority for patient education should be:

Although CPAP is effective in management of OSA, patient compliance with the treatment continues to be a major concern. Nursing interventions aimed at increasing compliance are consequently a priority. Steroids, bronchodilators, and pulse oximetry are not normally necessary. Daily exercise is beneficial but the promotion of compliance is a priority for patients using CPAP.

Which item in the care plan for a toddler with a seizure disorder should a nurse revise?

Arm restraints while asleep

The nurse is caring for a client with bipolar disorder who was recently admitted to an inpatient unit and is experiencing a manic episode. What is a priority nursing intervention for this client?

Closely monitor the client's eating and sleeping habits. Distraction and disorganization may prevent clients from eating or sleeping. Monitoring for needed intervention can prevent exhaustion and malnutrition. Liquid medications are indicated only if the client cannot or will not swallow tablets. Manic clients tend to disrupt group therapy, so this treatment usually is not for them. Family visits should not be tied to compliance with treatment. The client is unlikely to be able to concentrate and complete a journal at this time.

During a home visit to an elderly client with mild dementia, the client's daughter reports that she has one major problem with her mother. She says, "She sleeps most of the day and is up most of the night. I cannot get a decent night's sleep anymore." Which suggestions should the nurse make to the daughter? Select all that apply.

Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime. Promote relaxation before bedtime with a warm bath or relaxing music. Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day. A set routine and brief exercises help decrease daytime sleeping. Decreasing caffeine and fluids and promoting relaxation at bedtime promote nighttime sleeping. A strong sleep medicine for an elderly client is contraindicated due to changes in metabolism, increased adverse effects, and the risk of falls. Using caffeinated beverages may stimulate metabolism but can also have long-lasting adverse effects and may prevent sleep at bedtime.

During the morning assessment, a client states to the nurse, " I feel hung over from the sleeping pill I took last night." The nurse reviews the Medication Administration Record and determines that which medication is most likely to cause the client's symptoms?

Flurazepam The nonbenzodiazepine, non-barbiturate CNS depressants are often prescribed to promote sleep because there is less residual sleepiness with these medications and they do not appear to produce dependence or tolerance. These drugs include zaleplon, eszopiclone, and zolpidem tartrate. Flurazepam is most likely to cause the "hung" over sensation.

The student nurse is providing an education program for preschool parents. The nursing student should include which intervention to improve the child's sleep?

Limit fluids after supper 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.

Serotonin abnormalities are thought to be involved in the following disorders:

Mental depression and sleep disorders.

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

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

Which is the most frequent and persistent bereavement-associated symptom?

Sleep disturbances are the most frequent and persistent bereavement-associated symptom.

The nurse is caring for a new mother and newborn in a rooming-in unit and watches the mother put the infant in its bed, lying on its side, propped up with a pillow. The nurse should point out that this position can increase the risk of which situation?

Sudden infant death syndrome

The pediatric nurse is caring for a newborn infant. In which position will the nurse place the infant to sleep?

Supine Supine position is recommended as a way to reduce the incidence of sudden infant death syndrome (SIDS) among newborns. Other positions are inappropriate for placing the infant to sleep.

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?

The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep).

An intoxicated client is admitted to the hospital for alcohol withdrawal. What should the nurse do to help the client become sober?

The nurse should provide the client with a quiet room to sleep in. Alcohol is destroyed and oxidized in the body at a slow, steady rate. The rate of alcohol metabolism is not influenced by drinking black coffee, walking around the unit, or taking a cold shower. Therefore, it is best to have the client sleep off the effects of the alcohol.

The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking?

They put her to bed when she falls asleep. If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices.

In a predischarge program to educate clients with bipolar disorder and their family members, the nurse emphasizes which symptom is the most significant indicator for the onset of relapse?

decreased need for sleep and racing thoughts Decreased need for sleep and racing thoughts are the most prominent hallmarks of mania. Feelings of pleasure, motivation, and increased energy, within reason, are desired experiences. Also leaving a job to start a new business is not, in itself, a sign of impending illness.

The client with bipolar disorder, manic phase, has a valproic acid level of 15 mg/mL (104mmol/L). Which client behaviors should the nurse judge to be due to this level of valproic acid? Select all that apply.

irritability grandiosity flight of ideas The therapeutic level of valproic acid is 50 to 100 mg/mL (347 to 693 mmol/L). A level of 15 mg/mL (104mmol/L) is not considered therapeutic. Therefore, the client would be manifesting symptoms of mania. Irritability, euphoria, grandiosity, pressured speech, flight of ideas, distractibility, and a decreased need for sleep are some characteristics of a manic episode. Anhedonia and hypersomnia are related to a depressive illness and not mania.