Chapter 35: Rest and Sleep

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 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.

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? You Selected:

"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.

A client comes to the clinic and states to the nurse, "I am traveling overseas for a project frequently and am having a difficult time adjusting because of jet lag. What is the best response by the nurse?

"Light therapy can be beneficial and help ease the transition to a new time schedule or zone." 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.

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 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.

The nurse is educating a client and spouse about sudden jerking that occurs during sleep. What is the most appropriate nursing response?

"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.

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.

Which assessment finding(s) confirms or indicates that the client is experiencing rapid-eye movement (REM) sleep? Select all that apply.

-Blood pressure and pulse rate show wide variations and fluctuate rapidly. -The client is unable to move. -Deep tendon reflexes are depressed. -Muscles are relaxed, but muscle tone is maintained. Explanation: During REM sleep, blood pressure and pulse rate show wide variations and may fluctuate rapidly, the client is unable to move, and theta waves often have a sawtooth or notched appearance. Muscles are relaxed, but muscle tone is maintained. Sleepwalking and bed-wetting are most likely to occur during non-rapid-eye movement (NREM) sleep.

A client has voiced concerns about their ongoing inability to fall asleep. What aspectss of the client's health history will the nurse identify as potential causative factors? Select all that apply.

-Smokes 1 pack of cigarettes daily -Drinks black tea 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. For most clients, a 30-hour work week will not contribute to sleep disorders.

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.

Which client could be diagnosed with insomnia?

A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m. 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

An older adult client tells the home care nurse that he doesn't seem to sleep as well as he used to. The nurse will teach the client about what age-related change to sleep patterns in older adults?

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 (not II) and a decrease in deep sleep. These changes lead to a less restful sleep and more frequent awakenings during the night.

The nurse is providing education to a group at a local community center on how to improve sleep quality. The nurse associates each intervention suggested with an example of how it can improve sleep. Drag words from the choices below to fill in each blank in the following sentence. The nurse suggests that the clients sleep later in the morning if bedtime is delayedbecause it maintains the circadian rhythm .

Actions Reasons get up after 30 minutes of sleeplessness. it helps the mind associate the bedroom with sleep

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 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.

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.

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.

A client is experiencing slow-wave sleep. What assessment finding will the nurse identify as being consistent with this sleep stage?

Decreased temperature 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 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.

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.

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.

A nurse is providing community education about the importance of getting enough sleep. Which information about REM sleep is most accurate?

It plays a role in memory. 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?

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.

Which activity would be appropriate to suggest to the client who states that they have difficulty falling asleep at night?

Keeping the room cool and as dark as possible Explanation: A cool, dark room promotes sleep. The other listed activities would not make the client more drowsy at bedtime and may increase sleep latency.

A newly admitted client with chronic obstructive pulmonary disease informs the nurse that they frequently awakens during the night. The nurse should acvocate for what 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. A cool room generally promotes sleep so a heater may exacerbate sleep disturbances. Hypnotics are not a first-line treatment for most clients.

The nurse is preparing to educate a client with restless legs syndrome who reports sleeplessness and prefers to use nonpharmacologic methods to promote sleep. Which recommendation will the nurse include in the teaching?

Massage the legs before bed. Explanation: Massaging the legs is a recommended technique for improving discomfort from restless legs syndrome. It is recommended to avoid alcohol, sleep in a cool environment, and set a regular sleep routine.

A factory worker has a work schedule involving rotating work hours between days, evenings, and nights. The client tells the nurse about being a "morning person" and not sleeping well when working the night shift. Which information will the nurse teach the client about sleep hygiene?

Modify the sleep environment to simulate quiet and darkness. Explanation: The factory worker needs interventions that will promote natural, restful sleep. A quiet and dark environment is optimal for promoting sleep when trying to sleep during the day. Caffeine and stimulant medications will exacerbate the problem. Sleep aids can cause dependency and have side effects. Natural sleep hygiene is the best education. Applying for a different job may be possible but is more of a long-term solution.

A nurse is reviewing a journal article about the physiology of sleep. The nurse demonstrates understanding of the information by identifying which neurotransmitter as being involved with excitation? Select all that apply.

Norepinephrine Acetylcholine Dopamine Serotonin Explanation: Various neurotransmitters are involved with the sleeping process. Norepinephrine and acetylcholine—in addition to dopamine, serotonin, and histamine—are involved with excitation. Gamma-aminobutyric acid (GABA) appears to be necessary for inhibition.

The nurse is caring for a client who has been increasingly fatigued and irritable. The provider has ordered for an assessment for possible sleep disorders. Which step will the nurse perform first in the sleep assessment?

Observe the client's hours of sleep and review the client's sleep diary. Explanation: Observing the sleeping patterns and checking the client's sleep diary can lead the nurse to clues about the quality of the client's sleep. Neck circumference can be a factor in obstructive sleep apnea, but it is not routinely measured during a sleep assessment. Being overweight is a common finding in clients with a sleep disorder, but visual acuity issues are not. Auscultation of the lungs and abdomen is not pertinent to the potential disorder.

A new client in the medical-surgical unit reports difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nurse identifies the nursing concern of altered sleep pattern with insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this this client's nursing concern?

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 identified nursing concern addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other interventions do not address the situation at hand, or the nursing concern that the nurse noted.

An adultDocu client reports sleep latency of approximately 45 minutes each night. What is the nurse's best action?

Secure referrals for treatment of insomnia Explanation: The range of normality with respect to sleep patterns is broad. Most people require 7 to 10 minutes to fall asleep. Latency in excess of this may indicate insomnia, which warrants referrals. Exercise should be avoided shortly before bed and food intake is not typically the cause of insomnia.

The nurse is planning health education sessions for adults which will focus on the role of sleep and strategies for enhancing sleep. What principle will the nurse integrate into the education plan?

Sleep sufficiency is essential for overall health and wellness Explanation: Sleep health, also called sleep sufficiency, is becoming widely recognized as an essential component of overall health. Sleep patterns change with age, but there is no evidence that older adults systematically have unrealistic expectations. There is agreement that the norms for the quanitity of sleep should remain high, even as many people sleep less than in previous generations. Napping can be consistent with sleep sufficiency when practiced in a healthy way.

The nurse is providing health promotion education regarding sleep. What topic should the nurse prioritize?

Strategies for ensuring adolescents receive adequate sleep Explanation: Many adolescents receive inadequate amounts of sleep, requiring education and intervention. There are few interventions that can directly prevent nightmares. It is often unrealistic to expect infants to sleep through the night. Some adults have increased sleep latency but this is not as prevalent as sleep deficits in adolescents.

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; limiting evening fluids may be necessary to prevnet enuresis and reduce awakenings. Drinking milk at bedtime may undermine this. Sleeping in the same room as the parents does not promote sleep sufficiency and a later bedtime may exerbate the sleep deficit.

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.

A newly admitted client states to the nurse, "I average about 5.5 hours of sleep per night." What determination of this client's sleep patterns does the nurse discuss with the client?

The client may be sleep deprived to some degree. Explanation: Optimum daytime performance with minimal sleepiness and no accumulation of sleep debt in adults is related to obtaining 7 to 9 hours of sleep each night. Sleeping less than 6 hours has been linked to an increase in morbidity and early mortality. Providing medication for sleeping or being seen at a sleep clinic are potential options once the cause of the sleep pattern has been determined.

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 providing education for parents on the four month-old infant's sleep patterns. Which education will the nurse provide?

The infant should generally sleep 12 - 16 hours per day Explanation: Sleep recommendations include 12-16 hours of sleep per day for infants 4-12 months old, Infants experience REM sleep and naps are often numerous at this age. There is no need to limit infants' sleep.

The nurse is assessing a client and determines that they are in rapid eye movement (REM) sleep. What finding indicates to the nurse that the client is in this stage?

There is rapid eye movement under the eyelids. 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.

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 an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects which primary nursing concern?

altered sleep pattern related to acute pain Explanation: The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain. Anxiety may be present, but that is a symptom of the client's physical issue rather than the primary nursing complication. The client may have impaired mobility, but it would not be due to restless leg syndrome. Also, the client's role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.

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 nurse is instructing a parent on how to promote restful sleep for a child. What food would be the best bedtime snack for the child?

cheese and crackers Explanation: Combining foods that are high in tryptophan with healthy, complex carbohydrates improves sleep. A small protein- and carbohydrate-containing snack such as cheese and crackers about an hour before bed may be effective in promoting restful sleep for the child. A chocolate bar contains caffeine, which is central nervous system stimulant. Grapes with honey contain a high quantity of fructose, a form of processed sugar which can interfere with sleep if ingested too close to bedtime. Tuna salad contains protein but also contain high amount of fat, which can disrupt the sleep cycle.

A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest?

decrease in awareness of environment 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.

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.

The nurse is discussing sleep interventions with a client. What statement made by the client indicates an understanding of sleep restriction?

limiting time in bed to actual sleep time 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.

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 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.

Which factor necessitates the need for more sleep in the adolescent population?

rapid growth Explanation: The growth spurt that occurs during adolescence may necessitate the need for more sleep. However, the stresses of school, activities, and part-time employment may cause adolescents to have restless sleep, and many adolescents do not get enough sleep.

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 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.

The nurse is caring for a client who must receive medication overnight. As the nurse prepares to administer the medication, the client is noted to have relaxed muscle tone, is not moving, snores, and is difficult to arouse. How will the nurse document this stage of sleep?

stage 3 Explanation: Clients in the stage 3 sleep phase have entered the early phase of deep sleep. They may snore and will exhibit relaxed muscle tone with little or no physical movement. They are difficult to arouse. Clients in other sleep stages do not exhibit these characteristics.

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.

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: Older adults 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 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.