35 rest and sleep

The nurse is educating a client about nonpharmacologic measures to alleviate restless leg syndrome (RLS). Which education point(s) will the nurse include in the plan? Select all that apply.

• Applying heat or cold to the extremity can help relieve the symptoms.

• Biofeedback and TENS can help you relax and relieve symptoms.

• Massaging the legs may relieve symptoms.

A client describes difficulty falling asleep and difficulty maintaining sleep, and reports daytime fatigue and inability to concentrate. The nurse suggests which noninvasive techniques that may help promote restful sleep? Select all that apply.

• waking at the same time every morning

• removing bedtime distractions such as watching television in bed

• practicing relaxation techniques

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.

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 a small protein- and carbohydrate-containing snack about an hour before bedtime.

• Discontinue the use of tobacco or tobacco products.

• Perform moderate exercise.

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 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.

A new parent calls the pediatric nurse to talk about their 4-month-old infant who sleeps "all day long." The nurse informs the parent that an infant of this age requires how many hours of sleep?

12 to 16 hours each day

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.”

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

Which client could be diagnosed with insomnia?

A 50-year-old who is reporting increased irritability for the past 2 months. They state that they go to bed at 10 p.m. every night and try to sleep in but, no matter what they do, they always wake up around 4 a.m.

The nurse is assessing a client with a history of sleep apnea who is not adhering to the recommended schedule of continuous positive airway pressure (CPAP). Which statement made by the client indicates an understanding of the risks of not using the device?

“I know if I do not wear the CPAP, the oxygen in my blood may drop and damage my heart.”

The nurse observes the sleep pattern of a client with a BMI >30 and cardiac disease. The nurse notes occasional periods of apnea. Which action should the nurse take first?

Assess the client’s vital signs and pulse oximetry.

A nurse on the night shift notices that a client is grinding their teeth while sleeping. Which information will the nurse teach the client? Select all that apply.

• Teeth grinding is called bruxism.

• Teeth grinding can be caused by stress.

• You should observe for damage to teeth.

• With teeth grinding you should get regular dental care.

• You should limit caffeine at night.

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.”

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 they report severe lumbar and right leg pain. The nurse suspects which primary nursing concern?

altered sleep pattern related to acute pain

A perimenopausal woman reports insomnia. Which intervention(s) will the nurse suggest to the client? Select all that apply.

• Eliminate caffeine and alcohol in the evening because both are associated with disturbances in the normal sleep cycle.

• Eat a small snack of protein and carbohydrate before bedtime.

• Discuss the use of a sleep aid with the health care provider.

The nurse is managing the environment for clients on a busy hospital unit. Which interventions would the nurse perform to facilitate a more restful environment? Select all that apply.

• Maintain a brighter room during daylight hours and dim lights in the evening.

• Decrease the volume on alarms, pages, telephones, and staff conversations.

• Medicate for pain if needed.

The nurse is providing education for parents on the 4-month-old infant's sleep patterns. Which education will the nurse provide?

The infant should generally sleep 12 to 16 hours per day.

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."

The nurse is teaching a client with seasonal affective disorder about proper use of a full-spectrum light. Which teaching will the nurse include?

Sit within 3 ft (1 m) of the light for approximately 2 hours soon after awakening.

The nurse is planning care for clients to aid in healing and recovery. Which activity(ies) will the nurse recommend they incorporate into a rest break? Select all that apply.

• Focusing thoughts on a pleasant scene

• Taking a short 15- to 30-minute nap

• Stretching exercises

• Going for a short walk

A middle-aged client reports to the nurse that they have 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.

The nurse is planning health education sessions for adults that 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.

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.

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

strategies for ensuring adolescents receive adequate sleep

A nurse is preparing a presentation regarding hypnotic medications. What information should the nurse include? Select all that apply.

• Hypnotics may impair waking in a client.

• Hypnotics may cause dependence.

• Tapering of doses may be required after long-term use.

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.

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

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.

When a nurse notes that the client appears to be sleeping, is demonstrating irregular respirations, and is showing eye movement, the nurse identifies the stage of sleep the client is experiencing as

REM

A client has been in the hospital for the past 10 days following the development of an infection at their 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.

For the last 3 weeks, a nurse in a long-term care facility has administered a sedative hypnotic to a client who reports 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.

Which client should the nurse monitor closely for frequent nocturia?

older adult client with an enlarged prostate

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.

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

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.

A client is worried and states, “I just know I won’t be able to sleep before my surgery.” What sleeping pattern would the nurse anticipate?

The client will likely not be able to sleep.

The nurse is admitting a client with a body mass index (BMI) in the obesity range and a diagnosis of obstructive sleep apnea (OSA). The client states, "I just wake up a lot and do not feel rested, but it is not a big deal." What education should the nurse provide about complications related to OSA?

"OSA contributes to hypertension and heart disease."

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.”

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.

• "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 their room is helpful."

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.

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

strategies for ensuring adolescents receive adequate sleep

An adult client reports sleep latency of approximately 45 minutes each night. What action should the nurse take?

Secure referrals for treatment of insomnia.

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

The nurse recognizes that sleep deprivation related to environmental concerns will apply to which clients? Select all that apply.

• a 67-year-old who has two beers during the late night newscast

• a 32-year-old machinist, two-pack-a-day smoker

• an 84-year-old client hospitalized for prostate surgery

A newly admitted client with chronic obstructive pulmonary disease informs the nurse that they frequently awaken during the night. The nurse should advocate for what intervention?

low-flow oxygen

A client tells the nurse that they often have a difficult time falling asleep at night. What suggestion offered by the nurse may assist the client in achieving sleep?

a snack containing carbohydrates and protein

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

decreased temperature

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?

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

A nurse is developing a teaching plan for a client diagnosed with obstructive sleep apnea. Which item would the nurse instruct the client to avoid to reduce the disrupted breathing pattern when asleep? Select all that apply.

• alcohol

• tobacco

• sleeping pills

The client reports to the sleep clinic for a study following reports of sleepwalking and enuresis. Which sleep stage of non-rapid eye movement (NREM) sleep is affected based on the client’s reports?

NREM delta

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.

During an orientation class for new RN graduates, the nurse educator identifies which conditions as potential risks for clients to experience sleep pattern disturbance? Select all that apply.

• depression

• substance use

• constipation

• stroke

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.

A client begins snoring and is sleeping lightly. The stage of sleep is:

stage 2.

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.”

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

The client is sleeping, and arousal is easy. Occasionally, the client exhibits involuntary muscle jerking, which appears to startle the client. Vital signs are unchanged from 1 hour ago. The nurse assesses the stage of nonrapid eye movement (NREM) sleep, which the client exhibits as Stage:

1

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.”

The client reports unpleasant sensation in the legs with an urge to move them. Which questions will be important for the nurse to ask to determine what the client is experiencing? Select all that apply.

• "Do you use tobacco products?"

• "Have you been using any type of antihistamines for allergies?"

• "Does massaging the legs provide any relief?"

Which is not a lifespan consideration for sleep cycles?

By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases.

Which activity is 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.

A nurse has been assigned to sit overnight with a client who has been demonstrating unsafe actions. The charge nurse asks the the nurse to monitor the client closely to help identify any deficits in sleep quality.

For each characteristic, click to specify if it is consistent with the Rapid Eye Movement (REM) and/or the Non-Rapid Eye Movement (NREM) stage of sleep. Each characteristic may support more than one stage.

Characteristic	REM	NREM
changes in blood pressure	X	X
decrease in muscle mobility	X
increase in heart rate	X
increase in body temperature	X
reduction in metabolism		X

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.

Parents tell the nurse that their 5-year-old child is only sleeping 10 hours at night and is refusing to take an afternoon nap. What teaching will the nurse provide the parents?

"This is normal development for children in this age group."

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.

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

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

A client is prescribed escitalopram, diuretics, and pseudoephedrine. The client states, “I am tired all the time.” What does the nurse understand may be happening to this client?

decrease in rapid eye movement (REM) sleep due to prescribed medications

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 they report severe lumbar and right leg pain. The nurse suspects which primary nursing concern?

altered sleep pattern related to acute pain

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

decrease in the deep-sleep stage of the sleep cycle

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

• smokes 1 pack of cigarettes daily

• drinks black tea with all meals

• history of hyperthyroidism

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."

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.”

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.

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

Most sedative hypnotics lose their effect after 1 or 2 two weeks of administration.

The nurse 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.

The nurse is performing assessments on several clients at the clinic. Which client condition indicates the presence of a parasomnia?

a child who wets the bed each night

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.

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

strategies for ensuring adolescents receive adequate sleep

The nurse observes the sleep pattern of a client with a BMI >30 and cardiac disease. The nurse notes occasional periods of apnea. Which action should the nurse take first?

Assess the client’s vital signs and pulse oximetry.

The parents of a newborn ask when they can expect the newborn to sleep through the night. The nurse responds that the newborn will likely sleep through the night by what age?

6 to 9 months

The nurse is promoting bedtime rituals with a family. Which statement indicates the nurse may need to provide further instructions to the parent?

"My children love to roughhouse in their room to get rid of energy right before bedtime."

The nurse is providing client education for the parents of a child diagnosed with obstructive sleep apnea and obesity. What treatment measure(s) will the nurse explain during the education session? Select all that apply.

a weight loss plan

use of a continuous positive airway pressure (CPAP) machine

use of a mandibular advancement device (MAD)

The nurse is providing an education program for parents with preschool-aged children. The nurse should include which intervention to improve the children's sleep?

Preschool-aged children should limit fluids after supper.

Which client will the nurse monitor closely for excessive sleepiness?

client diagnosed with hypothyroidism

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

An older adult client informs the nurse about having trouble falling asleep and staying asleep recently. Which recommendation(s) should the nurse provide to help alleviate insomnia? Select all that apply.

• Get regular exercise during the day.

• Create a bedtime routine.

• Limit daytime napping.

• Talk about stressful issues during the day.

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 they report severe lumbar and right leg pain. The nurse suspects which primary nursing concern?

altered sleep pattern related to acute pain

The nurse makes the following assessment. A middle-age client reports falling asleep frequently at their job during the day, feeling like they are not getting enough sleep at night (even though the number of hours of sleep is unchanged), continuing to feel tired, and being unable to think clearly. Also, the client reports their spouse believes they are irritable upon awakening. Nursing interventions include teaching the client to:

use caution when driving an automobile.

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.

A nurse is preparing a presentation on sleep hygiene practices. What information should the nurse include? Select all that apply.

• Eliminate caffeine intake 6 hours prior to bedtime.

• Do not watch television in bed.

• Use blackout or other types of curtains/blinds to keep the room as dark as possible.

The nurse has entered the room of a newly admitted client and observed a continuous positive airway pressure (CPAP) on the client's bedside table. Which action(s) will the nurse take to assess the client's use of the CPAP machine? Select all that apply.

Discuss the client’s habit of using the CPAP.

Examine the fit of the mask.

A nurse is conducting an assessment of a middle-aged client who reports difficulties with sleeping at night. Which information would the nurse correlate with the client's sleep-wakefulness pattern? Select all that apply.

• "I usually go to bed around 9 and get up at about 7."

• "I usually get up two to three times a night to urinate."

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.”

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

The nurse is assessing an older adult client that reports feeling fatigued and tired throughout the day. What action should the nurse take?

Have the client further evaluated for depression.

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.

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.”