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.
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?
They are sleep deprived to some degree.
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.
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:
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
Parents tell the nurse that their 5-year-old is only sleeping 10 hours now and is refusing to take an afternoon nap. The nurse should teach the parents:
"This is normal development for children in this age group."
The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is:
observe the client's hours of sleep and review the client's sleep diary.
The nurse is providing client education for the parents of an obese child diagnosed with obstructive sleep apnea. What treatment measures would the nurse explain during the education session? Select all that apply.
a weight loss plan
use of a continuous passive airway pressure (CPAP) machine
use of a mandibular advancement device (MAD)
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.
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.”
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?
What factor has been hypothesized by researchers regarding current thoughts on sleep?
Chronic sleep deprivation is present.
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.
A student nurse is preparing a presentation regarding hypnotic medications. What information should the student nurse include? Select all that apply.
Hypnotics may impair waking in a client.
Hypnotics may be addictive.
Tapering of doses may be required after long-term use.
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.
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 caring for a client who is having difficulty sleeping. Which medication does the nurse anticipate will be prescribed by the health care provider?
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 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.
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.
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.
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.
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.
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."
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 client reports periodic difficulty falling asleep. Which teaching will the nurse provide? Select all that apply.
Decrease caffeine intake.
Adhere to a regular schedule for waking and going to sleep.
Go on a daily walk.
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.
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.
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 per day?
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.
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.
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.
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.
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.
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.
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.
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."
Which assessment finding(s) confirms or indicates that the client is experiencing rapid-eye movement (REM) sleep? Select all that apply.
Muscles are relaxed, but muscle tone is maintained.
Blood pressure and pulse rate show wide variations and fluctuate rapidly.
Deep tendon reflexes are depressed.
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?
They are sleep deprived to some degree.
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?
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
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.
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
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?
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.
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 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 client tells the nurse that the client often has a difficult time falling asleep at night. What suggestion offered by the nurse may assist the client in achieving sleep?
a snack containing carbohydrates and protein
A client begins snoring and is sleeping lightly. The stage of sleep is:
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 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 his room is helpful."
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."
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?
The nurse is educating a client and spouse about sudden jerking that occurs during sleep. What is the most appropriate nursing response?
The nurse is caring for a client who is having difficulty sleeping. Which medication does the nurse anticipate will be prescribed by the health care provider?
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 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.”
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.
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 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?
Which activity would be appropriate to suggest to the client who states that she has difficulty falling asleep every evening?
Drink a glass of warm milk before bed.
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.
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.
The nurse is attempting to wake a client from sleep and is having a difficult time arousing them. What stage of sleep does the nurse identify the client is experiencing?
The nurse should obtain a sleep history on which clients as a protocol?
all clients admitted to a health care agency
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.
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
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?
The client is a 76-year-old who reports difficulty falling asleep and daytime drowsiness. Which figure best reflects REM and NREM cycles of this client?
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.
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
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.”
The nurse is admitting a client that has obesity and is diagnosed with obstructive sleep apnea (OSA). The client states, "I just wake up a lot and don't feel rested but it's not a big deal." What education should the nurse provide about the complications related to OSA?
OSA contributes to hypertension and heart disease.
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
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 in circles under the eyes and excessive yawning by 1 week.
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.”
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.
A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client?
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.
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?
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 educating a client about nonpharmacologic measures to alleviate restless leg syndrome (RLS). Which education points would 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 relax the client and relieve symptoms
massaging the legs may relieve symptoms
The caregiver of a preschool-age child tells the nurse, “I am afraid my child sleeps too much,” and reports that the child takes a daily 2-hour nap in addition to sleeping 12 hours at night. What is the appropriate nursing response?
“Your child should get 10-13 total hours of sleep time in a 24-hour period.”
The nurse is providing client education for the parents of an obese child diagnosed with obstructive sleep apnea. What treatment measures would the nurse explain during the education session? Select all that apply.
a weight loss plan
use of a continuous passive airway pressure (CPAP) machine
use of a mandibular advancement device (MAD)
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 caring for a client who reports an inability to sleep. Which education provided by the nurse promotes sleep hygiene?
Ensure adequate exposure to natural sunlight during the day.
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.
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 his room is helpful."
Which is not a lifespan consideration for sleep cycles?
By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases.
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.