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A nurse caring for patients in a long-term care facility is implementing interventions to help promote sleep in older adults. Which is the best action for these patients?
- A. Increase physical activities during the day.
- B. Encourage short periods of napping during the day.
- C. Increase fluids during the evening.
- D. Dispense diuretics during the afternoon hours.
Correct Answer: A
Rationale: In order to promote sleep in the older adult, the nurse should encourage daily physical activity such as walking or water aerobics. The nurse discourages napping during the day, decreases fluids at night, and dispenses diuretics in the morning (or early evening when necessary).
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A nursing student is caring for an older adult with arthritis who states she did not sleep well and was 'up all night to use the bathroom.' To help promote sleep, the student plans to discuss re-timing which medication with the primary nurse?
- A. Furosemide (diuretic) 10:00 AM, 10:00 PM
- B. Melatonin 9:00 PM
- C. Acetaminophen 10:00 AM, 10:00 PM
- D. Artificial tears every 8 hours, 8:00 AM, 2:00 PM, 8:00 PM
Correct Answer: A
Rationale: It is best to administer diuretics in the morning or early evening to prevent nocturia. Melatonin promotes sleep and rest. Acetaminophen can relieve arthritis pain and help promote rest. Artificial tears, used for dry eyes, will not affect sleep.
After reporting an adult patient's loud snoring and changes in vital signs occurring overnight the patient's health care provider, a nocturnal polysomnography study is prescribed. What teaching will the nurse provide about this test?
- A. This is a blood test, taken in the evening to evaluate leptin and ghrelin.
- B. The patient is monitored overnight to evaluate for sleep apnea.
- C. A patient is evaluated for leg jerking and awakenings during the night.
- D. Adults, rather than children, can be diagnosed with this test.
Correct Answer: B
Rationale: Polysomnography is an overnight sleep study to determine if an individual has sleep apnea and treatment. Leptin and ghrelin are hormones that regulate nutritional intake. Leptin signals the brain to stop eating, whereas ghrelin promotes continued eating. Research suggests that sleep deprivation lowers leptin levels and elevates ghrelin levels, increasing appetite; however, this does not help diagnose sleep apnea. Jerking legs in the early stage of intravenously is expected. Both adults and children can benefit from diagnosis of sleep apnea with this test.
A nurse in a pediatric unit notes a school-aged child snores and appears to have labored breathing during sleep. Which assessment question could the nurse ask the patient or parents?
- A. Do you have trouble sleeping?
- B. Have you missed a lot of school due to not feeling well?
- C. Have you been wetting the bed lately?
- D. Do you have a history of high blood pressure?
Correct Answer: C
Rationale: OSA (pediatric) is defined by the presence of snoring, labored/obstructed breathing, enuresis, or daytime consequences (hyperactivity or other neurobehavioral problems, sleepiness, fatigue). Adults, children, and adolescents with symptoms of OSA, including snoring, should have polysomnography to confirm the diagnosis. Although OSA may cause insomnia, this is not the primary diagnosis in this case. Narcolepsy is a condition characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. Hypertension is a consequence of OSA in adults.
A nurse caring for patients on a surgical unit should implement which recommendation to promote sleep?
- A. Keep the room light dimmed during the day.
- B. Maintain a cool temperature in the room for sleep.
- C. Keep the door of the room open for fresh air.
- D. Offer a hypnotic to patients on a regular basis.
- E. Offer pain medication prior to sleep, as needed.
- F. Provide earplugs if the patient agrees.
Correct Answer: B,E,F
Rationale: The nurse should keep the room cool and provide earplugs and eye masks if desired. The nurse should maintain a bright room environment during daylight hours and dim lights in the evening, keeping the door of the room closed to keep out extraneous noise. Sleep aid medications should only be offered as prescribed with the knowledge that they can become habit forming.
A nurse in a rehabilitation facility develops a plan to help promote patients' sleep. What interventions will the nurse include in the plan?
- A. Maintain a consistent bedtime and time to awaken.
- B. Drink two or three glasses of water at bedtime.
- C. Have a large snack at bedtime.
- D. Take a sedative-hypnotic every night at bedtime.
Correct Answer: A
Rationale: Keeping a consistent bedtime and awakening schedule, even when up late, helps promote sleep. Drinking two or three glasses of water at bedtime will probably cause the patient to awaken during the night to void. A large snack may be uncomfortable right before bedtime; instead, a small protein and carbohydrate snack is recommended. Taking a sedative-hypnotic every night disturbs REM and NREM sleep, and sedatives also lose their effectiveness quickly.