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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.
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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.
A patient experiencing menopause tells the nurse at the medical clinic that she would like to try a CAH hormonal sleep aid like her friend uses. What information can the nurse give the patient?
- A. Melatonin, an over-the-counter hormonal sleep aid, has varied effectiveness.
- B. Lavender is a hormonal scented sleep aid.
- C. Lorazepam, a naturally occurring benzodiazepine, is recommended for sleep.
- D. Valerian is a natural hormonal sleep aid.
Correct Answer: A
Rationale: Melatonin, used as a complementary or alternate to traditional pharmacologic agents, is a hormone thought to regulate the sleep-wake cycle. Valerian is an herb; lavender is a plant used for aromatherapy and relaxation. Benzodiazepines are pharmacologic medications used to decrease anxiety and promote sleep and relaxation.
A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep?
- A. Patient taking iron supplements for anemia
- B. Patient with Parkinson's disease who is taking dopamine
- C. Older adult taking diuretics for congestive heart failure
- D. Child taking antibiotics for an ear infection
- E. Patient taking antidepressants
- F. Patient taking low-dose aspirin prophylactically
Correct Answer: B,C,E
Rationale: Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems.
A nurse recommends that a patient with a sleep disorder keep a sleep diary. Which data will the nurse ask the patient to document?
- A. Daily mental activities
- B. Daily physical activities
- C. Morning and evening body temperature
- D. Daily measurement of fluid intake and output
- E. Presence of anxiety or worries affecting sleep
- F. Morning and evening blood pressure readings
Correct Answer: A,B,E
Rationale: A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is typically kept in the graphic record.
A nurse observes involuntary muscle jerking in a sleeping patient. What action will the nurse take next?
- A. No action is necessary; this is normal in stage 1 sleep.
- B. Report the neurologic deficit to the health care provider.
- C. Lower the temperature in the patient's room.
- D. Awaken the patient, as this is an indication of night terrors.
Correct Answer: A
Rationale: Involuntary muscle jerking occurs in stage I NREM sleep and is a normal finding. No further actions are needed for this patient.