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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.
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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.
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 on a postpartum unit is teaching new parents about newborn safety and sleep patterns. Which comment from a parent indicates further teaching is required?
- A. I can expect my newborn to sleep an average of 16 to 24 hours a day.
- B. Eye movements or groans during my baby's sleep is an emergency.
- C. It is essential that I place my infant on their back to sleep.
- D. I will not place pillows or blankets in the crib to prevent suffocation.
Correct Answer: B
Rationale: Eye movements, groaning, grimacing, and moving are normal activities at this age; no emergency exists. Newborns sleep an average of 16 to 24 hours a day. Infants should be placed on their backs for the first year to prevent SIDS. Parents should be cautioned about placing pillows, crib bumpers, quilts, stuffed animals, and other items in the crib as they pose a suffocation risk.
A nurse is caring for an older adult who is having trouble falling asleep at night. What nursing interventions are appropriate for this patient?
- A. Assess the patient for depression.
- B. Discourage napping during the day.
- C. Decrease fluids during the evening.
- D. Administer diuretics in the morning.
- E. Encourage the patient to engage in some type of physical activity.
- F. Assess medication for side effects of sleep pattern disturbances.
Correct Answer: A,B,C,D,E,F
Rationale: For patients who are having trouble initiating sleep, the nurse should arrange for assessment for depression and treatment, discourage napping, promote activity, and assess medications for sleep disturbance side effects. Limiting fluids and administering diuretics in the morning are appropriate interventions.
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.