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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.
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As part of interprofessional rounds, a nurse in a skilled facility assesses for sleep deficits. Patients with which health problems would the team identify as higher risk for sleep disturbances?
- A. Uncontrolled hypothyroidism
- B. Anxiety
- C. GERD
- D. HIV
- E. Arthritis
- F. Urinary tract infection
Correct Answer: A,B,C
Rationale: A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. Worries and anxiety can interfere with sleep, as can pain. A patient who has GERD may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.
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).
A nurse is providing education in a senior center on sleep and sleep hygiene in older adults. What teaching point will the nurse include?
- A. Drinking a cup of regular tea at night induces sleep.
- B. Using alcohol moderately promotes a deep sleep.
- C. Eating a bedtime snack high in tryptophan and carbohydrates improves sleep.
- D. Exercising right before bedtime can hinder sleep.
Correct Answer: C
Rationale: The nurse would teach that having a small bedtime snack high in tryptophan and carbohydrates improves sleep. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity within a 3-hour interval before normal bedtime can hinder sleep.
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.
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.