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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.
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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 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 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 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 working the night shift is watching the monitors on a telemetry unit and observes a slight increase in a patient's vital signs during sleep. Which of these points will the nurse correlate to changes in vital signs?
- A. They are aware of his surroundings at this point.
- B. They are in delta sleep at this time.
- C. It would be most difficult to awaken them at this time.
- D. This is most likely an NREM stage.
- E. This stage constitutes around 20% to 25% of total sleep.
- F. The muscles are relaxed in this stage.
Correct Answer: C,E
Rationale: This scenario describes REM sleep. During REM sleep, it is difficult to arouse a person, and the vital signs increase. REM sleep constitutes about 20% to 25% of sleep. In stage I NREM sleep, the person is somewhat aware of surroundings. In stage IV NREM sleep (delta sleep), the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.