Nokea
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.
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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 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.
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 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 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.