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Which action is best for the nurse to include in the plan of care in order to improve sleep quality for a critically ill patient in the intensive care unit (ICU)?
- A. Ask all visitors to leave the ICU for the night.
- B. Lower the level of light from 8:00 P.M. until 7:00 A.M.
- C. Avoid the use of opioids for pain relief during the evening hours.
- D. Schedule assessments to allow at least 4 hours of uninterrupted sleep.
Correct Answer: B
Rationale: Lowering the level of light will help mimic normal day/night patterns and maximize the opportunity for sleep. Although frequent assessments and opioid use can disturb sleep patterns, these actions are necessary for the care of critically ill patients. For some patients, having a family member or friend at the bedside may decrease anxiety and improve sleep.
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Which information will the nurse plan to include when teaching a patient with narcolepsy about management of the disorder?
- A. Stimulant drugs should be used for only a short time because of the risk for abuse.
- B. Driving an automobile may be possible with appropriate treatment of narcolepsy.
- C. Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.
- D. Antidepressant drugs are prescribed to treat the depression caused by the disorder.
Correct Answer: B
Rationale: The accident rate for patients with narcolepsy who are receiving appropriate treatment is similar to the general population. Stimulant medications are used on an ongoing basis for patients with narcolepsy. The purpose of antidepressant drugs in the treatment of narcolepsy is the management of cataplexy, not to treat depression. Changes in sleep hygiene are recommended for patients with narcolepsy to improve sleep quality.
After the nurse has taught a patient about the use of extended-release zopiclone for insomnia, which patient statement indicates a need for further teaching?
- A. I will take the medication an hour before bedtime.
- B. I should take the medication on an empty stomach.
- C. I should not take this medication unless I can sleep for at least 6 hours.
- D. I will schedule activities that require mental alertness for later in the day.
Correct Answer: A
Rationale: Benzodiazepine receptor agonists such as zopiclone work quickly and should be taken immediately before bedtime, not one hour before. The other patient statements are correct.
A patient with sleep apnea who received a new prescription for a continuous positive airway pressure (CPAP) device a week ago returns to a clinic and says that severe daytime fatigue is still a problem. Which action should the nurse take first?
- A. Teach about radiofrequency ablation.
- B. Plan to schedule a nighttime PSG study.
- C. Ask the patient whether the CPAP is being used every night.
- D. Discuss the possible surgical approaches used for sleep apnea.
Correct Answer: C
Rationale: CPAP is very effective in reducing sleep apnea, but patient adherence is frequently a problem. Surgery, radiofrequency ablation, or a follow-up PSG study may be indicated, but the nurse's first action should be to assess whether the CPAP is being used as prescribed.
The nurse takes the health history for four patients in the clinic. Which information regarding the patients' sleep is most important to communicate to the health care provider?
- A. A 21-year-old student takes melatonin to assist in sleeping when travelling from Canada to Europe.
- B. A 32-year-old who is experiencing a stressful week uses diphenhydramine for several nights.
- C. A 41-year-old with a body mass index (BMI) of 42 kg/m?² says that the spouse complains about the patient's snoring.
- D. A 64-year-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning.
Correct Answer: C
Rationale: The patient's BMI and snoring suggest possible sleep apnea, which can cause complications such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to be affecting this patient's sleep quality.
The nurse is caring for a patient who has sleep deprivation and teaching about the effects that lack of sleep can have on the body. Which of the following information would be included in the teaching plan for this patient?
- A. Decreased insulin resistance
- B. Increased growth hormone
- C. Increased risk of type 2 diabetes
- D. Irritability, moodiness
- E. Increased risk of gastro-esophageal reflux disease (GERD)
Correct Answer: C, D, E
Rationale: Patients with sleep deprivation are at an increased risk of GERD, type 2 diabetes, heart disease, hypertension, and impaired immune function and can also experience cognitive impairment, and behavioural changes such as irritability and moodiness. Sleep deprivation causes an increase in insulin resistance and a decrease in growth hormone.