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Which of these actions should the nurse take first for a patient in the clinic who is complaining of insomnia and daytime fatigue?
- A. Question the patient about the use of over-the-counter (OTC) sleep aids.
- B. Suggest that the patient decrease intake of caffeine-containing beverages.
- C. Advise the patient to get out of bed if unable to fall asleep in 10-20 minutes.
- D. Recommend that the patient use any prescribed sleep aids for only 2-3 weeks.
Correct Answer: A
Rationale: The nurse's first action should be assessment of the patient for factors that may contribute to poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions may be appropriate, but assessment is needed first to choose appropriate interventions to improve the patient's sleep.
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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.
Which action by the nurse manager of an acute care unit will improve the alertness of nurses who work the night shift?
- A. Arrange for older staff members to work most night shifts.
- B. Provide a sleeping area for staff to use for napping at night.
- C. Post reminders about the relationship of sleep and alertness.
- D. Schedule nursing staff to rotate day and night shifts monthly.
Correct Answer: B
Rationale: Short on-site naps will improve alertness. Rotating shifts causes the most disruption in sleep habits. Reminding staff members about the impact of lack of sleep on alertness will not improve sleep or alertness.
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.
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.
Which instruction will the nurse include when teaching a patient with chronic insomnia about ways to improve sleep quality?
- A. Avoid aerobic exercise during the day.
- B. Read in bed for a few minutes each night.
- C. Keep the bedroom temperature slightly warm.
- D. Try to go to bed at the same time every evening.
Correct Answer: D
Rationale: A regular evening schedule is recommended to improve sleep time and quality. Aerobic exercise may improve sleep quality, but should occur several hours before bedtime. Reading in bed is discouraged for patients with insomnia. The bedroom temperature should be slightly cool.