Nursing Care to Promote Sleep and Rest

Every question here, with the answer

1. A patient reports poor sleep and says, “I work nights, so I sleep during the day when I’m working, but my schedule changes on days off.” What is the best nursing action during the focused sleep assessment?

   1. Delay questions about sleep timing until after a sleep study is completed.
   2. Tell the patient to use the same bedtime as day-shift workers.
   3. Focus only on medication history because schedule changes are expected with night work.
   4. Modify the assessment to ask about sleep timing during workdays versus days off.

   Answer: Modify the assessment to ask about sleep timing during workdays versus days off.

   For patients who work nights, the nurse should adjust the sleep assessment and ask follow-up questions about work time versus time off. The other options either ignore the patient’s actual schedule, delay needed assessment, or narrow the assessment too much.

2. The nurse is teaching a patient with insufficient sleep how to keep a sleep log. Which items should the nurse ask the patient to record? Select all that apply.

   1. The sleep specialist’s interpretation of a hypnogram
   2. Caffeine or alcohol amount and timing
   3. What medications are taken and at what times
   4. Number and duration of sleep disruptions
   5. Exercise frequency, timing, and duration

   Answer: Caffeine or alcohol amount and timing, What medications are taken and at what times, Number and duration of sleep disruptions, Exercise frequency, timing, and duration

   A sleep log should include factors such as medications, exercise, disruptions, naps, and caffeine or alcohol use because these help identify patterns and sleep hygiene issues. The sleep specialist’s hypnogram interpretation is part of sleep study review, not an item the patient records in a sleep diary.

3. A patient scheduled for polysomnography says, “I’m worried because I don’t understand what all the wires are for.” Which response by the nurse is most appropriate?

   1. “The study mainly reviews the sleep log you completed at home.”
   2. “The test only checks your oxygen level while you sleep.”
   3. “The wires are used to give medication if you stop sleeping during the study.”
   4. “The test records several body functions during sleep, including brain waves, heart rhythm, eye movements, muscle movements, and oxygen saturation.”

   Answer: “The test records several body functions during sleep, including brain waves, heart rhythm, eye movements, muscle movements, and oxygen saturation.”

   Polysomnography records multiple physiologic measures, including EEG, ECG, EOG, EMG, and SaO2. The other responses are incomplete or incorrect because the study is not limited to oxygen monitoring, medication delivery, or sleep log review.

4. A patient asks what activities may help create a relaxing bedtime routine. Which options should the nurse include? Select all that apply.

   1. Using a cell phone or tablet as the main bedtime activity
   2. Reading before sleep
   3. Watching television in bed until sleepy
   4. Practicing meditation
   5. Listening to mellow sounds or music

   Answer: Reading before sleep, Practicing meditation, Listening to mellow sounds or music

   The section identifies mellow sounds or music, reading, and meditation as possible relaxation routine activities. Watching TV and using electronic devices tend to stimulate rather than relax and may make it harder to fall asleep.

5. A nurse is preparing to administer a medication for sleep but is unsure whether two ordered medications are compatible in the same syringe. What is the safest nursing action?

   1. Administer the medications by the most convenient route to reduce patient discomfort.
   2. Rely on memory if the nurse has given the medications before.
   3. Ask the patient’s family whether the medications have been given together in the past.
   4. Consult interdisciplinary partners or current written or electronic resources before administration.

   Answer: Consult interdisciplinary partners or current written or electronic resources before administration.

   Safe medication administration requires the nurse to use current resources and interdisciplinary collaboration rather than relying on memory. Convenience or family recall does not replace verification of compatibility, dose, route, and administration safety.

6. A patient is beginning a medication to promote sleep. Which nursing actions or teaching points are appropriate? Select all that apply.

   1. Anticipate laboratory tests for organ function when indicated.
   2. Teach the patient about signs and symptoms of serious allergic reactions such as angioedema and anaphylaxis.
   3. Tell the patient that over-the-counter and herbal sleep remedies do not need to be discussed with the healthcare team.
   4. Tell the patient that hallucinations or seizures are expected and harmless effects of sleep medications.
   5. Perform frequent assessments and reassessments for effectiveness and results.

   Answer: Anticipate laboratory tests for organ function when indicated., Teach the patient about signs and symptoms of serious allergic reactions such as angioedema and anaphylaxis., Perform frequent assessments and reassessments for effectiveness and results.

   Sleep-promoting medications can significantly affect the CNS, and nurses should assess and reassess for effectiveness and results. The section also notes possible cardiovascular, respiratory, renal, and allergic concerns, so organ function testing and education about serious allergic reactions may be needed; hallucinations or seizures are serious CNS effects, and OTC or herbal products can be relevant to safety.