HESI Sleep Patterns Flashcards
scenario
The client is a 40-year-old scene in the medical clinic who is complaining of fear fatigue during the day. They also report waking up frequently throughout the night. They have a new baby at home, and a new job, which requires daily commute one hour each way to and From Work. Almost fell asleep while driving home last week and this is making them afraid to drive.
Which statement is the best description of the sleep pattern for a normal adult?
An adult has 4 to 6 sleep cycles, each with non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, during a normal normal night sleep
Rationale: every 90 minutes REM sleep recurs. When Sleeper awaken at any stage of the sleep cycle. It must start again at stage one.
The nurse obtains a health history that reveals the client is worried about the pressures of their growing family and new job. They have been unable to maintain their normal exercise routine and has gained 15 pounds in the last six months. The client admits they frequently smoke when they cannot sleep. Their spouse who has accompanied them on their visit to the clinic states that they’re snoring has worsened in both frequency and noise level over the last three months. The client has even resorted to taking one of the spouses diazepam tablets before bedtime.
How does the nurse respond to the clients disclosure that they use their spouses diazepam tablets to help them sleep?
You should not take someone else’s prescription.
Rationale: it is never appropriate for a nurse to suggest that a client takes someone else’s prescription, due to the risk of contraindications or drug interactions
The client reports a few years ago they took to Mazepin for sleep and it worked for a while. They ask if they can have a new prescription.
Which response by the nurses is most appropriate?
“ you should be reevaluated by a healthcare provider before resuming this medication.”
Rationale: the client should always be reevaluated before resuming any medication. A new prescription needs to be filled if indicated. Continued evaluation is also needed if temazepam is used for more than two weeks or in high doses, both of which put the client at risk for tolerance and/or physical dependence.
The nurse performs a focus assessment on the client before he sees the healthcare provider. As part of the assessment, the nurse evaluates the client for which additional symptoms that are commonly associated with sleep deprivation?
- Nocturia.
Rationale: urination during the night, disrupts, sleep cycle, and contributes to sleep deprivation - Sleep apnea.
Rationale: sleep apnea occurs when there is a lack of airflow through the nose and mouth for a period of 10 seconds, or longer during sleep, resulting in sleep deprivation
Based on the results from the assessment, the nurse formulates a plan of care for the client.
Which statements reflect potential, expected outcomes for the nursing diagnosis, “disturbed sleep pattern related to stress from new job?”
- Client can identify ways to relieve stress during the day and before bedtime.
Rationale: it is important for the client to be able to identify ways, relieve stress before going to bed at night - Client will report a 50% decrease in awakenings within one week.
Rationale: this outcome is directly related to the nursing diagnosis is specific in measurable, and is realistically timed - Client reports fewer incidences of dozing off during the day.
Rationale: it is important for the nurse to report less daytime sleepiness. This outcome is directly related to the nursing diagnosis.
Which intervention should the nurse add to the clients Plan of care?
- Monitor bedtime, food and beverage intake which might interfere with sleep.
Rationale: food and drinks, containing caffeine, stimulants, or alcohol, can do to fear with sleep patterns - And the client to get out of bed, if unable to fall back asleep within 30 minutes and do a quiet activity until becoming sleepy.
Rationale: lying in bed, awake for more than 30 minutes may increasing anxiety and inhibit onset of sleep. A quiet activity, such as reading or muscle relaxation can be helpful.
The HCP conducts a physical exam. While the HCP agrees that job stresses likely exacerbating this disturbed sleep pattern the spouse reports of increased snoring episodes is concerning. Diagnostic testing is prescribed a polysomnogram (sleep study) reveals more than 200 episodes of sleep apnea during the night pulse oximeter is used during the testing and the clients oxygen saturation levels dropped to 82% periodically. The client is diagnosed with obstructive sleep apnea and is prescribed a nasal continuous positive airway pressure (CPAP) device to be used at night
Which is the best explanation by the nurse instructing the client about the use of OSA?
There’s a lack of airflow through the nose and/or mouth for periods of 10 seconds, or longer during sleep
Rationale: this describes obstructive sleep apnea efforts by the brain and respiratory muscles continue but airflow is obstructed
The client returns to the clinic after using the CPAP machine at home for three months they report no improvement and their symptoms and appear is healed and irritable. They describe sleeping only three or four hours each night and blames it on discomfort caused by CPAP machine. the nurse record the clients appearance and their complaints in the chart
The nurse considers which information to be subjective data?
- Client states he only sleeps three or four hours per night.
Rationale: the statement by the client subjective data - The client reports that the CPAP apparatus is uncomfortable.
Rationale: the client reports the data of making it subjective - The client states he has been yawning a lot at home.
Rationale: information reported by the wife is subjective
After further examination and testing by the HCP, the client is referred to a surgeon and is scheduled for a uvulopalatopharyngoplasty the removal of tissue in the throat to treat the obstructive sleep apnea the client is admitted to the hospital and an apnea monitor is prescribed
The nurse should assign the client to room?
A private room near the nursing station and report room
Rationale: due to increased monitoring necessitated, this client sleep apnea. The client room should be near the nursing station.
To promote sleep for hospitalized client which intervention should the nurse implement?
Close the door to the clients room, whenever possible to hear the noise level and light coming into the room
Rationale: reducing the amount of light and noise of the car, lights, hallway, and overhead paging are important nursing interventions to facilitate sleep in a hospitalized client
The client refuses to wear the CPAP mask while hospitalized. The night before the surgical procedure of the pulse oximeter alarms. The nurse enters a clients room observes that they are sleeping, and that their oxygen saturation has decreased to 84%.
Which priority action should the nurse implement?
Gently shake the client to awaken him
Rationale: although the nurse wants to promote sleep, the client must be awaken to relieve the obstruction increase oxygen saturation 
At 3 AM the client awaits and requests a sleeping pill stating they need to make sure they get some sleep the night before surgery. Their prescriptions includes zolpidem tartrate 5 mg PO at bedtime PRN for sleep. Their last respiratory rate while sleeping was 12 with an oxygen saturation level of 89% their current vital signs are P 80 beats/min, BP 120/70 mmHg, R 22 breaths/men, T 98.9°F (37.16° C) , and oxygen saturation 95%
How should the nurse proceed?
Explain that their oxygen saturation level is too low and that it wouldn’t be safe
Rationale: the client saturation level is too low, in order to tolerate the hypnotic drug, which will likely drop their oxygen saturation level further
The client surgery is completed without complications after two hour stay in the post anesthesia unit. They returned to their room the next day the nurse observes the following vital signs: the clients heart rate drops from 80 BPM to 65 BPM while they are sleeping. Their oxygen saturation remains greater than 95% with regular, respirations of 16 to 20 per minute
What action should the nurse implement?
Document this expected finding
rationale: I do decrease of up to 20 BPM during NREM sleep is considered a normal, finding in a part of the bodies circadian rhythm
And managing the clients post operative care which tasks should the RN delegate to the UAP?
- Obtain pulse oximetry and respiratory rate every two hours.
Rationale: this task may be delegated. However, the nurse must evaluate the data after it is obtained by the UAP. - Serve the prescribe breakfast tray to the client.
Rational: this task may be delegated to the UAP
