HESI Sleep Patterns Case Study – Flashcards
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Which statement is the best description of the sleep pattern for a normal adult?
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An adult has four to six sleep cycles, each with NREM sleep and REM sleep during a normal night's sleep. About every 90 minutes, REM sleep recurs. When a sleeper awakens at any stage of the sleep cycle, the cycle must start again at Stage I.
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The nurse obtains a health history that reveals Mr. Owens is worried about the pressures of his new job. He has been unable to maintain his normal exercise routine and has gained 15 lbs. in the last 6 months. Mr. Owens admits he frequently smokes when he cannot sleep. His wife, who has accompanied him on the visit to the clinic, states his snoring has worsened in both frequency and noise level over the last 3 months. Mr. Owens has even resorted to taking one of his wife's diazepam (Valium) tablets before bedtime. The nurse recognizes Mr. Owens' anxiety should be based on what information?
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Anxiety stimulates the sympathetic nervous system resulting in less sleep. This chemical change causes increasing norepinephrine levels in the blood, lessens Stage IV NREM and REM sleep, and results in more awakenings.
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Mr. Owens reports that a few years ago he took temazepam (Restoril) for sleep, and it worked for a while. In which drug classification is temazepam (Restoril) found?
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Hypnotic. Temazepam (Restoril) is classified as a hypnotic medication: it is a benzodiazepine derivative with sedative effects.
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Mr. Owens asks the nurse if he can start taking Restoril again. How should the nurse respond?
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"You should be re-evaluated by a healthcare provider before resuming this medication." The client should always be re-evaluated before resuming any medication. A new prescription needs to be filled if indicated. Continued evaluation is also needed if temazepam (Restoril) is used for more than 2 weeks or in high doses, both of which put the client at risk for tolerance and/or physical dependence.
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The nurse assesses Mr. Owens for which other symptom that is commonly associated with sleep deprivation?
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Nocturia. Urination during the night disrupts the sleep cycle and contributes to sleep deprivation.
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The nurse formulates a plan of care for Mr. Owens. Which statement reflects an expected outcome for the nursing diagnosis, "Disturbed sleep pattern related to stress from new job."?
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Client will report a 50% decrease in night awakenings within one week. This outcome is directly related to the nursing diagnosis, is specific and measurable, and is realistically timed.
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Which intervention should the nurse add to Mr. Owens' plan of care?
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Instruct the client to get out of bed if unable to fall back to sleep within 30 minutes and do a quiet activity until becoming sleepy. Lying in bed awake for more than 30 minutes may increase anxiety and inhibit the onset of sleep. A quiet activity such as reading or muscle relaxation can be helpful.
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The nurse educates Mr. Owens on the effects that diet, exercise, stress reduction medications, and the environment have on sleep patterns. What information reflects correct client teaching?
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The presence of unusual stimuli or the absence of familiar stimuli may inhibit sleep. Any change in the environment can inhibit sleep, including a quiet, peaceful environment when the client is accustomed to noise.
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When teaching the client and his wife about actions to promote rest and sleep, the nurse demonstrates by administering a back massage on Mr. Owens. Which statement describes correct teaching?
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Effleurage the entire back using slow movement and light pressure. Effleurage is a French term meaning "to touch lightly." This type of massage typically uses a gentle, sweeping, relaxing stroke that glides over the skin.
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The Nurse Practitioner conducts a physical exam. While the practitioner agrees that job stress is exacerbating the disturbed sleep pattern, the wife's report of increased snoring episodes is disturbing. Diagnostic testing is prescribed. A polysomnogram (sleep study) reveals over 200 episodes of sleep apnea during the night. A pulse oximeter is used during the testing, and Mr. Owens' oxygen saturation level drops at times to 82%. Mr. Owens is diagnosed with obstructive sleep apnea, and he is prescribed a nasal continuous positive airway pressure (CPAP) device at night. Which statement describes the use of a pulse oximeter?
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Measures the arterial blood oxygen saturation using a noninvasive finger sensor. Arterial blood oxygen is non-invasively measured, and the percentage of hemoglobin that is saturated with oxygen is reported.
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How should the nurse explain obstructive sleep apnea to Mr. Owens and his wife?
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There is a lack of airflow through the nose and/or mouth for periods of 10 seconds or longer during sleep. This describes obstructive sleep apnea. Efforts by the brain and respiratory muscles continue, but airflow is obstructed.
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After providing teaching about use of the CPAP machine, the nurse schedules Mr. Owens for a follow-up visit, and he is instructed to call if questions arise. Mr. Owens returns to the clinic after using the CPAP machine at home for 3 months. He reports no improvement in his symptoms and appears disheveled and irritable. He describes sleeping only 3 or 4 hours each night and blames it on discomfort caused by the CPAP machine. The nurse records Mr. Owens' appearance and complaints. Which information is considered objective data by the nurse?
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Client yells at his wife when she says he is irritable. Because this was observed by the nurse, it is objective data.
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After further examination and testing by the healthcare provider, Mr. Owens is referred to a surgeon and is scheduled for removal of his tonsils and uvula to treat the obstructive sleep apnea. He is admitted to the hospital and an apnea monitor is prescribed. The charge nurse should assign Mr. Owens to which room?
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A private room near the nursing station and report room. Due to the increased monitoring necessitated by the client's sleep apnea, the room should be near the nursing station.
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To promote sleep in a hospitalized client, which intervention should the nurse implement?
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Close the door to the client's room whenever possible to decrease the noise level and light coming into the room. Reducing the amount of light and the noise of call lights, hallway traffic, and overhead paging are important nursing interventions to facilitate sleep for a hospitalized client.
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Mr. Owens refuses to wear the CPAP mask while hospitalized. The night before his surgical procedure, the pulse oximeter alarms. The nurse enters his room and observes that Mr. Owens is sleeping and his oxygen saturation has decreased to 84%. Which action should the nurse take?
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Gently shake the client to awaken him. Although the nurse wants to promote sleep, the client must be awakened to relieve the obstruction and increase oxygen saturation.
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At 3:00 a.m. Mr. Owens awakes and requests a sleeping pill, stating he needs to make sure he gets some sleep the night before surgery. His prescriptions include zolpidem tartrate (Ambien) 5 mg PO at bedtime PRN for sleep. His last respiratory rate while sleeping was 12 with an oxygen saturation level of 89%. His current vital signs are: P 80, B/P 120/70, R 22, T 98.9° F, and oxygen saturation 95%. Which data should the nurse consider when deciding whether or not to give this medication?
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Respiratory rate and oxygen saturation level while sleeping. These data are most indicative of the client's sleep oxygenation status, which may worsen when taking hypnotic medications.
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Mr. Owens' surgery is completed without complications. After a two hour stay in the post anesthesia unit, he returns to his room. The next day, the nurse notes a pattern in his vital signs. Mr. Owens' heart rate drops from 80 bpm to 65 bpm while sleeping. His oxygen saturation remains greater than 95% with regular respirations of 16 to 20 per minute. Which action should the nurse take?
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Document this expected finding. A decrease of up to 20 bpm during NREM sleep is considered a normal finding and a part of the body's circadian rhythm.
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In managing Mr. Owens' postoperative care, which task should the nurse delegate to the unlicensed assistive personnel (UAP)?
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Obtain pulse oximetry and respiratory rate every 2 hours. This task may be delegated. However, the nurse must then evaluate the data after it is obtained by the UAP.
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The nurse monitors Mr. Owens' postoperative lab values. The nurse notes that his white blood cell count (WBC) is 15,000 mm3. What assessment should the nurse perform first?
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Measure the tympanic temperature. The client's WBC is elevated, indicating a possible infection. The client should be assessed for fever.
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The nurse notifies the healthcare provider of the elevation in WBC and receives a prescription for an oral antibiotic. Mr. Owens is to receive the first dose prior to discharge. When entering his room with the medication, the nurse observes that Mr. Owens is asleep. His wife asks the nurse to leave the medication at the bedside for self-administration when he awakens. Which is the correct nursing action?
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Wake the client and administer the first dose of the antibiotic. Although the client may need sleep, his need for the antibiotic is greater.
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Mr. Owens has been prescribed levoflloxacin (Levaquin) 500 mg PO daily. The nurse has received 250 mg tablets from the pharmacy. Which nursing action should be taken?
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Administer two 250 mg tablets of the medication. Two 250 mg tablets = 500 mg.
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When leaving the hospital Mr. Owens states, "I really need to get back to work. All of this has caused a great strain on my job." How should the nurse respond to Mr. Owens' statement?
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"You seem concerned about missing work and the pressures of your job." The nurse is therapeutically restating the client's feelings, which is likely to encourage the client to continue the conversation.
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Mr. Owens is seen in the surgeon's office for his follow-up evaluation two weeks after his surgery. Which method effectively evaluates improvement of the client's sleep apnea as it relates to respiration?
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Review the sleep log kept by Mrs. Owens with recorded respiratory rate and pattern at night. A log of nightly respiratory rate and pattern specifically evaluates the nursing diagnosis of ineffective respiratory patterns.
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During the follow-up visit, Mr. Owens states, "I'm a little worried about my son. He is 16 and seems to be sleeping too much. If this keeps up, I'm afraid my sleep will be disturbed again!" Which initial response by the nurse is best?
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"Please tell me about your son's sleep habits." This information is needed to determine what is "too much." The response also invites the client to continue expressing his concerns.
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Mr. Owens reports his son sleeps sometimes until noon in the summer, but he often stays up very late at night. Which response by the nurse is best?
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"Many adolescents start developing this type of pattern as they develop independence." This is particularly common during the summer months, if there are no school obligations to make them rise earlier.
