Sleep, Rest, And Palliative Comfort
Help Questions
NCLEX-PN › Sleep, Rest, And Palliative Comfort
A client in a long-term care facility tells the practical nurse (PN) that they have difficulty falling asleep at night. Which action should the PN take to promote the client's rest?
Tell the client to take a long nap in the afternoon.
Recommend the client watch television until they feel tired.
Offer the client a warm, non-caffeinated beverage before bedtime.
Suggest the client exercise vigorously one hour before bedtime.
Explanation
Offering a warm, non-caffeinated beverage, such as milk or herbal tea, can be a relaxing ritual that promotes sleep. Watching television can be stimulating and interfere with sleep. Long afternoon naps can disrupt nighttime sleep patterns. Vigorous exercise close to bedtime can increase alertness and make it harder to fall asleep.
The practical nurse (PN) is reinforcing teaching with an older adult client about sleep hygiene. Which statement by the client indicates that the teaching has been effective?
"I'll have a cup of coffee in the evening to keep me warm."
"I should try to go to bed and wake up at the same time every day."
"I will drink a glass of wine each night to help me relax."
"It's best if I stay in bed and try to sleep, even if I'm wide awake."
Explanation
Maintaining a consistent sleep-wake schedule, even on weekends, helps regulate the body's internal clock and promotes better sleep quality. Alcohol (wine) can disrupt the sleep cycle. Staying in bed when unable to sleep can create a negative association with the sleep environment. Coffee contains caffeine, a stimulant that should be avoided in the evening.
The practical nurse (PN) is caring for a client who is terminally ill and unconscious. The family asks why the nurse is providing frequent mouth care. What is the PN's best response?
"It is a required facility policy for all clients."
"It helps stimulate the client's appetite."
"It prevents the development of cavities."
"It keeps the mouth moist and promotes comfort."
Explanation
For an unconscious or terminally ill client, especially one who may be mouth-breathing or receiving medications that cause dry mouth, frequent oral care is essential to prevent drying and cracking of the mucous membranes, which can be a significant source of discomfort. Preventing cavities is not the primary goal in palliative care. While it may be policy, explaining the comfort-related rationale is more therapeutic. Appetite stimulation is not relevant for an unconscious client.
A client in the hospital complains that the noise from the hallway is keeping them awake. Which action should the practical nurse (PN) take?
Ask the charge nurse to move the client to a private room.
Tell the client that noise is unavoidable in a hospital.
Close the client's room door and offer earplugs.
Administer a prescribed sleeping medication immediately.
Explanation
The most direct and appropriate action is to reduce the environmental stimuli. Closing the door is a simple, effective measure, and offering earplugs provides the client with an additional tool to block out noise. This approach addresses the client's specific complaint with a non-pharmacological, client-centered solution. Telling the client noise is unavoidable is unhelpful. Requesting a room change may not be feasible and is not the first step. Medication should be considered after simpler measures fail.
A client receiving palliative care is restless and moaning. The client has a prescription for morphine sulfate every 4 hours as needed for pain. The last dose was given 4 hours ago. Which action is the priority for the practical nurse (PN)?
Administer the prescribed dose of morphine sulfate.
Turn and reposition the client for comfort.
Document the client's restlessness in the chart.
Ask the client's family if this is normal behavior.
Explanation
Restlessness and moaning are key indicators of pain, especially in a client who may be unable to verbalize their needs. Since the last dose was 4 hours ago and the medication is available, the priority action is to provide pain relief by administering the prescribed analgesic. While repositioning and documentation are important, they do not address the most likely cause of the client's distress. Asking the family can provide context but should not delay pain management.
The practical nurse (PN) is assisting a client with preparing for sleep. The client states, "I'm so worried about my surgery tomorrow that I'll never get to sleep." What is the most therapeutic response by the PN?
"Don't worry, you have an excellent surgeon."
"It sounds like you are feeling anxious. Would you like to talk about it?"
"I can ask the nurse for a sleeping pill for you."
"Let's watch some TV to take your mind off of it."
Explanation
This response uses the therapeutic communication techniques of reflecting and offering self. It acknowledges the client's feelings (anxiety) and provides an opportunity for the client to verbalize their concerns, which can help reduce stress and promote rest. Telling the client not to worry dismisses their feelings. Offering a pill or a distraction avoids addressing the underlying emotional need.
The practical nurse (PN) observes that a client with dementia is becoming increasingly agitated and restless in the late afternoon. This client has a history of 'sundowning'. Which intervention is most appropriate to promote rest for this client?
Encouraging a group activity with other residents.
Waiting until the client falls asleep from exhaustion.
Turning on bright, overhead lights in the room.
Playing soft, familiar music and reducing stimuli.
Explanation
For a client with dementia experiencing sundowning, a calm and quiet environment is crucial. Reducing stimuli, such as noise and excessive light, and playing familiar music can have a soothing effect, decrease agitation, and promote rest. Bright lights can be overstimulating. A group activity may overwhelm the client. Allowing the client to become exhausted is not a therapeutic or safe approach.
A client is scheduled for a procedure in the morning and has a prescription for a sedative-hypnotic to be given at bedtime. After administering the medication, which action is a priority for the practical nurse (PN)?
Raise the side rails on the bed and place the call light within reach.
Ensure the client has snacks available at the bedside.
Tell the client to report any dizziness in the morning.
Document that the medication was administered.
Explanation
Sedative-hypnotics can cause dizziness, drowsiness, and impaired coordination, which significantly increases the risk for falls. The priority action after administration is to implement safety measures, such as raising the side rails (per facility policy) and ensuring the call light is easily accessible so the client can call for assistance before getting out of bed. While documentation is required, immediate client safety is the priority. Snacks are not a priority, and safety instructions should be given before the client becomes drowsy.
A client on a palliative care service has Cheyne-Stokes respirations. The client's family is distressed by the breathing pattern. Which action should the practical nurse (PN) take?
Notify the health care provider of respiratory distress.
Administer a prescribed bronchodilator.
Auscultate the client's lung sounds immediately.
Explain that this is an expected breathing pattern near the end of life.
Explanation
Cheyne-Stokes respirations (alternating periods of apnea and deep, rapid breathing) are a common and expected finding in the actively dying process. The priority is to provide emotional support and education to the family. Explaining that this is an expected pattern can help reduce their anxiety and fear. The pattern does not typically cause distress to the client and does not usually require pharmacological intervention or immediate notification of the provider in a palliative care context.
The practical nurse (PN) enters the room of a client who is sleeping and finds a family member waking them up to talk. Which action should the PN take?
Document the family's interruption in the client's chart.
Ignore the situation as it is a family matter.
Quietly explain to the family member the importance of uninterrupted rest for healing.
Tell the family member they must leave the room immediately.
Explanation
The PN acts as a client advocate by promoting an environment conducive to rest. Gently and respectfully educating the family about the client's need for sleep is the most therapeutic and appropriate action. It addresses the issue without being confrontational. Ordering the family to leave is unnecessarily harsh. Ignoring the situation fails to advocate for the client's needs. Documentation is appropriate, but direct intervention is needed first.