A nurse is assessing a client who has a long history of rheumatoid arthritis. The nurse should expect to find which of the following?

Choice A rationale

Sleep deprivation significantly disrupts the regulation of neurotransmitters in the brain, particularly serotonin and dopamine. These chemicals are essential for maintaining emotional stability and a balanced mood. When a person lacks sufficient restorative sleep, the amygdala becomes hyper-reactive to negative stimuli, leading to heightened emotional responses. This neurological irritability often manifests as sudden mood swings, irritability, or increased emotional sensitivity during daily interactions and tasks.

Choice B rationale

While tension headaches are commonly associated with high levels of stress or poor posture, they are not typically classified as a primary direct physiological adverse effect of sleep deprivation itself. Although a lack of sleep can lower a person's pain threshold or increase general discomfort, the clinical literature specifically focuses on cognitive and psychological impairments. Therefore, tension headaches are considered an indirect or secondary symptom rather than a primary diagnostic indicator of sleep loss.

Choice C rationale

Chronic insomnia and prolonged sleep deprivation are heavily linked to the development or exacerbation of depression. Lack of sleep impairs the prefrontal cortex, which is responsible for executive function and emotional regulation. This impairment can lead to persistent feelings of hopelessness, loss of interest in activities, and a general decline in mental health. Long-term disruption of the circadian rhythm often precedes clinical depressive episodes in many vulnerable patients in clinical settings.

Choice D rationale

Hyperreflexia refers to overactive or overresponsive bodily reflexes, which is usually indicative of an upper motor neuron lesion or specific electrolyte imbalances rather than simple sleep deprivation. Sleep loss tends to result in delayed reaction times and diminished motor coordination rather than an exaggerated reflex response. The physiological strain of insomnia typically suppresses the nervous system's efficiency, leading to lethargy and slowed physical movements rather than the spasticity seen in hyperreflexia.

Choice E rationale

Altered taste, or dysgeusia, is not a recognized physiological consequence of inadequate sleep. Taste perception is governed by the gustatory cells in the taste buds and the cranial nerves that transmit these signals to the brain. While sleep deprivation can influence appetite and cravings for high-calorie foods due to changes in ghrelin and leptin levels, it does not physically change the sensory mechanism of taste or the ability to distinguish between different flavor profiles.

Choice A rationale

This statement is incorrect because the National Council of State Boards of Nursing and the American Nurses Association recognize 5 rights of delegation, not 4. These rights include the right task, right circumstance, right person, right direction or communication, and right supervision or evaluation. Omitting any of these rights increases the risk of medical errors and compromises patient safety, as each component is essential for the legal and clinical validity of the delegation process.

Choice B rationale

While a nurse manager has overall responsibility for the unit's functioning, the primary responsibility for delegating specific nursing tasks during a shift lies with the individual licensed nurse. The registered nurse must assess the client's needs and the competency of the assistive personnel before delegating. Delegating is a dynamic, clinical decision-making process that occurs at the bedside throughout the shift rather than a static administrative duty performed solely by management.

Choice C rationale

This statement is dangerous and professionally inaccurate. A delegatee has a professional obligation to ask questions and seek clarification if they do not understand a task or feel incompetent to perform it safely. Clear communication is one of the five rights of delegation. If an assistive person performs a task without proper understanding, it can lead to patient injury. The delegating nurse must ensure the delegatee understands the expectations and reporting parameters.

Choice D rationale

This is the correct statement because the delegating nurse retains accountability for the outcome of the delegated task. While the delegatee is responsible for the performance of the activity, the licensed nurse is responsible for supervising, monitoring, and evaluating the results. The nurse must ensure the task was completed correctly and documented appropriately. This oversight ensures that the patient receives safe and effective care despite the task being performed by another individual.