A nurse is assessing the status of a patient who is sleeping.
Which assessment data indicate that the patient is most likely in stage 3 of non-rapid eye movement (NREM) sleep?

Choice A rationale:

Excessive NREM sleep does not cause periodic pauses in breathing. NREM (Non-Rapid Eye Movement) sleep consists of stages 1 through 4 and is characterized by a decrease in physiological activity, including a decrease in muscle tone. There is no direct association with breathing interruptions in NREM sleep.

Choice B rationale:

Insomnia is a sleep disorder characterized by difficulty falling asleep or staying asleep, but it does not involve periodic pauses in breathing. It is unrelated to the symptoms described in the question.

Choice C rationale:

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness and sudden episodes of muscle weakness (cataplexy). It is not associated with periodic pauses in breathing, as described in the question.

Choice D rationale:

Sleep apnea is the correct answer. Sleep apnea is a sleep disorder characterized by repeated episodes of paused or shallow breathing during sleep. The patient may stop breathing for brief periods, then start breathing again. This pattern is consistent with the symptoms described in the question. Sleep apnea can have serious health implications and is important to recognize and address.

Choice A rationale:
Using a pain scale from 0 to 10 is a crucial principle in managing a client's postoperative pain. It allows for a standardized assessment of pain severity and helps healthcare providers determine the effectiveness of pain management interventions.
Choice B rationale:
Considering the client's individual expression of pain is essential in providing personalized care. People experience and express pain differently, so tailoring the approach to each client's unique needs is vital for effective pain management.
Choice C rationale:
Expecting the client to express pain both verbally and nonverbally is another important principle in pain management. Some clients may not be able to communicate verbally, so nurses should be attentive to nonverbal cues such as grimacing, restlessness, or changes in vital signs to assess pain.
Choice D rationale:
Administering opioids with caution is a general principle in pain management, but the statement that they will eventually lead to addiction is an oversimplification. While there is a risk of opioid addiction, it is not an absolute certainty, and the benefits of pain relief often outweigh the risks. Therefore, this statement is not entirely accurate.
Choice E rationale:
Administering analgesics for fast-acting pain relief is a valid principle, especially in the postoperative period when the client may be experiencing acute pain. Fast-acting analgesics help alleviate immediate discomfort.