A nurse is assisting with teaching a class about physiological changes that occur during sleep. The nurse should include that which of the following changes occur during non-rapid eye movement (NREM) sleep?

Choice A reason : Decreased blood pressure is not a typical response to the fight-or-flight reaction. During this response, blood pressure usually increases due to the release of stress hormones like adrenaline, which cause the heart to beat faster and harder.

Choice B reason : Dilated pupils are a common manifestation of the fight-or-flight response. This physiological change allows more light into the eyes, which can improve vision and help an individual to better assess the situation and respond to potential threats.

Choice C reason : Bronchial airway constriction is not associated with the fight-or-flight response. In fact, the bronchial airways typically dilate to increase airflow and oxygen intake to prepare the body for action.

Choice D reason : Hypoglycemia, or low blood sugar, is not a direct result of the fight-or-flight response. The body actually mobilizes glucose stores, leading to elevated blood sugar levels, to provide energy for muscles during a stress response.

Choice A reason : Administering an opioid narcotic can be an effective measure for managing dyspnea in end-of-life care. Opioids, such as morphine, can reduce the sensation of breathlessness and improve comfort without significantly affecting oxygen saturation levels. The use of opioids is a well-established practice in palliative care for the relief of dyspnea, particularly when other causes of dyspnea have been addressed and managed appropriately.

Choice B reason : Increasing the heat in the client's room is not a recommended action for managing dyspnea and may actually worsen the client's comfort. Patients experiencing dyspnea often feel better in a cooler environment, as warm temperatures can make breathing feel more labored⁴.

Choice C reason : Placing the head of the client's bed flat is not advisable for managing dyspnea. Elevating the head of the bed can help ease breathing by reducing pressure on the diaphragm and allowing for better lung expansion. A semi-upright position, such as Fowler's or semi-Fowler's position, is typically recommended for patients experiencing dyspnea.

Choice D reason : Nasotracheal suctioning is a procedure used to clear secretions from the airway. While it may be necessary in some cases, it is not a standard action for managing dyspnea in end-of-life care unless there is a specific indication, such as excessive secretions that the patient cannot clear on their own. It can be uncomfortable and distressing for the patient and should be used judiciously⁵.