A nurse is assisting with teaching a client about the sleep-wake cycle. The nurse should include that which of the following factors can interfere with the sleep-wake cycle?

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.

Choice A reason : Change in marital status.A change in marital status is considered a social stressor rather than a physiological one. It relates to the personal and emotional aspects of one's life, impacting mental and emotional well-being rather than directly causing a physiological response.

Choice B reason : Financial difficulties.Financial difficulties are categorized as social stressors. They can lead to significant stress but do not directly cause a physiological response. Instead, they can indirectly affect health over time through sustained stress.

Choice C reason : Academic pressure.Academic pressure is a psychological stressor. It involves cognitive and emotional challenges that can lead to stress but is not a direct physiological stressor.

Choice D reason : Burn injury.A burn injury is a physiological stressor. It causes an immediate physical response in the body, triggering pain receptors, inflammatory responses, and the need for physical healing processes.