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 : Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. While the causes of ADHD are not fully understood, current research does not establish childhood obesity as a direct risk factor for developing ADHD. ADHD is thought to be linked to genetic factors and certain environmental exposures during pregnancy.

Choice B reason : Hypotension, or low blood pressure, is generally not associated with childhood obesity. In fact, obesity, especially in the long term, is more commonly linked to hypertension (high blood pressure) due to increased strain on the heart and blood vessels, and not hypotension.

Choice C reason : Rheumatoid arthritis is an autoimmune condition that causes joint inflammation and damage. It is not typically considered a direct complication of childhood obesity. While obesity can contribute to joint problems due to increased mechanical stress, it is not a known cause of autoimmune conditions like rheumatoid arthritis.

Choice D reason : Diabetes mellitus, particularly type 2 diabetes, is a well-documented potential complication of childhood obesity. Obesity increases the risk of developing insulin resistance, which can lead to elevated blood sugar levels and eventually type 2 diabetes. The excess fat, particularly visceral fat, is associated with chronic inflammation and metabolic changes that contribute to the development of diabetes⁴.

Choice A reason : Using a cane to ambulate is generally a measure to improve stability and reduce the risk of falling for individuals who may have balance or mobility issues. It is not inherently a risk factor for falls; rather, it is a compensatory strategy to mitigate the risk of falls1.
Choice B reason : Macular degeneration can significantly impact visual acuity and contrast sensitivity, leading to difficulties in navigation and increasing the risk of tripping or misjudging distances. Poor vision is a well-documented risk factor for falls, especially in unfamiliar or complex environments.
Choice C reason : A grab bar in the bathroom is a safety device installed to provide stability and support for individuals while they are using the bathroom facilities. It is a preventive measure against falls and does not increase the risk of falling.
Choice D reason : An electrical cord on the floor over a walkway is a tripping hazard. It is a common home hazard that can cause falls, especially in the elderly or those with mobility and visual impairments78.
Choice E reason : Unsecured throw rugs over tile floors are a recognized fall hazard. They can easily slip underfoot or cause tripping if the edges are not secured, which is particularly dangerous in areas like the kitchen where spills can make the floor even more slippery.