A nurse is caring for a client who has depression.

After two days of treatment, the nurse notices that the client is suddenly more active and there are no longer signs of a depressive state.

Which of the following interventions should the nurse recommend for the plan of care?

A rationale:

Going to another room and reading for 20 minutes when waking up at night is a recommended strategy for managing insomnia. This technique helps to break the cycle of lying in bed awake and worrying, which can worsen insomnia. Reading can be a relaxing activity that can help to promote sleepiness. It's important to choose a book that is not too stimulating and to avoid reading in bright light.

Choice B rationale:

Stopping napping in the afternoon is also a recommended strategy for managing insomnia. Napping can interfere with nighttime sleep by reducing sleep drive. It's best to avoid napping altogether or to limit naps to 30 minutes or less early in the afternoon.

Choice C rationale:

Watching television in the bedroom is not recommended for managing insomnia. The light from the television can suppress the production of melatonin, a hormone that helps to regulate sleep. The noise from the television can also be stimulating and make it difficult to fall asleep. It's best to avoid watching television in the bedroom or to turn off the television at least 30 minutes before bedtime.

Choice D rationale:

Eating the evening meal at least 3 hours before bed is generally a good practice for sleep hygiene. Eating too close to bedtime can lead to indigestion, which can make it difficult to fall asleep. It's best to avoid heavy, fatty, or spicy foods before bed.

Choice A rationale:

Disorientation is a significant neurological finding that can signal a serious adverse reaction to lorazepam, particularly in older adults. It's crucial to report it immediately to the provider for prompt assessment and intervention.

Lorazepam, a benzodiazepine, can cause central nervous system (CNS) depression, which can manifest as disorientation, confusion, memory impairment, and even delirium.

Older adults are more vulnerable to CNS depressant effects due to age-related physiological changes, such as decreased metabolism and clearance of medications, as well as increased brain sensitivity.

Early identification and management of disorientation can prevent potential complications, such as falls, injuries, and worsening cognitive decline.

Choice B rationale:

Increased anxiety can be a paradoxical reaction to lorazepam, but it's not as immediately concerning as disorientation in terms of potential for serious harm.

The nurse should still monitor anxiety levels and report any significant changes to the provider, as dosage adjustments or alternative medications may be necessary.

Choice C rationale:

Blurred vision is a common side effect of lorazepam, but it's typically mild and transient.

It's important to assess the severity and duration of blurred vision and report it to the provider if it persists or interferes with daily activities.

Choice D rationale:

Anorexia, or loss of appetite, can be a side effect of lorazepam, but it's not as urgent as disorientation.

The nurse should monitor the patient's nutritional intake and weight, and report any significant changes to the provider.