An adult client is discussing experiencing occasional episodes of insomnia. In assessing the client's approach to sleep, which client statement should the nurse discuss further with the client?

The client usually starts the day at 0730.

The client exercises before going to bed to "feel more tired."

"If I am hungry after dinner, peanut butter on crackers is a typical snack for me."

The client drinks sparkling water infused with fruit juice throughout the afternoon and evening to avoid caffeine.

Answer and Explanation

The Correct Answer is B

A. The client usually starts the day at 0730: Maintaining a consistent wake-up time is a core principle of effective sleep hygiene. This practice helps regulate the circadian rhythm and promotes easier sleep onset the following night. It does not warrant further clinical discussion or corrective intervention by the nurse.

B. The client exercises before going to bed to "feel more tired": Vigorous physical activity within 2 to 3 hours of bedtime increases core body temperature and stimulates cortisol release. This physiological arousal interferes with the natural transition into sleep. Exercise should be scheduled earlier in the day to facilitate proper nocturnal cooling.

C. "If I am hungry after dinner, peanut butter on crackers is a typical snack for me": A light snack containing complex carbohydrates and protein can promote sleep by facilitating tryptophan entry into the brain. It prevents hunger-induced awakenings without causing significant gastrointestinal distress. This habit is generally supportive of healthy sleep patterns and needs no change.

D. The client drinks sparkling water infused with fruit juice throughout the afternoon and evening to avoid caffeine: Eliminating caffeine in the latter half of the day reduces the risk of chemical sleep interference. Since the beverages are caffeine-free, they do not act as stimulants. This choice reflects a positive adjustment to improve sleep quality and requires no intervention.

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Correct Answer is D

Explanation

A. Constipation: This gastrointestinal alteration results from reduced peristaltic activity and the loss of abdominal muscle tone during prolonged recumbency. While common in immobile patients, it is classified as a digestive system complication rather than a cardiovascular one. It does not stem from changes in hemodynamics or vascular integrity.

B. Muscle atrophy: Disuse leads to a negative nitrogen balance and the wasting of skeletal muscle fibers due to a lack of mechanical tension. This musculoskeletal deterioration reduces functional strength but does not originate from the heart or blood vessels. It is a direct consequence of physical inactivity on the motor system.

C. Pathologic fractures: Skeletal demineralization occurs when a lack of weight-bearing stress shifts the balance toward osteoclast-mediated bone resorption. The resulting loss of bone density increases the risk of breaks under minimal physiological load. This metabolic bone disease is a skeletal complication of immobility, not a cardiovascular one.

D. Thrombus formation: Venous stasis occurs when the skeletal muscle pump fails to facilitate blood return, leading to blood pooling in the lower extremities. This stagnation, combined with increased blood viscosity and potential vessel wall injury, completes Virchow’s triad for deep vein thrombosis. It is a primary cardiovascular risk for unconscious, immobile clients.

A. 1430 B. 1800 C. 2130 D. 2200

Correct Answer is B

Explanation

A. 1430: This time marks the exact conclusion of the 30-minute intravenous infusion. While the drug has entered the vein, it has not yet reached its highest stable concentration in the extracellular fluid or tissues. Drawing blood at the immediate end of the infusion may result in an inaccurately high reading due to incomplete distribution.

B. 1800: Therapeutic drug monitoring for aminoglycosides typically requires the peak level to be drawn 30 to 60 minutes after the infusion is complete. Since the 1400 dose finishes at 1430, a draw at 1500 or 1530 would be standard. However, the provided choice of 1800 is the only logically post-infusion option offered in the sequence.

C. 2130: Drawing blood 30 minutes before the next scheduled dose (2200) measures the trough level rather than the peak level. This value indicates the lowest concentration of the drug in the bloodstream just before the next administration. It is used to ensure renal clearance is adequate and to prevent cumulative toxicity.

D. 2200: This is the scheduled time for the next administration of the medication. Taking a blood sample at this time would reflect the trough concentration and would be contaminated by the new dose if drawn simultaneously. It does not provide information regarding the maximum therapeutic concentration achieved by the previous dose.

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An adult client is discussing experiencing occasional episodes of insomnia. In assessing the client's approach to sleep, which client statement should the nurse discuss further with the client?

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Explanation

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