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A nurse is caring for a client who has depression and reports only sleeping a few hours each night.
Which of the following instructions should the nurse give the client to promote sleep? .

"You should drink a glass of wine 1 hour before you go to bed.”.

"You should take a nap after lunch.”. .

"You should eat a meal just prior to bedtime.”. .

"You should limit yourself to two caffeinated beverages per day.”. .

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Alcohol can interfere with sleep patterns and should not be used as a sleep aid.

Choice B rationale:

Napping can make it harder to fall asleep at night.

Choice C rationale:

Eating just before bedtime can cause discomfort and disrupt sleep.

Choice D rationale:

Limiting caffeine intake can help improve sleep, as caffeine is a stimulant that can interfere with the ability to fall asleep.

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Correct Answer is C

Explanation

Choice A rationale:

Obtaining a prescription for haloperidol is not the first intervention the nurse should implement. Medication should be considered only after non-pharmacological interventions have been attempted.

Choice B rationale:

Taking the client to the seclusion room is not the first intervention the nurse should implement. Seclusion should be used only as a last resort when all other interventions have failed and the client is a danger to themselves or others.

Choice C rationale:

Verbally de-escalating the client is the first intervention the nurse should implement. This involves using calm, clear communication to help the client regain control of their emotions.

Choice D rationale:

Placing the client in restraints is not the first intervention the nurse should implement. Restraints should be used only as a last resort when all other interventions have failed and the client is a danger to themselves or others.

A. Discourage visitation from the client's family B. Provide a high-stimulation environment for the client. C. Limit the client's need to make decisions. D. Keep the client's room dark at night.

Correct Answer is C

Explanation

Choice A rationale:

Discouraging visitation from the client’s family could increase feelings of isolation and confusion, which could exacerbate delirium.

Choice B rationale:

A high-stimulation environment could overstimulate the client and worsen delirium.

Choice C rationale:

Limiting the client’s need to make decisions can reduce stress and confusion, which can help manage delirium.

Choice D rationale:

Keeping the client’s room dark at night could disrupt the client’s sleep-wake cycle and potentially worsen delirium.

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A nurse is caring for a client who has depression and reports only sleeping a few hours each night. Which of the following instructions should the nurse give the client to promote sleep? .

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A nurse is caring for a client who has depression and reports only sleeping a few hours each night.
Which of the following instructions should the nurse give the client to promote sleep? .