To promote adequate sleep for a patient who suffers from a sleep pattern disturbance, what are the most appropriate nursing interventions? (Select all that apply).

Choice A reason: This is incorrect. Reporting the findings to the health care provider immediately is an important step, but not the priority action of the nurse. The nurse should first assess the patient for orthostatic hypotension, which is a common cause of sudden blood pressure drop.

Choice B reason: This is incorrect. Checking the patient’s apical rate to check for a pulse deficit is a relevant step, but not the priority action of the nurse. A pulse deficit is the difference between the apical and radial pulse rates. The nurse should first check the patient for orthostatic hypotension, which is a condition where the blood pressure drops when the patient changes position, causing dizziness and fainting.

Choice C reason: This is correct. Immediately checking the patient for orthostatic hypotension is the priority action of the nurse. Orthostatic hypotension is a condition where the blood pressure drops when the patient changes position, causing dizziness and fainting. It can be caused by dehydration, medications, blood loss, or autonomic nervous system disorders. The nurse should measure the patient’s blood pressure and heart rate while lying down, sitting, and standing, and observe for any signs of hypoperfusion, such as pallor, sweating, or confusion.

Choice D reason: This is incorrect. Elevating the head of the patient’s bed to at least 45 degrees is a helpful step, but not the priority action of the nurse. Elevating the head of the bed can improve the patient’s breathing and reduce the risk of aspiration, but it can also worsen the orthostatic hypotension by lowering the blood pressure further. The nurse should first check the patient for orthostatic hypotension and then adjust the bed position accordingly.

Choice A reason: This is a correct choice because providing personal hygiene before bedtime is an appropriate nursing intervention to promote adequate sleep for a patient who suffers from a sleep pattern disturbance. This intervention can help the patient to feel more comfortable, relaxed, and refreshed, and to reduce the risk of infection or skin breakdown.

Choice B reason: This is a correct choice because synchronizing the schedule for medications and vital signs is an appropriate nursing intervention to promote adequate sleep for a patient who suffers from a sleep pattern disturbance. This intervention can help the patient to have uninterrupted sleep cycles, and to avoid unnecessary disturbances or discomforts from frequent assessments or treatments.

Choice C reason: This is an incorrect choice because administering sleep aids every night at the same time is not an appropriate nursing intervention to promote adequate sleep for a patient who suffers from a sleep pattern disturbance. This intervention can cause dependence, tolerance, or adverse effects from the sleep aids, and may not address the underlying cause of the sleep problem. The nurse should use non-pharmacological methods to promote sleep, and administer sleep aids only as prescribed and indicated.

Choice D reason: This is a correct choice because assisting the patient to use the toilet before bed is an appropriate nursing intervention to promote adequate sleep for a patient who suffers from a sleep pattern disturbance. This intervention can help the patient to avoid nocturia, which is the need to urinate at night, and to prevent urinary tract infections or incontinence.

Choice E reason: This is a correct choice because straightening and changing any soiled bed linens is an appropriate nursing intervention to promote adequate sleep for a patient who suffers from a sleep pattern disturbance. This intervention can help the patient to maintain a clean, dry, and comfortable sleeping environment, and to prevent skin irritation or infection.