A patient with rheumatoid arthritis reports, For the past month ...

[bucstennis@aim.com]

A patient with rheumatoid arthritis reports, For the past month I've been having a lot of trouble falling asleep. When I finally get to sleep, I wake up several times during the night. Which information should the nurse seek initially?
 
  a. What have you done to try to improve your sleep?
  b. What would be a good sleep pattern for you?
  c. How much exercise are you getting?
  d. Do you have pain at night?

Question 2

A home care nurse assesses a very demanding patient with chronic obstructive pulmonary disease (COPD). Afterward, the nurse talks with the spouse who has provided this patient's care for 6 years. The spouse says, I don't need much sleep anymore.
 
  I might need to help him during the night. Select the nurse's most therapeutic response.
 
  a. It sounds like you are very devoted to your spouse.
  b. I noticed you fell asleep while I was assessing your spouse. I'm concerned about you.
  c. Your spouse is lucky to have you to provide care rather than being placed in a nursing home.
  d. If you keep going like this, your health will be impaired also. Then who will take care of both of you?

[Ptupou85]

Answer to Question 1

ANS: D
Patients with diseases such as arthritis may have sleep disturbance related to nightly pain. Because the pain is chronic, the patient may fail to realize it is the reason for the inability to sleep. The other options do not follow the patient's lead or begin problem solving without an adequate baseline.

Answer to Question 2

ANS: B
Sleep deprivation can cause accidents. The correct answer makes an observation, gives important information about safety, and communicates care and compassion for the spouse. The distracters do not invite further dialogue with the spouse.

[bucstennis@aim.com]

Thanks for the timely response, appreciate it

[Chelseyj.hasty]

Excellent