A client is complaining of irritability, difficulty with memory, ...

[haleyc112]

A client is complaining of irritability, difficulty with memory, constant fatigue, and an inability to fall asleep.
 
  The client averages 3 hours of sleep each night, has been following a restricted calorie evening meal as part of a weight loss plan, and exercises every evening. Instead of food, the client drinks no-calorie caffeinated sodas. What should the nurse suggest to this client?
  1. Eating a larger meal later in the evening will facilitate better sleep and relieve the symptoms.
  2. An MRI might be necessary to determine the factors causing the symptoms.
  3. Dieting is a common cause for difficulty sleeping.
  4. Changes in hormones due to exercising late in the evening and late intake of caffeine might be disrupting the NREM sleep phase, causing the stated symptoms.

Question 2

A client diagnosed with narcolepsy, sleepwalking, and cataplexy is prescribed a selective serotonin reuptake inhibitor (SSRI). Which explanation regarding this medication is the most accurate?
 
  1. It lowers levels of serotonin, thereby increasing serotonin and elevating energy levels.
  2. It helps with sleepwalking because the increase in serotonin allows the client a deeper sleep.
  3. It decreased sleepiness, as SSRIs are stimulants, which will help the client maintain wakefulness.
  4. It decreased episodes of slurred speech, sagging of the jaw, and head nodding.

[smrtceo]

Answer to Question 1

Correct Answer: 4
Rationale 1: Eating a larger meal in the evening usually causes sleeplessness.
Rationale 2: A MRI would not be ordered until other conditions were ruled out.
Rationale 3: Dieting can have an affect on sleep, but it would not be the best response in this case.
Rationale 4: Decreases in neurotransmitters signal the change from wakefulness to nonrapid eye movement (NREM) sleep. Late exercise increases adrenaline, and caffeine is a stimulant. Both of these factors could interrupt NREM sleep.
Global Rationale: Decreases in neurotransmitters signal the change from wakefulness to nonrapid eye movement (NREM) sleep. Late exercise increases adrenaline, and caffeine is a stimulant. Both of these factors could interrupt NREM sleep. Eating a larger meal in the evening usually causes sleeplessness. A MRI would not be ordered until other conditions were ruled out. Dieting can have an affect on sleep, but it would not be the best response in this case.

Answer to Question 2

Correct Answer: 4
Rationale 1: Increased levels of serotonin elevate mood, not energy levels.
Rationale 2: Though increased serotonin might improve sleep, there is no indication that increased serotonin reduces sleepwalking.
Rationale 3: SSRIs are serotonin reuptake inhibitors. Amphetamines, methylphenidate, and modafinil are stimulants.
Rationale 4: Cataplexy is a sudden loss of muscle strength manifesting as slurred speech, sagging of the jaw, head nodding, or even complete collapse of the body. Stimulants such as modafinil are not effective for cataplexy symptoms. Older therapies for cataplexy include antidepressants, such as TCAs or SSRIs.
Global Rationale: Cataplexy is a sudden loss of muscle strength manifesting as slurred speech, sagging of the jaw, head nodding, or even complete collapse of the body. Stimulants such as modafinil are not effective for cataplexy symptoms. Older therapies for cataplexy include antidepressants, such as TCAs or SSRIs. Increased levels of serotonin elevate mood, not energy levels. Though increased serotonin might improve sleep, there is no indication that increased serotonin reduces sleepwalking. SSRIs are serotonin reuptake inhibitors. Amphetamines, methylphenidate, and modafinil are stimulants.