# A nurse is caring for a hospitalized patient who reports difficulty falling asleep due to environmental noise. Which nursing intervention would be most appropriate to promote sleep? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542665 > language: ko > subject: Fundamentals ## 문제 A nurse is caring for a hospitalized patient who reports difficulty falling asleep due to environmental noise. Which nursing intervention would be most appropriate to promote sleep? ## 보기 1. Administer a prescribed sedative medication immediately 2. Keep the patient's room lights on to reduce anxiety 3. Encourage the patient to watch television until feeling drowsy 4. Minimize environmental noise and create a quiet atmosphere **✔ 정답** **정답: 4** ## 해설 Minimizing environmental noise directly addresses the cause of sleep disturbance and is the first-line non-pharmacological intervention. Other options (sedatives, lights, TV) may disrupt natural sleep patterns or are not evidence-based. ## 심화 해설 Understanding the Problem The patient's primary complaint is difficulty falling asleep, and the identified cause is environmental noise. This is a classic example of an external sensory stimulus disrupting the natural transition from wakefulness to NREM Stage 1 sleep. In a hospital setting, noise acts as a physiological stressor, activating the sympathetic nervous system and increasing levels of cortisol, which directly counteracts the parasympathetic dominance required for sleep onset. The most direct and evidence-based nursing intervention is to eliminate the root cause of the disruption. Analysis of Options Option 1 (Administer sedative immediately) is inappropriate as a first-line intervention. Sedatives address the symptom, not the cause, and carry risks of dependence, altered sleep architecture (reducing restorative slow-wave sleep), and daytime hangover effects. Non-pharmacological interventions should always be prioritized. Option 2 (Keep room lights on) is counterproductive. Light is a powerful zeitgeber (time cue) that suppresses the pineal gland's secretion of melatonin, a hormone essential for regulating the circadian sleep-wake cycle. Light exposure before bedtime delays sleep onset. Option 3 (Encourage television) introduces both light and variable noise, which are stimulating. The blue light emitted from screens is particularly potent at suppressing melatonin, and program content can be cognitively arousing, further delaying sleep. Option 4 (Minimize environmental noise and create a quiet atmosphere) is the correct and most appropriate intervention. This directly targets the patient's stated problem. Research consistently demonstrates that hospital environmental noise is a significant predictor of poor sleep quality. A study on patients with acute leukaemia found that hospital noise negatively affected sleep and hindered recovery, making strategies to mitigate it crucial for rehabilitation [1]. Similarly, a review of ICU environments confirmed noise is a major stressor causing sleep disruption [2]. Proactive noise management, including environmental modifications, has been shown to significantly improve sleep quality in vulnerable patient populations, such as those post-hematopoietic stem cell transplantation . Even in surgical patients, implementing a noise-reduction management protocol has been associated with improved postoperative outcomes . By closing doors, lowering alarm volumes where safe, speaking softly, and coordinating care to minimize disruptions, the nurse creates an environment conducive to the physiological process of sleep onset.References (research sources) - [1]Impact of Hospital Environmental Noise on Sleep Quality and Rehabilitation Outcomes in Patients with Acute Leukaemia Receiving Chemotherapy.Research articleZhou X, Mao Y, Yao Z, Li J, Xu R. (2026) · DOI: 10.4103/nah.nah_224_25 - [2]Noise in the Intensive Care Unit: A Narrative Review of Its Characteristics, Clinical Impact, and Reduction Strategies.Research articleVrettou CS, Koliotsis PT, Golemati S, Mastorakis G, Karaviti V, Mavromati S, Tagara M, Papadopoulou MP, Dimopoulou I. (2026) · DOI: 10.1155/ccrp/4782724 ## 임상 시나리오 Clinical Sleep Promotion Protocol for Environmental Noise This guide outlines non-pharmacological interventions for managing sleep disturbances caused by environmental noise in hospitalized patients, prioritizing root-cause resolution. 1. Assessment - Identify specific noise sources (e.g., alarms, staff conversations, equipment, other patients). - Assess patient's usual sleep patterns, bedtime routines, and noise sensitivity. - Evaluate the impact of sleep deprivation on vital signs, pain perception, and cognitive status. 2. Intervention: Environmental Modification - **Noise Reduction:** Close patient room doors. Lower alarm volumes where safe. Establish "quiet hours" protocols and use visual alerts instead of audible ones when possible. Encourage use of "Do Not Disturb" signs. - **Sound Masking:** Offer earplugs or a white noise machine to create a consistent, low-level background sound that masks intermittent disruptive noises. - **Light Control:** Dim overhead lights and close curtains or blinds. Provide an eye mask. Minimize unnecessary nighttime entries that require turning on lights. - **Clustering Care:** Coordinate with the healthcare team to group necessary nighttime assessments and interventions, allowing for at least 90-120 minutes of uninterrupted sleep to complete a full sleep cycle. 3. Patient Education & Comfort - Explain the rationale for noise and light reduction to the patient and family to gain cooperation. - Reinforce bedtime routines from home (e.g., reading, warm blanket, relaxation techniques). - Advise against screen time (TV, phone) at least 1 hour before sleep due to blue light's effect on melatonin. 4. Re-evaluation & Escalation - Reassess the patient's perception of noise and sleep quality the following morning. - If environmental modifications are insufficient, consider a warm, non-caffeinated beverage or a back massage. - Only after exhausting non-pharmacological measures should a PRN sedative be considered, in collaboration with the provider, while documenting prior interventions. ## 핵심 개념 - **NREM Stage 1 Sleep** — The transition phase between wakefulness and sleep, easily disrupted by external stimuli like noise. - **Zeitgeber** — An environmental time cue, such as light, that regulates the body's circadian rhythms. - **Melatonin** — A hormone secreted by the pineal gland that regulates the sleep-wake cycle; its secretion is suppressed by light. - **Sleep Architecture** — The basic structural organization of normal sleep, including NREM and REM stages; can be altered by medications. - **Sympathetic Nervous System** — The part of the autonomic nervous system that activates the 'fight-or-flight' response, increasing alertness and cortisol levels, which counteracts sleep. ## 같은 주제 문제 - [A nurse is assessing a patient's sleep patterns. 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