# A 68-year-old client seen in an outpatient clinic reports difficulty falling asleep and early morning waking for the past month. The client naps for 90 minutes each afternoon, drinks a cup of coffee with lunch, and often watches television in bed until feeling sleepy. Which instructions should the nurse include when teaching this client strategies to improve sleep quality? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=558428&lang=en > language: en > subject: Personal Hygiene > category: BCC ## Question A 68-year-old client seen in an outpatient clinic reports difficulty falling asleep and early morning waking for the past month. The client naps for 90 minutes each afternoon, drinks a cup of coffee with lunch, and often watches television in bed until feeling sleepy. Which instructions should the nurse include when teaching this client strategies to improve sleep quality? Select all that apply. 1 Take a 90-minute nap each afternoon to help make up for lost nighttime sleep. 2 Continue drinking coffee with lunch since caffeine earlier in the day does not affect sleep. 3 Get out of bed after about 20 minutes if unable to fall asleep and return only when drowsy. 4 Keep the bedroom cool, dark, and quiet each night to support falling asleep. 5 Go to bed and wake at the same time every day, including weekends. 6 Watch television in bed until feeling sleepy to help relax before sleep. ## Explanation Effective teaching for this client centers on stimulus control, environmental control, and a stable sleep-wake schedule. Leaving bed when unable to sleep and returning only when drowsy preserves the mental link between bed and sleep. A cool, dark, quiet room minimizes stimulation that interferes with sleep onset. A fixed bedtime and wake time, even on weekends, supports circadian stability and long-term sleep quality. In contrast, a long afternoon nap reduces the buildup of sleep drive needed for nighttime rest, caffeine taken at lunch can persist long enough to disturb sleep in older adults, and screen use in bed introduces light and mental stimulation that delays sleep onset rather than promoting it. ## In-depth explanation Correct Answer Choices 3, 4, 5 Clinical Reasoning Effective teaching for this client centers on stimulus control, environmental control, and a stable sleep-wake schedule. Leaving bed when unable to sleep and returning only when drowsy preserves the mental link between bed and sleep. A cool, dark, quiet room minimizes stimulation that interferes with sleep onset. A fixed bedtime and wake time, even on weekends, supports circadian stability and long-term sleep quality. In contrast, a long afternoon nap reduces the buildup of sleep drive needed for nighttime rest, caffeine taken at lunch can persist long enough to disturb sleep in older adults, and screen use in bed introduces light and mental stimulation that delays sleep onset rather than promoting it. Option Review - Incorrect — A single long or late afternoon nap can reduce nighttime sleep drive and make falling asleep harder, so recommending this nap pattern is not appropriate for this client. - Incorrect — Caffeine consumed at lunch can remain in the body for several hours, especially in older adults, and may still disrupt nighttime sleep, so this statement is inaccurate. - Correct — If the client cannot fall asleep within about twenty minutes, leaving bed and returning only when drowsy prevents the bed from becoming linked with wakefulness and supports the sleep drive. - Correct — A cool, dark, and quiet sleep environment limits sensory stimulation and creates conditions that are more conducive to falling and staying asleep. - Correct — Maintaining a consistent bedtime and wake time every day, including weekends, helps stabilize the circadian rhythm and improves overall sleep quality. - Incorrect — Watching television in bed adds light and stimulation that can delay sleep onset and weakens the association between the bed and sleep, making this recommendation inappropriate. Sources 12026 NCLEX-RN Test Plan 2NIA: Six healthy sleep habits for older adults ## Clinical scenario A 68-year-old client seen in an outpatient clinic reports difficulty falling asleep and early morning waking for the past month. The client naps 90 minutes each afternoon, drinks coffee with lunch, and often watches television in bed until feeling sleepy. ## Related questions - [A hospice nurse is planning pain management for a client with metastatic cancer who can ta…](https://mymerci.kr/pages/nclex_q.php?qn_id=363998&lang=en) - [A nurse is creating a pressure injury prevention plan for an immobile older adult admitted…](https://mymerci.kr/pages/nclex_q.php?qn_id=366392&lang=en) - [A dying client's family asks to perform meaningful spiritual and cultural rituals at the b…](https://mymerci.kr/pages/nclex_q.php?qn_id=368302&lang=en) - [A nurse cares for family members after a loved one is told that an illness is terminal. 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