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?"
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.
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