A nurse is caring for an adult client who reports having trouble getting to sleep at night. Which of the following recommendations should the nurse make?

Choice A reason: Turning on overhead lights disrupts sleep by stimulating retinal photoreceptors, raising alertness via melatonin suppression. Scientifically, dim or red light preserves rest, making this contrary to reducing environmental stressors for sleep optimization in acute care settings.

Choice B reason: Rubber-soled shoes reduce noise from footsteps, minimizing auditory disturbances to sleep. Scientifically, quiet environments lower cortisol and enhance sleep quality, aligning with evidence-based stressor reduction strategies to promote rest in hospital clients effectively.

Choice C reason: Opening curtains increases light and noise exposure, disrupting sleep cycles via circadian misalignment. Scientifically, darkness supports melatonin production, so this heightens stressors, opposing the goal of improving rest in shared hospital rooms per sleep science.

Choice D reason: Shift reports near rooms raise noise levels, activating the hypothalamic-pituitary axis, disturbing sleep. Scientifically, quiet zones reduce awakenings, making this detrimental to stressor reduction, as it elevates auditory interference contrary to sleep promotion goals.

Choice A reason: Difficulty swallowing isn’t a typical pain sign from epidural failure; it suggests throat or nerve issues unrelated to disc pain. Scientifically, this lacks connection to spinal analgesia efficacy, as herniated disc pain manifests elsewhere, not in pharyngeal function.

Choice B reason: Constipation may result from opioids in epidurals, not unrelieved pain. It’s a side effect, not a pain indicator. Scientifically, bowel changes reflect medication impact, not disc pain intensity, making this an unreliable marker for epidural effectiveness.

Choice C reason: Urinary retention is an epidural side effect from nerve blockade, not a direct pain signal. Scientifically, it indicates spinal anesthesia depth, not failure to relieve herniated disc pain, distinguishing it from pain-specific behavioral cues.

Choice D reason: Clenched teeth reflect facial tension, a common involuntary response to unrelieved spinal pain. Scientifically, this aligns with pain behavior studies, as muscle guarding and grimacing indicate persistent disc-related discomfort, signaling epidural inadequacy effectively.