Ch. 8 Sleep and Sleep Disorders
The nurse recalls that what sleep disorder is characterized by an inability to keep from falling asleep even when engaged in a task or activity? 1 Insomnia 2 Parasomnia 3 Narcolepsy 4 Hypersomnia
Narcolepsy is also known as sleep attacks. It is a syndrome characterized by sudden sleep attacks, sleep paralysis, and visual or auditory hallucinations at the onset of sleep. Narcolepsy is diagnosed with the use of an EEG or by other brain studies that are used to distinguish narcolepsy from an intracranial mass or encephalitis. Insomnia is difficulty falling or staying asleep. Parasomnia is a disruptive sleep disorder that includes nightmares, night terrors, sleepwalking, and confusional arousals. Hypersomnia is excessive daytime sleepiness. Patients with hypersomnia can fall asleep at any time, which can be disruptive at work or dangerous when operating machinery or driving. Text Reference - p. 106
A patient has mild obstructive sleep apnea (OSA) and is advised to use a mouth guard device. What device should the nurse provide to the patient? 1 Oral appliance 2 Oropharyngeal tube 3 Nasopharyngeal tube 4 Non-rebreather mask
The device used to guard the patient's mouth, in order to resolve OSA, is known as an oral appliance. This device brings the mandible and tongue forward to enlarge the airway space, thus preventing airway occlusion. An oropharyngeal tube and nasopharyngeal tube are artificial airways which are used when a patient has a compromised airway. A non-rebreather mask is a face mask used to deliver oxygen to the patient. Text Reference - p. 111
A patient with insomnia asks for something to help him or her sleep. The medication prescription is "temazepam (Restoril) 30 mg by mouth (PO) qhs as needed." Available are 20-mg tablets. How many tablets should the nurse administer? 1 0.25 tablet 2 0.5 tablet 3 1.5 tablets 4 2.5 tablets
Using ratio and proportion, multiply 20 by x and multiply 30 × 1 to yield 20x = 15. Divide 30 by 20 to yield 1.5 tablets. Text Reference - p. 104
A patient with sleep apnea is scheduled for surgery that involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove the obstructing tissue. What is this surgery called? 1 Mastectomy 2 Tonsillectomy 3 Uvulopalatopharyngoplasty 4 Genioglossal advancement and hyoid myotomy
Uvulopalatopharyngoplasty is a surgery for resolving sleep apnea. This surgery involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove the obstructing tissue. Mastectomy is surgery for the excision of breast cancer. Tonsillectomy is surgery for the excision of the tonsils. Genioglossal advancement and hyoid myotomy is another surgery for sleep apnea. It involves advancing the attachment of the muscular part of the tongue on the mandible. Text Reference - p. 111
A patient with sleep apnea asks the nurse, "What can I do to get better sleep?" What is an appropriate nursing response? 1 "Taking 1-2 sleeping pills at night will prevent sleep apneic episodes." 2 "Keeping your hypertension under control is beneficial for general health." 3 "Being overweight is a contributing factor; losing weight can often resolve apnea." 4 "High blood glucose levels contribute to the apnea; monitor your sugar carefully."
Being overweight is an important risk factor for sleep apnea. Reducing weight often helps in resolving this condition. Taking sleeping pills may habituate a person, and taking it on a regular basis should be avoided. Keeping hypertension and blood glucose in control is beneficial for general health, but is not related to sleep apnea specifically. Text Reference - p. 110
The patient is scheduled for a sleep study test to see if the patient has mild sleep apnea. What should the nurse teach the patient to do until the test can be completed? 1 Take sleep medications 2 Use the spouse's continuous positive airway pressure (CPAP) mask 3 Sleep in a side-lying position 4 Do not use pillows when sleeping
Conservative treatment for mild obstructive sleep apnea (OSA) begins with sleeping on one's side. Sleep medication often makes OSA worse. CPAP is adjusted for the patient and used with more severe symptoms after diagnosis. Elevating the head of the bed may eliminate OSA. Text Reference - p. 109
A patient was just diagnosed with narcolepsy and asks the nurse what can be done to cure it. What is the best response the nurse can give this patient? 1 "If you take your medicine and naps, you will be cured." 2 "Patient support groups may be able to help you feel better." 3 "Drug therapy and behavioral strategies will be used to help treat it." 4 "Safety precautions must only be used when you are driving an automobile."
Measures to treat narcolepsy include drug therapy for promoting wakefulness during the day, sleep hygiene measures, and other behavioral strategies to enhance nighttime sleep. Narcolepsy cannot be cured. A patient support group may help the patient feel better, but it will not cure narcolepsy. Safety precautions are needed with driving, but also with other activities, as falling asleep or losing muscle control can transform actions that ordinarily are safe (such as walking down a long flight of stairs) into hazards. Text Reference - p. 107
A nurse reporting to work for the night shift says that he has been experiencing fragmented sleep during the day. What is fragmented sleep? 1 Inability to initiate sleep 2 Less than the recommended amount of sleep 3 Frequent awakenings that interrupt sleep continuity 4 Amount of sleep required to be alert the next day
Fragmented sleep refers to frequent awakenings that interrupt sleep continuity. Dyssomnia is the inability to initiate or maintain sleep. A person is said to have insufficient sleep if he or she receives less than the recommended amount of sleep, which is 7 to 8 hours in 24 hours. Adequate sleep is the amount of sleep required to be fully awake and alert the next day. TEST-TAKING TIP: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 105
A patient reports of an inability to sleep after working the night shift. What should the nurse recommend to promote a normal circadian cycle? 1 The patient should use a bright light during early mornings. 2 The patient should darken the room completely when sleeping. 3 The patient should work a rotational shift instead, alternating between day and night. 4 The patient should reduce the number of hours working night shift
Light is the strongest cue for the human sleep-wake cycle. When the patient keeps the room dark during daytime, the brain secretes melatonin which makes the person sleepy. Using bright lights in mornings may cause the sleep-wake cycle to move to an earlier time, and interfere with the sleep. Having a rotational shift will increase the problems as the body will have to adjust to different rhythms regularly. Reducing the number of night shifts will also prevent the body from adjusting to a new sleep-wake cycle. Text Reference - p. 103
A patient is admitted to a hospital with a sleep disorder. The patient has continuous involuntary movement of the legs during sleep. What is this condition called? 1 Insomnia 2 Sleep terror 3 Obstructive sleep apnea 4 Periodic limb movement disorder
Periodic limb movement disorder (PMLD) is a condition in which the patient has continuous involuntary movement of the legs during sleep. Insomnia is a sleep disorder characterized by difficulty falling asleep or staying asleep. The patient with insomnia may wake up too early, and may not feel refreshed after sleep. Sleep terror is a condition in which there is sudden awakening from sleep along with a loud cry and signs of panic. Obstructive sleep apnea is a condition in which there is disturbed sleep due to obstruction of airway. Text Reference - p. 111
A nurse differentiates between rapid eye movement (REM) and non-rapid eye movement (NREM), the two sleep stages. Which statement is true related to the REM stage of sleep? 1 The most vivid dreams occur in this stage. 2 This stage occurs in the beginning of sleep. 3 The eyes are fixed in place in this stage. 4 This stage comprises the majority of the sleep cycle
REM sleep is the period when the most vivid dreaming occurs. This stage follows NREM sleep and is not the beginning of sleep. Slow eye movements are seen in NREM stage 1 sleep. REM sleep accounts for 20% to 25% of sleep, while NREM sleep comprises 70% of sleep. Text Reference - p. 103
A nurse is explaining the sleep cycle to a patient who is being monitored for insomnia. What stage of sleep would the nurse identify as the period when the most vivid dreams occur? 1 Rapid eye movement (REM) 2 Non-rapid eye movement (NREM) Stage 1 3 Non-rapid eye movement (NREM) Stage 2 4 Non-rapid eye movement (NREM) Stage 3
Rapid eye movement (REM) is the sleep period when the most vivid dreaming occurs. This period accounts for 0 to 25% of sleep. 75 to 80% of total sleep time comprises non-rapid eye movement (NREM) sleep. NREM consists of 3 stages. NREM stage 1 is the transition phase from wakefulness to sleep. NREM stage 2 comprises most of the night's sleep. NREM stage 3 is a deep sleep, which declines as people age. Text Reference - p. 103
