Chapter 19 Sleep Wake Disorders

A client tells the nurse, "I just don't sleep more than 5 hours at night." The nurse assesses the client best for individual sleep requirements by asking which question? "Are you aware that some people require less sleep than others?" "When did this pattern of sleep start for you?" "Do you usually feel rested and alert when you get up?" "Are you taking any medication that could affect your sleep

"Do you usually feel rested and alert when you get up?"

A client reports symptomatology that supports the diagnosis of sleep paralysis. The nurse effectively assesses the client by asking which question? "Do you ever have nightmares?" "Have you ever fallen asleep while driving?" "Do you have a history of obsessive compulsive behavior?" "Is it difficult for you to fall asleep?"

"Have you ever fallen asleep while driving?"

The nurse appropriately assesses an obese, hypertensive, Type 2 diabetic client when asking: "Do you regularly have nightmares?" "Is getting to sleep a problem for you?" "Do you snooze when you sleep?" "How much sleep do you usually get each night?"

"How much sleep do you usually get each night?"

Which statement by a patient who was educated about the importance of acquiring adequate sleep indicates a need for further teaching? "I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can." "Getting less than 6 hours of sleep at night may increase my risk for medical problems." "Getting enough sleep will increase my productivity at work." "Since I have to drive for my job, getting enough sleep will help me avoid accidents."

"I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can."

One criterion for the diagnosis of primary insomnia is met when the client makes which statement? "I've actually missed work because I'm too tired to go." "I was diagnosed with depression 2 months ago." "I've had problems falling asleep for 3 weeks now." "I have these terrible nightmares when I fall asleep."

"I've actually missed work because I'm too tired to go."

A client diagnosed with a chronic sleep disorders begins to cry and states, "I can't keep going like this! I work in a bank and if I can't function correctly I'll lose my job. I just don't think I'll get better." Which statement provides a therapeutic response to the client's concerns? "Don't worry! I'm sure with treatment everything will get better." "You are not alone. Many people who come for sleep studies are going through the same thing." "You seem so sad. May I ask if something else is troubling you?" "There is much hope for improvement through treatment. Let's talk about some strategies for your problems at work."

"There is much hope for improvement through treatment. Let's talk about some strategies for your problems at work."

What is the usual time period that medications to treat insomnia are usually prescribed? 1 to 2 days 1 to 2 months 3 weeks 2 weeks

2 weeks

HYPERSOMNOLENCE DISORDERS

Excessive daytime sleepiness Chronic—begins in young adulthood Excessive sleepiness impairs social and vocational functioning Treatment—maintain regularsleep-wake schedule, pharmacotherapy

A depressed client is likely to report a sleep disorder that includes which characteristics? Frequent awakenings during the night Nightmares Difficulty falling asleep Sleepwalking

Frequent awakenings during the night

When providing possible interventions to promote the safety of a client reporting symptoms of somnambulism, the nurse should include which intervention? Gating the stairways Sleeping on a mattress placed on the floor Regular bedtime dose of a benzodiazepine Avoiding the use of serotonergic medications

Gating the stairways

TYPES SLEEP DISORDERS

Hypersomnia disorders Narcolepsy - hypocretin deficiency Breathing-related sleep disorders Circadian rhythm disorders Disorders of arousal Nightmare disorder Rapid eye movement sleep Behavior disorder Restless leg syndrome Substance-induced sleep disorders Insomnia

A 38-year-old patient referred for sleep studies reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. These symptoms support which sleep-related diagnosis? Circadian rhythm disorder Hypersomnolence REM sleep behavior disorder Breathing-related sleep disorder

Hypersomnolence

client reports insomnia and shares that a friend has recommended a nonprescription hormone product that can be purchased at the local health food store. The nurse suspects that the medication contains which component? A benzodiazepine A tranquilizer Melatonin Lithium

Melatonin

SLEEP DISORDER RISK FACTORS

Older age Female gender Psychiatric disorder Medical condition Shift work.....

An older adult client is reporting symptomatology that suggests REM sleep behavior disorder (RSBD). Which comorbid condition should the nurse assess for? Lymphoma Hypertension Acute renal failure Parkinson's disease

Parkinson's disease

A slightly obese client reports falling asleep during the daytime even though she has slept all night. Her husband says she snores, and her blood pressure is noted to be in the low hypertensive range. The nurse anticipates that the client will be scheduled for which diagnostic test? Hypertension screening Polysomnography Glycosylated hemoglobin Positron emission tomography

Polysomnography

What non-habit-forming melatonin receptor agonist is often prescribed for insomnia? Zolpidem (Ambien) Ramelteon (Rozerem) Eszopiclone (Lunesta) Zaleplon (Sonata)

Ramelteon (Rozerem)

SLEEP DISORDER CAUSES

Self-induced sleep deprivation Medications Alcohol/drugs Various medical disorders Psychiatric disorders

Non-REM (NREM) sleep Composed of three stages

Stage 1- wakefulness-sleep Stage 2- sleep ensues with increased stimuli needed to wake Stage 3-slow wave/delta sleep- restorative

A client reports to the nurse that falling asleep can often take hours. Which intervention should the nurse implement? Teach the client how to do progressive relaxation. Advise the client to drink an ounce or two of brandy at bedtime. Suggest that the client seek a referral for polysomnography. Point out that reducing stress at work would be advisable.

Teach the client how to do progressive relaxation.

A client asks the nurse to explain what basal sleep requirement is. What is the nurse's best response? The basal temperature of your body needed to induce the best sleep. The sleep time by your body needed to repair cellular damage. The amount of sleep needed to be fully awake and perform well in the daytime. The amount of sleep needed to transition to rapid eye movement (REM) sleep.

The amount of sleep needed to be fully awake and perform well in the daytime.

What is the most effective nursing intervention regarding the accurate assessment of sleep disorders? A sleep diary Information regarding sleep cycles Client description of the symptomatology Assessment for substance abuse

A sleep diary

A nurse cares for these four patients. Which patient has the highest risk for problems with sleep physiology? a. Retiree who volunteers twice a week at Habitat for Humanity b. Corporate accountant who travels frequently c. Parent with three teenagers d. Lawn care worker

B

Normally, most people sleep at night. What is the physiological rationale? a. The master biological clock responds to darkness with sleep. b. Darkness stimulates histamine release, which promotes sleep. c. Cooler environmental temperatures stimulate retinal messages. d. Stimulation of the sympathetic nervous system promotes sleep.

A

A client newly diagnosed with hypersomnolence asks about what medication will be prescribed to manage this disorder. The nurse will base his/her response based on what knowledge? There is no effective medication treatment for hypersomnolence disorder. Medication therapy with benzodiazepines may be initiated. A stimulant will most likely be prescribed. The client will be started on an anticholinesterase inhibitor.

A stimulant will most likely be prescribed.

The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority? a. "It's important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents." b. "Sleep deprivation is usually self-limiting. See your health care provider if it lasts more than a year." c. "Turn the radio on with a soft volume as you prepare for bed each evening. It will help you relax." d. "Three glasses of wine each evening help many patients who suffer from sleep deprivation."

A

Which person would be most likely to experience sleep fragmentation? a. An obese adult b. A toddler who attends day care c. A person diagnosed with mild osteoarthritis d. An adolescent diagnosed with anorexia nervosa

A

10. The stage of sleep known as rapid eye movement or REM sleep is characterized by atonia and myoclonictwitches in addition to the actual rapid movement of the eyes. Atonia is thought to be a protective mechanism as it: a. Limits physical movements b. Prevents nightmares c. Enhances the dream state d. Regulates the autonomic nervous system

A

A patient experiencing primary insomnia asks the nurse, "I take a nap during the day. Doesn't that make up for a lost night's sleep?" Select the nurse's best reply. a. "Circadian drives give daytime naps a structure different from nighttime sleep." b. "The body clock operates on a 24-hour cycle, making nap effectiveness unpredictable." c. "It is a matter of habit and expectation. We expect to be more refreshed from a night's sleep." d. "Sleep restores homeostasis but works more efficiently when aided by melatonin secreted at night."

A

A patient reports, "The medicine prescribed to help me get to sleep worked well for about a month, but I don't have any more of those pills, and now my insomnia is worse than ever. I had nightmares the last 2 nights." Which type of medication did the health care provider most likely prescribe? a. Benzodiazepine b. Tricyclic antidepressant c. Conventional antipsychotic d. Central nervous system stimulant

A

A patient says, "I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep." Which medication would the nurse expect a health care provider to prescribe for this patient? a. zolpidem (Ambien) b. flurazepam (Dalmane) c. risperidone (Risperdal) d. methylphenidate (Ritalin)

A

Which season would be most associated with increased periods of wakefulness in the general population? a. Summer b. Winter c. Spring d. Fall

A

A night shift worker reports, "I'm having trouble getting to sleep after a night's work. I have a hearty breakfast with coffee, read the paper, do my exercises, and then go to bed. However, I just lie awake until it is nearly time to get up to be with my family for dinner." What changes should the nurse suggest? Select all that apply. a. Drink juice with breakfast rather than coffee. b. Exercise after awakening rather than before. c. Turn on the television when going to bed. d. Do not read the paper. e. Eat a light breakfast.

A, B, E (Sleep can be disrupted by caffeine, a central nervous system stimulant, exercise performed just before trying to sleep, and eating a heavy meal before retiring. Reading the newspaper is not likely to be so stimulating that it disrupts the patient's ability to sleep. Television will be disruptive to sleep.)

3. Which behaviors will the nurse encourage a patient diagnosed with insomnia disorder to adopt? Select all that apply. a. Avoiding exercising at bedtime b. Avoiding napping during the day c. Eating a hearty snack at bedtime d. Getting up at the same time each day e. Moving the clock so it is not visible from the bed

A,B,D,E

4. Which treatment is typically prescribed for primary insomnia? Select all that apply. a. Cognitive-behavioral therapy-insomnia (CBT-I) b. Intravenous medication for sedation c. Stimulus control d. Sleep restriction e. Sleep hygiene measures

A,C,D,E

SLEEP MEDICATIONS ~ HORMONES

Ambien, Sonata, Benadryl, Lunesta Melatonin

A home care nurse assesses a very demanding patient with chronic obstructive pulmonary disease (COPD). Afterward, the nurse talks with the spouse who has provided this patient's care for 6 years. The spouse says, "I don't need much sleep anymore. I might need to help him during the night." Select the nurse's most therapeutic response. a. "It sounds like you are very devoted to your spouse." b. "I noticed you fell asleep while I was assessing your spouse. I'm concerned about you." c. "Your spouse is lucky to have you to provide care rather than being placed in a nursing home." d. "If you keep going like this, your health will be impaired also. Then who will take care of both of you?"

B

A nurse counsels a patient on ways to determine the person's total sleep requirement. Which instruction would produce the most accurate results? a. "For 1 full week, record what you remember about your dream content and related feelings as soon as you wake up. Bring the record to your next appointment." b. "While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings." c. "For 2 full weeks, record how much time you sleep each night and rate your daytime alertness on a scale of 1 to 10. Calculate your average alertness score." d. "All adults need 7 or 8 hours of sleep to function properly. Let's design ways to help you reach that goal."

B

A nurse who works night shift says, "I am exhausted most of the time. I sleep through my alarm. Sometimes my brain does not seem to work right. I am worried that I might make a practice error." Which question should the nursing supervisor ask first? a. "What stress are you experiencing in your life?" b. "How much sleep do you get in a 24-hour period?" c. "Would it help if you do some exercises just before going to bed?" d. "Have you considered using a hypnotic medication to help you sleep?"

B

A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems? a. Skull x-rays b. Electroencephalogram (EEG) c. Positron emission tomography (PET) d. Single-photon emission computed tomography (SPECT)

B

A patient reports, "Nearly every night I awaken feeling frightened after a bad dream. The dream usually involves being hunted by people trying to hurt me. It usually happens between 4 and 5 AM." The nurse assesses this disorder as most consistent with criteria for which problem? a. Sleep deprivation b. Nightmare disorder c. Night terror disorder d. REM sleep behavior disorder

B

A person is prescribed lorazepam (Ativan) 2 mg po bid prn for anxiety. When the person takes this medication, which change in sleep is anticipated? The patient will: a. have fewer dreams. b. have less slow-wave sleep. c. experience extended sleep latency. d. enter sleep through rapid eye movement (REM) sleep.

B

A person says, "I often feel like I have been dreaming just before I awake in the morning." Which rationale correctly explains the comment? a. Sleep architecture changes during the sleep period, resulting in increased slow-wave sleep at the end of the cycle. b. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods. c. Dreams occur more frequently when a person is experiencing unresolved conflicts or depression. d. Dream content relates directly to developmental tasks. The person is likely feeling autonomous.

B

Which comment is most likely from a patient with chronic sleep deprivation? a. "I turn on the television every night to get to sleep. I set the timer so it goes off in 30 minutes." b. "I have diarrhea frequently and not much energy, so I stay at home most of the time." c. "I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours." d. "When my alarm clock goes off every morning, it seems like I am dreaming."

B

A new patient at the sleep disorders clinic tells the nurse, "I have not slept well in a year, so I never feel good. I do not expect things will ever improve or be any different." Interventions the nurse should consider include: (select all that apply) a. suggesting use of alcohol as a sedative. b. providing instruction in relaxation techniques. c. counseling the patient to address cognitive distortions. d. health teaching regarding factors that influence sleep. e. teaching fatigue-producing activities to become overtired. f. encouraging long daytime naps to compensate for sleep deprivation.

B, C, D

Which neurotransmitters are most responsible for wakefulness? Select all that apply. a. Gamma-aminobutyric acid (GABA) b. Norepinephrine c. Acetylcholine d. Dopamine e. Galanin

B, C, D

1. Which patient statement supports a diagnosis of narcolepsy? a. "My wife tells me I snore at night." b. "I sleepwalk several nights a week." c. "I have no control over when I fall asleep." d. "My legs feel funny, and that keeps me awake."

C

2. Madelyn, a 29-year-old patient recently diagnosed with depression, comes to the mental health cliniccomplaining of continued difficulty sleeping. One week ago she was started on a selective serotonin reuptake inhibitor (SRRI), fluoxetine (Prozac), for her depressive symptoms. When educating Madelyn your response is guided by the knowledge that: a. SSRIs such as fluoxetine more commonly cause hypersomnolence as opposed to difficulty sleeping. b. The sleep problem is caused by the depression and is unrelated to the medication. c. The neurotransmitters involved in sleep and wakefulness are the same neurotransmitters targeted bymany psychiatric medications and the problem may be temporary. d. The medication should be discontinued since sleep

C

5. Light projected into the retina is believed to trigger changes in sleep patterns and quality of sleep.Therefore the nurse should suggest: a. Not reading within an hour of bedtime b. Exercising before bedtime in a darkened environment c. Limiting use of electronic devices in the hour before bedtime d. Dimming the screen on cellphones and computers in the evening

C

8. Larry is a 50-year-old man who works about 60 hours per week. He arrives at the clinic seeking assistancewith a weight gain of 50 pounds over the past year. Larry admits to sleeping 4 to 5 hours a night. The nurse recognizes that the weight gain may be related to: a. A new onset of diabetes b. Suspected cardiovascular disease c. Dysregulation of hormones that influence appetite d. Comorbidity of depression with obesity

C

9. Sleep deprivation is considered a safety issue that results in loss of life and property. Psychomotorimpairments of sleep deprivation are similar to symptoms caused by: a. Sleeping in excess of 10 hours b. Misuse of caffeine products c. Alcohol consumption d. Working more than 40 hours per week

C

A nurse provides health education for an adult with sleep deprivation. It is most important for the nurse to encourage caution when the patient engages in: a. using a vacuum cleaner. b. cooking a meal. c. driving a car. d. bathing.

C

A patient says, "It takes me about 15 minutes to go to sleep each night." This comment describes: a. delta sleep. b. parasomnia. c. sleep latency. d. rapid eye movement sleep.

C

7. Many people allow life circumstances to dictate their amount of sleep instead of recognizing sleep as apriority. Which statement will the nurse recognize as progress in the patient's sleep hygiene program? a. "I go to bed even if I am not sleepy, hoping I will fall asleep." b. "I have one glass of red wine at bedtime each night." c. "I take a nap each day to 'catch up' on my sleep deficit." d. "I have removed the television from my bedroom."

D

A 76-year-old man tells the nurse at the sleep disorder clinic, "I awaken almost nightly in the midst of violent dreams in which I am defending myself against multiple attackers. Then I realize I have been hitting and kicking my wife. She has bruises." Which health problem is most likely? a. Sleep Paralysis b. Night Terror Disorder c. Sleep-Related Bruxism d. Rapid Eye Movement (REM) Sleep Behavior Disorder

D

A patient tells the nurse, "Everyone says we should sleep 8 hours a night. I can only sleep 6 hours, no matter how hard I try. Am I doing harm to my body?" Select the nurse's best response. a. "Tell me about strategies you have tried to increase your total sleep hours." b. "Lack of sleep acts as a stressor on the body and can cause physical changes." c. "If you have really tried to sleep more, maybe you should consult your health care provider." d. "If you function well with 6 hours of sleep, you are a short sleeper. That's normal for some people."

D

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?"

D

A young adult says to the nurse, "I go to sleep without any problem, but I often wake up during the night because it feels like there are rubber bands in my legs." Which assessment question should the nurse ask to assess for restless legs syndrome (RLS)? a. "What type of birth control do you use?" b. "How much caffeine do you use every day?" c. "How much exercise do you get in a typical day?" d. "Does anyone else in your family have this problem?"

D

person is prescribed sertraline (Zoloft) 100 mg PO daily. Which change in sleep is likely secondary to this medication? The patient will have: a. more dreams. b. excessive sleepiness. c. less slow-wave sleep. d. less rapid eye movement (REM) sleep.

D

What factors are consistently observed to increase the risk for sleep disturbances? Gender and race Diet and exercise alcohol and tobacco income and education

alcohol and tobacco