Exam 5 week 14
A patient on the surgical unit has a history of parasomnia (sleepwalking). What statement describes parasomnia? a. Hypnotic medications reduce the risk of sleepwalking. b. The patient is often unaware of the activity on awakening. c. The patient should be restrained at night to prevent personal harm. d. The potential for sleepwalking is reduced by exercise before sleep.
b. The patient is often unaware of the activity on awakening. Rationale: During sleep walking, the individual may not speak and may have limited or no awareness of the event. On awakening, the individual does not remember the event.
Which question is most appropriate when the nurse is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)? - "Do you smoke?" - "Do you tend to awaken early in the morning?" - "Are you under a lot of stress at work or at home right now?" - "Do you have a history of chronic obstructive pulmonary disease?"
- "Do you smoke?" Smoking is a major etiologic factor in OSA. Early wakening and stress are associated with insomnia, not OSA in particular. COPD exacerbates the hypoxemia associated with OSA but does not precipitate the onset of OSA itself.
Which patient is at highest risk for obstructive sleep apnea (OSA)? - 82-yr-old man with Parkinson's disease who has dysphagia - 68-yr-old obese man who smokes one pack of cigarettes per day - 18-yr-old woman with cystic fibrosis who has recurrent pneumonia - 35-yr-old woman with a BMI of 22 kg/m2 who has seasonal allergies to pollen
- 68-yr-old obese man who smokes one pack of cigarettes per day Risk of OSA increases with obesity (BMI >30 kg/m2), age older than 65 years, neck circumference greater than 17 inches, craniofacial abnormalities, and acromegaly. Smokers are more at risk for OSA, and OSA is more common in men than women (until menopause).
The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? - Have patient follow hospital routines. - Avoid waking patient for nonessential tasks. - Give prescribed sleeping medications at dinner. - Turn television on low to late-night programming.
- Avoid waking patient for nonessential tasks. Avoiding awakening patient for nonessential tasks promoted sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as laboratory draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits. The other tasks do not promote sleep.
A nursing student is reviewing a process recording with the instructor. The student engaged the patient in a discussion about availability of family members to provide support at home once the patient is discharged. The student reviews with the instructor whether the comments used encouraged openness and allowed the patient to "tell his story." This is an example of which step of the nursing process? - Planning - Assessment - Intervention - Evaluation
- Evaluation Reviewing a conversation with a patient and determining whether the student encouraged openness and allowed the patient to "tell his story," expressing both thoughts and feelings, involve evaluation.
The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? Select all that apply. - Can cause urinary retention - Should not be used indefinitely - May have toxic effects on the liver - May cause diarrhea and anxiety - Are not regulated by the U.S. Food and Drug Administration (FDA)
- Should not be used indefinitely - May have toxic effects on the liver - Are not regulated by the U.S. Food and Drug Administration (FDA)
A new nurse is experiencing lateral violence at work. Which steps could the nurse take to address this problem? - Challenge the nurses in a public forum to embarrass them and change their behavior - Talk with the department secretary and ask if this has been a problem for other nurses - Talk with the preceptor or manager and ask for assistance in handling this issue - Say nothing and hope things get better
- Talk with the preceptor or manager and ask for assistance in handling this issue Talking with a preceptor, manager, or mentor notifies others of the problem, provides support for the nurse, and helps the nurse learn skills in addressing lateral violence.
Insufficient sleep is associated with (select all that apply) a. increased body mass index. b. increased insulin resistance. c. impaired cognitive functioning. d. increased immune responsiveness. e. increased daytime body temperature.
a. increased body mass index. b. increased insulin resistance. c. impaired cognitive functioning. Insufficient sleep and sleep loss are associated with decreased immune function, lowered body temperature, and decreased growth hormone levels. Cognitive function and performance on simple behavioral tasks are impaired within 24 hours of sleep loss. The effects of sleep loss are cumulative. Chronic insufficient sleep places the individual at risk for decreased cognitive function, depression, impaired daytime functioning, social isolation, and overall reduction in quality of life. Individuals who report less than 6 hours of sleep each night have higher body mass index (BMI) and are more likely to be obese. The risks for developing diabetes and glucose intolerance are increased in individuals with a history of insufficient sleep.
When teaching the patient with primary insomnia about sleep hygiene, the nurse should emphasize a. the importance of daytime naps. b. the need to exercise before bedtime. c. the need for long-term use of hypnotics. d. avoiding caffeine-containing beverages 6-9 hours before bedtime.
d. avoiding caffeine-containing beverages 6-9 hours before bedtime. Consumption of stimulants (e.g., caffeine, nicotine, methamphetamine, other drugs of abuse), especially before bedtime, results in insomnia. Caffeine has a half-life of between 6 and 9 hours.
Sleep is best described as a a. loosely organized state similar to coma. b. state in which pain sensitivity decreases. c. quiet state in which there is little brain activity. d. state in which an individual lacks conscious awareness of the environment.
d. state in which an individual lacks conscious awareness of the environment. Sleep is a state during which a person lacks conscious awareness of environmental surroundings and from which the person can be easily aroused.
An overweight patient with sleep apnea would like to avoid using a nasal CPAP device if possible. To help him reach this goal, the nurse suggests that the patient a. lose excess weight. b. take a nap during the day. c. eat a high-protein snack at bedtime. d. use mild sedatives or alcohol at bedtime.
a. lose excess weight. Excessive weight worsens sleep apnea, and weight loss reduces sleep apnea. A referral to a weight loss program or for bariatric surgery may be indicated.
Which statement(s) is/are true regarding rapid eye movement (REM) sleep (select all that apply)? a. The EEG pattern is quiescent. b. Muscle tone is greatly reduced. c. It occurs only once in the night. d. It is separated by distinct physiologic stages. e. The most vivid dreaming occurs during this phase.
b. Muscle tone is greatly reduced. e. The most vivid dreaming occurs during this phase. Rapid eye movement (REM) sleep accounts for 20% to 25% of sleep. REM sleep follows non-REM sleep. In a healthy adult, REM sleep occurs 4 to 5 times during a period of 7 to 8 hours of sleep. This stage is considered paradoxic because the brain waves resemble wakefulness. Muscle tone is greatly reduced and the person cannot stand during REM sleep. REM sleep is thought to be important for memory consolidation and is the period when the most vivid dreaming occurs.
While caring for a patient with a history of narcolepsy with cataplexy, the nurse can delegate which activity to the unlicensed assistive personnel (UAP)? a. Teaching about the timing of medications b. Walking the patient to and from the bathroom c. Developing a plan of care with a family member d. Planning an appropriate diet that avoids caffeine-containing foods
b. Walking the patient to and from the bathroom Specific activities that may be delegated to unlicensed assistive personnel (UAP) include routine measurement of vital signs in stable patients, feeding or assisting patients at mealtimes, helping stable patients ambulate, and helping patients with bathing and hygiene. Nursing interventions that require independent nursing knowledge, skill, or judgment, such as assessment, patient teaching, and evaluation of care, cannot be delegated.
A patient complains to the nurse that he is unable to sleep well since he has been diagnosed with gastroesophageal reflux disease (GERD). What is the nurse's best response? - "You should be able to rest if you eat a larger meal before bedtime." - "You should sleep in a recliner in the lowest position every night to reduce symptoms." - "A pillow wedge may help you sleep more comfortably while in bed." - "Drinking at least 8-12 ounces at bedtime should help you sleep through the night."
- "A pillow wedge may help you sleep more comfortably while in bed." Gastroesophageal reflux disease is a condition in which stomach acid rises up into the esophagus and causes irritation that is commonly referred to as "heartburn." Patients are often advised to sleep at a minimum 30-degree incline to reduce abdominal pressure and stomach acid entry into the esophagus. Patients diagnosed with GERD should consume small, frequent meals during the day. A large meal at night stimulates the secretion of stomach acid and increased intra-abdominal pressure. While sleeping in a recliner is commonly recommended to reduce stomach acid irritation, the recliner should not be placed in the lowest reclining position. This position defeats the purpose of sleeping at a slight inclination. Drinking a large amount of fluid at bedtime could lead to nocturia which interrupts sleep patterns.
A 72-year-old patient asks the nurse about using an over-the-counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse's best response? - "Antihistamines are better than prescription medications because these can cause a lot of problems." - "Antihistamines should not be used because they can cause confusion and increase your risk of falls." - "Antihistamines are effective sleep aids because they do not have many side effects." - "Over-the-counter medications when combined with sleep-hygiene measures are a good plan for sleep."
- "Antihistamines should not be used because they can cause confusion and increase your risk of falls." Older adults should avoid the use of over-the-counter antihistamines. These medications have a long duration of action in older adults and can cause confusion, constipation, urinary retention, and increased risk of falls.
Which of the following statements by a nursing student demonstrates an understanding of collaboration? - "Collaboration is a new way of interacting with physicians." - "Collaboration means that the care team can make all of the decisions for the patient." - "Collaboration with patients has been used by nurses throughout the history of nursing." - "Collaboration is an outdated concept that has been replaced by managed care."
- "Collaboration with patients has been used by nurses throughout the history of nursing." History shows that from the time of Florence Nightingale, nurses have worked with patients to assess their needs and wants. Collaboration with fellow care providers such as physicians is not a new concept; it is becoming more prevalent. To correctly use collaboration, the team does not make decisions without including the patient.
A patient diagnosed with narcolepsy wants to know what can be done to cure it. What is the best response the nurse can give this patient? - "If you take your medicine and naps, you will be cured." - "Patient support groups may be able to help you feel better." - "Drug therapy and behavioral strategies will be used to help treat it." - "Safety precautions must only be when you are driving an automobile."
- "Drug therapy and behavioral strategies will be used to help treat it." Narcolepsy cannot be cured. Measures to treat narcolepsy include drug therapy for promoting wakefulness during the day, sleep hygiene measures, and other behavioral strategies to enhance nighttime sleep. 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 are ordinarily safe (e.g., walking down a long flight of stairs) into hazards.
The nurse caring for a hospitalized child overhears the child's mother state she is very tired due to working a full-time job and staying at the hospital every evening. What is the nurse's best response? - "I can ask the health care provider to examine you also when she returns." - "What medications are you currently taking?" - "I can bring in a recliner chair so you can try to rest." - "I am taking the best care of your child. There's no need for you to worry."
- "I can bring in a recliner chair so you can try to rest." Offering a chair so this mother can rest is the best action of the nurse. Healthy individuals experience fatigue intermittently when they have overexerted themselves physically and/or mentally - and in these situations, fatigue serves as a useful physiological signal as the need to rest. In healthy individuals, fatigue is relieved by physical and/or cognitive rest. For fatigue to be recognized as a significant health problem, it needs to be a prominent symptom for at least 2 consecutive weeks. It is normal for this mother to experience fatigue. A physical examination is not needed unless a medical problem or severe anxiety occur. Telling the mother not to worry or asking about medication use do not address her fatigue and need for rest.
Which statement made by the parent of a school-age child requires follow-up by the nurse? - "I encourage evening exercise about an hour before bedtime." - "I offer my daughter a glass of warm milk before bedtime." - "I make sure that the room is dark and quiet at bedtime." - "We use quiet activities such as reading a book before bedtime."
- "I encourage evening exercise about an hour before bedtime." Best evidence related to sleep hygiene recommends avoiding exercise within 2 hours of bedtime. Exercise should be in the morning or afternoon. Encourage the parent to use quiet activities before bedtime to promote sleep.
Which statement made by the patient indicates a need for further teaching on sleep hygiene? - "I'm going to do my exercises before I eat dinner." - "I'm going to go to bed every night at about the same time." - "I set my alarm to get up at the same time every morning." - "I moved my computer to the bedroom so I could work before I go to sleep."
- "I moved my computer to the bedroom so I could work before I go to sleep." This statement requires further teaching. Good sleep-hygiene practices state that the bedroom should only be used for sleeping. Work and study should not be done in the bedroom.
The nurse teaches a patient with a sleep disorder about sleep hygiene. Which statement, if made by the patient, indicates understanding of the instructions? - "I will go to bed at the same time whether I am sleepy or not." - "I should set the temperature in my bedroom under 70° F at night." - "I must stop drinking alcoholic beverages 2 hours before I go to bed." - "I can use the prescribed sleeping pills every night to help me stay asleep."
- "I should set the temperature in my bedroom under 70° F at night." Good sleep hygiene should include a cool, dark, and quiet bedroom; going to bed only when sleepy; avoiding sleeping pills or using them cautiously; and avoiding alcohol for at least 4 to 6 hours before bedtime.
Which statement made by an older adult best demonstrates understanding of taking a sleep medication? - "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." - "Sleep medicines won't cause any sleep problems once I stop taking them." - "I'll talk to my health care provider before I use an over-the-counter sleep medication." - "I'll contact my health care provider if I feel extremely sleepy in the mornings."
- "I'll talk to my health care provider before I use an over-the-counter sleep medication." The statement, "I'll talk to my health care provider before I use an over-the-counter sleep medication" shows an understanding of the risks of over-the-counter sleep medications. The use of nonprescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption even when they initially seemed effective. Caution older adults about using over-the-counter antihistamines because of their long duration of action that can cause confusion, constipation, urinary retention, and increased risk of falls.
The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? - "I feel refreshed when I wake up in the morning." - "I use soft music at night to help me relax." - "It takes me about 45 to 60 minutes to fall asleep." - "I take the pain medication for my leg pain about 30 minutes before I go to bed."
- "It takes me about 45 to 60 minutes to fall asleep." Good sleep-hygiene practices indicate that individuals should fall asleep within 30 minutes of going to bed. Taking 45 to 60 minutes to fall asleep indicates a potential sleep problem and requires follow-up on sleep-hygiene practices. If an individual does not fall asleep within 30 minutes, encourage him or her to get out of bed and do a quiet activity until he or she feels sleepy.
Which statement by a mother in the pediatric clinic requires further assessment by the nurse? - "My 13 month old goes to bed around 7 pm and wakes up at 10 am." - "My 2 year old sleeps about 9 hours at night and still takes a nap." - "My 9-year-old daughter sleep 10 hours a night, sometimes 11 hours." - "My 16 year old finishes homework late at night but wakes up at 6 am every day."
- "My 16 year old finishes homework late at night but wakes up at 6 am every day." General recommendations for sleep amounts vary with age as follows: Infants: 14-16 hours each dayToddlers: 9-10 hours at night plus 2-3 hours of daytime napsSchool-age children: 9-11 hoursTeenagers: 9 hours Adults: 7-9 hoursThe teenager in this question does not appear to be getting 9 hours of sleep. The nurse should further assess for any abnormal findings related to sleep pattern in this patient.
A patient is evaluated in the emergency department after causing an automobile accident while being under the influence of alcohol. While assessing the patient, which statement would be the most therapeutic? - "Why did you drive after you had been drinking?" - "We have multiple patients to see tonight as a result of this accident." - "Tell me what happened before, during, and after the automobile accident tonight." - "It will be okay. No one was seriously hurt in the accident."
- "Tell me what happened before, during, and after the automobile accident tonight." Focusing gives direction, which enables the nurse to obtain clearer information without probing. Asking "why" questions can convey judgment on the part of the nurse. Giving false reassurance is not a therapeutic communication technique.
Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? - "I'll give the baby a bottle to help her fall asleep." - "We'll place the baby on her back to sleep." - "We put the baby's stuffed animals in the crib to make her feel safe." - "I know the baby will not need to be fed until morning."
- "We'll place the baby on her back to sleep." This is based on the current evidence that shows that parents need to place an infant on his or her back to prevent suffocation. Bottles, stuffed animals, and pillows should not be placed in the bed with an infant.
The nurse is contacting the health care provider about a patient's sleep problem. What is the correct order for the steps for SBAR? 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 2. "Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 3. "I'm calling to ask if you would order a hypnotic such as zolpidem (Ambien) to use on a prn basis." 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1° C (98.8° F). - 2, 1, 3, 4 - 1, 2, 3, 4 - 2, 1, 4, 3 - 1, 2, 4, 3
- 2, 1, 4, 3 SBAR is Situation, Background, Assessment, and Recommendation. This is the correct sequence of steps in SBAR for the patient and sleep problem.
A nurse prepares to contact a patient's physician about a change in the patient's condition. Using SBAR (Situation, Background, Assessment, and Recommendation) communication, which of the following is the correct order? 1."She is a 53-year-old female who was admitted 2 days ago with pneumonia and was started on Levaquin at 5 pm yesterday. She complains of a poor appetite." 2. "The patient reported feeling very nauseated after her dose of Levaquin an hour ago." 3. "Would you like to make a change in antibiotics, or could we give her a nutritional supplement before her medication?" 4. "The patient started complaining of nausea yesterday evening and has vomited several times during the night." - 1, 3, 4, 2 - 4, 1, 2, 3 - 2, 1, 3, 4 - 4, 2, 1, 3
- 4, 1, 2, 3 The nurse describes the patient's complaint of nausea and vomiting to the physician (Situation). Specific patient demographic information and reason for admission with current symptomology are provided (Background). The physician is informed of the patient's complaint of nausea after receiving Levaquin (Assessment). Physician is asked if he or she would like to make a change in the antibiotic or provide a nutritional supplement before medication administration (Recommendation).
Which individual most clearly exhibits the signs and symptoms of primary insomnia? - A patient in the habit of having a cappuccino in the late evening while watching TV - A patient whose increased sleep latency is not clearly attributable to any particular cause - A patient who has experienced frequent nighttime awakenings since the recent death of a spouse - A patient whose corticosteroid therapy causes him to feel "edgy" and unable to fall asleep at night
- A patient whose increased sleep latency is not clearly attributable to any particular cause Insomnia that is not directly attributable to a cause is considered primary or idiopathic. The stimulants such as caffeine, prescription medications, or psychologic trauma result in secondary insomnia.
The nurse providing care to a group of patients during the night sets a goal of promoting restful sleep. How would the nurse best define sleep? - An unconscious state in which arousal is not easily accomplished - A basic but unorganized behavior that is not necessary for survival - A state of chemical balance among acetylcholine, norepinephrine, and serotonin - A state during which a person lacks conscious awareness but can easily be aroused
- A state during which a person lacks conscious awareness but can easily be aroused Sleep is a state during which an individual lacks conscious awareness of environmental surroundings and from which one can be easily aroused. Sleep is a basic, highly organized behavior.
When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? Select all that apply. - Check for needed adaptive equipment. - Exaggerate lip movements to help the patient lip read. - Give the patient time to respond to questions. - Keep communication short and to the point. - Communicate only through written information.
- Check for needed adaptive equipment. - Give the patient time to respond to questions. - Keep communication short and to the point. Communication techniques such as assessing the need for adaptive equipment, keeping communication short and direct, and giving the patient time to respond help the nurse provide clear effective communication. Patients may have difficulty with rapid or lengthy explanations. Exaggerated lip reading may be difficult or demeaning to individuals with hearing deficits.
A patient in the intensive care unit is becoming more irritable from lack of sleep. What nursing action will best help facilitate the patient's sleeping? - Give the patient a back rub. - Keep the lights on during the day. - Talk to the patient when waking up at night. - Cluster activities to allow longer rest periods
- Cluster activities to allow longer rest periods Combining patient care activities to avoid frequently disturbing the patient's sleep will help the patient get more sleep and thus be less irritable. A back rub may help, but keeping the lights off in the room at night and only talking to the patient if the patient wants to talk will best facilitate sleep.
While documenting the care of a patient experiencing fatigue, which statement is correctly entered into the patient's medical record? - Patient reports feeling too tired to continue completing household chores. - Patient's fatigue is disproportional to physical symptoms. - Patient complains of feeling tired but has ambulated into the clinic today. - Patient should be referred for home health consultation.
- Patient reports feeling too tired to continue completing household chores. Similar to pain, fatigue has been defined as a "subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities". The nurse should not document inferences, but the patient's stated words. The underlying cause of the patient's fatigue should be explored first to determine what referrals are necessary in the treatment plan.
Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? Select all that apply. - Collaboration between staff members from sending and receiving departments - Requiring that the patient visit the facility before a transfer is arranged - Using a standardized transfer policy and transfer tool - Arranging all patient transfers during the same time each day - Relying on family members to share information with the new facility
- Collaboration between staff members from sending and receiving departments - Using a standardized transfer policy and transfer tool Providing a standardized process, policy, and tool can assist in a predictable, safe transfer of important patient information between health care facilities. Communication and collaboration between the sender and receiver of information enable the staff to validate that information was received and understood. Requiring a patient visit is not always necessary, and relying on family members to share information does not release staff from their responsibilities.
The nurse is developing a teaching plan of general health for an adolescent who will be entering college. The nurse should discuss which modifiable factors that could affect the student's sleep pattern? Select all that apply. - Coping strategies - Study habits - Diet - Social concerns - Age
- Coping strategies - Study habits - Diet - Social concerns Assessment of sleep is critical as a component of health and well-being assessment in every person. Changes in daily routine, stress, diet, social concerns, and anything that affects daily functioning, routine, or affect can be accompanied by a sleep problem of some type. Thorough assessment of sleep quality can be complex for a variety of reasons. Age is not a modifiable factor affecting sleep quality.
A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which of the following research-based benefits is the nurse likely to identify as positive outcomes of collaboration? Select all that apply. - Decreased length of stay for patients - Decreased staff resignations - Decreased use of pain medications - Increased reimbursement from insurance carriers - Increased patient follow-up appointments after discharge - Increased job satisfaction of the staff
- Decreased length of stay for patients - Decreased staff resignations - Increased job satisfaction of the staff Documented positive outcomes from collaboration include a shortened length of stay, increased job retention and decreased staff turnover, increased job satisfaction for registered nurses, and improved problem-solving skills. Identified research has not demonstrated less use of pain medication, increased reimbursement, or better follow-up by patients after discharge.
Parents of a newborn tell the nurse they are exhausted when they wake up in the mornings. What should the nurse suspect as the most likely cause of the parent's fatigue? - Possible thyroid disorder - Disrupted sleep pattern - Iron deficiency anemia - Recent changes in diet
- Disrupted sleep pattern A newborn does not have established, regular sleep patterns. Therefore, parents of newborns experience sleep pattern disturbances. While the nurse should assess for all possible causes of fatigue and obtain a history of any current concerns, sleep deprivation is the most common etiology in this situation.
What principle should guide the nurse's practice when providing care for older patients? - Drug therapy should be used conservatively. - Older adults require less sleep than younger adults. - Cognitive-behavioral interventions are less effective than among younger adults. - Patient teaching should focus on older adults accepting age-related changes in their sleep cycles.
- Drug therapy should be used conservatively. Drug therapy for sleep difficulties should be used conservatively in older adults. They do not necessarily need less sleep, and cognitive-behavioral therapies should still be used. Changes in sleep cycles do accompany aging, but teaching should not simply focus on accepting, rather than addressing, these changes.
The nurse is developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? - Instruct the patient to sleep in a supine position. - Have patient limit fluid intake 2 hours before bedtime. - Elevate the head of the bed to sleep. - Encourage patient to take an over-the-counter sleep aid.
- Elevate the head of the bed to sleep. Lifestyle changes and modifications of sleep habits should be included on a plan of care for a patient with OSA. Individuals should sleep with the head of the bed elevated and use a side or prone position. Other modifications include good sleep-hygiene practices, alcohol modification, smoking cessation, and weight reduction.
A patient on the surgical unit after coronary artery bypass grafting complains of vivid nightmares. What assessment should the nurse complete to determine the most likely cause of the nightmares? - Ask the patient about a history of posttraumatic stress disorder. - Determine if the patient has a history of sleep apnea or narcolepsy. - Evaluate the medications the patient is receiving for possible side effects. - Review the documentation record to determine if the patient had a fever last night.
- Evaluate the medications the patient is receiving for possible side effects. Medication side effects are the most common cause of nightmares in patients in acute care settings. Drug classes most likely to cause nightmares are sedative-hypnotics, â-adrenergic antagonists, dopamine agonists, and amphetamines.
The nurse should teach a patient about the dangers of excessive drowsiness when prescribed a combination of which medications? Select all that apply. - Gabapentin (Neurontin) - Fluoxetine (Prozac) - Diphenhydramine (Benadryl) - Lorazepam (Ativan) - Zolpidem (Ambien) - Pseudoephedrine (Sudafed)
- Gabapentin (Neurontin) - Fluoxetine (Prozac) - Diphenhydramine (Benadryl) - Lorazepam (Ativan) - Zolpidem (Ambien) Common pharmacological agents used for sleep disorders, to aid in sleeping, include: Neurontin (anticonvulsant), Prozac (antidepressant), Benadryl (antihistamine), Ativan (benzodiazepine), and Ambien (benzodiazepine receptor-like agent). Sudafed is commonly prescribed for congestion and is more likely to act as a stimulant.
A first year college student spends several hours a night studying and does not spend much time preparing healthy meals. When the student complains of fatigue, the nurse recognizes which type of fatigue in this student? - Physiological - Secondary - Unknown etiology - Mental
- Physiological Most sources describe three general classifications of fatigue that are delineated by cause: physiological, secondary, and unknown etiology. Physiological fatigue occurs when there is an imbalance between exercise, other activity, sleep, and diet. Secondary fatigue is caused by an underlying medical condition or treatment and will usually be resolved or decreased if the underlying problem is addressed. The last type of fatigue includes those with an unknown etiology.
Motivational interviewing (MI) is a technique that applies understanding a patient's values and goals in helping the patient make behavior changes. What are other benefits of using MI techniques? Select all that apply. - Gaining an understanding of patient's motivations - Focusing on opportunities to avoid poor health choices - Recognizing patient's strengths and supporting their efforts - Providing assessment data that can be shared with families to promote change - Identifying differences in patient's health goals and current behaviors
- Gaining an understanding of patient's motivations - Recognizing patient's strengths and supporting their efforts - Identifying differences in patient's health goals and current behaviors MI is a technique used to promote an understanding of patients' motivation, health goals, and current behaviors in a nonjudgmental environment while focusing on the patient's strengths and efforts. The nurse provides a supportive approach to help the patient establish and promote positive health care changes.
Which sleep-hygiene actions at bedtime can the nurse delegate to the nursing assistant? Select all that apply. - Giving the patient a backrub - Turning on quiet music - Dimming the lights in the patient's room - Giving a patient a cup of coffee - Monitoring for the effect of the sleeping medication that was given
- Giving the patient a backrub - Turning on quiet music - Dimming the lights in the patient's room - Monitoring for the effect of the sleeping medication that was given Giving the patient a backrub, turning on quiet music, and dimming the lights are all appropriate sleep-hygiene measures. These activities are within the scope of practice for the nursing assistant. Coffee, tea, cola, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night and should not be ingested before bedtime. Monitoring medication effect is a registered nurse activity.
The school nurse is teaching health-promoting behaviors that improve sleep to a group of high-school students. Which points should be included in the education? Select all that apply. - Go to bed at the same time each night. - Study in your bedroom to have a quiet place. - Turn on the television to help you fall asleep. - Avoid drinking coffee or soda before bedtime. - Turn off your cell phone at bedtime.
- Go to bed at the same time each night. - Avoid drinking coffee or soda before bedtime. - Turn off your cell phone at bedtime. Going to bed at the same time each night, avoiding drinking coffee and soda before bedtime, and turning off electronic devices are effective sleep-hygiene practices for adolescents. Use of electronic devices is a main cause of sleep disruption in adolescents.
A nurse is assigned to care for a patient for the first time and states, "I don't know a lot about your culture and want to learn how to better meet your health care needs." Which therapeutic communication technique did the nurse use in this situation? - Validation - Empathy - Sarcasm - Humility
- Humility Humility is admitting to limitations in knowledge and skill. This enables the nurse to admit a knowledge deficit so guidance is sought from the patient. Humility helps improve the therapeutic relationship and enables a nurse to provide safe and effective care.
A new nurse complains to her preceptor that she has no time for therapeutic communication with her patients. Which of the following is the best strategy to help the nurse find more time for this communication? - Include communication while performing tasks such as changing dressings and checking vital signs. - Ask the patient if you can talk during the last few minutes of visiting hours. - Ask Pastoral care to come back a little later in the day. - Remind the nurse to complete all her tasks and then set up remaining time for communication.
- Include communication while performing tasks such as changing dressings and checking vital signs. It is important for the nurse to take the opportunity to provide communication opportunities while providing routine patient care.
A nurse working in a free clinic has recognized that health promotion for teenagers who are pregnant is needed. The nurse works to develop a team of health care experts in several disciplines from across the region to work toward improving the nutrition of pregnant teenagers. This is an example of what type of collaboration? - Nurse-patient collaboration - Nurse-nurse collaboration - Intraprofessional collaboration - Interorganizational collaboration
- Interorganizational collaboration Interorganizational collaboration occurs between regional, national, or international organizations to achieve a common goal. Nurse-patient collaboration occurs when a nurse is working directly with a patient. Nurse-nurse collaboration occurs between nurses and among professionals in nursing management projects. Intraprofessional collaboration occurs among members of a professional discipline.
The nurse is caring for a patient who is diagnosed with narcolepsy and cataplexy. What therapeutic drug regimen will the nurse educate the patient about? - Valerian and diazepam - Melatonin and ropinirole - Modafinil and desipramine - Diphenhydramine and low dose fluoxetine
- Modafinil and desipramine Narcolepsy drug management includes amphetamine-like stimulants or nonamphetamine wake-promotion drugs (e.g., modafinil) to relieve excessive daytime sleepiness and antidepressant drug therapy (e.g., desipramine) to control cataplexy. Drugs that often cause drowsiness such as diazepam, melatonin, and diphenhydramine are not indicated for use in patients with narcolepsy.
Which of the following behaviors by a nurse indicates the effective use of collaboration with other professionals? - Strongly defends own professional role - Avoids conflict - Negotiates with others - Aggressively presents a personal view of a situation
- Negotiates with others Conflicts may arise during collaboration, requiring the skill of negotiation. Strongly defending the professional role does not allow for input from other disciplines. Avoiding conflict does not allow proper representation of the nursing role. Collaboration should be based on professional roles, not personal views.
A nurse is talking with a young-adult patient about the purpose of a new medication. The nurse says, "I want to be clear. Can you tell me in your words the purpose of this medicine?" This exchange is an example of which element of the transactional communication process? - Message - Obtaining feedback - Channel - Referent
- Obtaining feedback In this example the nurse's question is a way to obtain feedback. Feedback is the message a receiver receives from the sender. It indicates whether the receiver, in this case the patient, understood the meaning of the sender's message.
The nurse uses silence as a therapeutic communication technique. What is the purpose of the nurse's silence? Select all that apply. - Prevent the nurse from saying the wrong thing - Prompt the patient to talk when he or she is ready - Allow the patient time to think and gain insight - Allow time for the patient to drift off to sleep - Determine if the patient would prefer to talk with another staff member
- Prompt the patient to talk when he or she is ready - Allow the patient time to think and gain insight Silence can provide the patient an opportunity to think and gain insight. Often the patient feels compelled to break the silence and is prompted to talk.
Nurses must communicate effectively with the health care team for which of the following reasons? Select all that apply. - Improve the nurse's status with the health team members - Reduce the risk of errors to the patient - Provide optimum level of patient care - Improve patient outcomes - Prevent issues that need to be reported to outside agencies
- Reduce the risk of errors to the patient - Provide optimum level of patient care - Improve patient outcomes Effective communication in health care has been linked to a decrease in medical errors and an improvement in quality of care and patient outcomes. The status of the nurse or reportable issues are not the focus of communication with patients.
The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? - Incontinence - Nausea and vomiting - Bradycardia - Respiratory depression
- Respiratory depression Benzodiazepines in older adults should be used on a short-term, limited basis. Respiratory depression is an adverse effect of benzodiazepines in older adults. Other adverse effects for which to assess include next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination.
A patient informs the nurse that she is having difficulty getting to sleep and staying asleep. Which studies does the nurse anticipate educating the patient about? - EEG - Self-report - Actigraphy - Polysomnography
- Self-report The diagnosis of insomnia is based on self-report of difficulty falling or remaining asleep. EEG is used with polysomnography sleep studies to diagnose other sleep disorders. Actigraphy measures gross motor activity.
A patient is experiencing insufficient sleep and having health issues as a result. What disorder does the nurse inform the patient can be related to sleep disorders? - Insufficient sleep is linked to a decreased risk for type 2 diabetes mellitus. - Inadequate sleep in people with hypertension leads to future decreases in blood pressure. - Short sleep duration may result in metabolic changes that are linked to obesity. - Radiation for cancer treatment is associated with fragmented sleep and fatigue.
- Short sleep duration may result in metabolic changes that are linked to obesity. Short sleep duration may result in metabolic changes that are linked to obesity. Insufficient sleep is linked to an increased risk for type 2 diabetes mellitus. Inadequate sleep leads to further elevations in blood pressure in people with hypertension. Chemotherapy for cancer treatment is associated with fragmented sleep and fatigue, but inadequate sleep does not contribute to cancer.
A patient is seeking care for problems related to an inability to sleep and stay asleep over the past several months. What does the nurse anticipate teaching the patient regarding? - Melatonin - Benzodiazepines - Sleep hygiene practices - Over-the-counter sleep aids
- Sleep hygiene practices Sleep hygiene practices are effective in the management of insomnia and should be the first line of therapy. Melatonin may be helpful for jet lag but has a short duration of action. Benzodiazepines have a prolonged half-life and may result in daytime sleepiness. Over-the- counter sleep aids may lead to tolerance or have anticholinergic side effects.
The nurse is preparing a patient to have a sleep study to determine if sleep apnea is present. What should the nurse teach the patient to do until the test can be completed? - Take sleep medications. - Use the spouse's CPAP mask. - Sleep in a side-lying position. - Do not use pillows when sleeping.
- Sleep in a side-lying position. 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.
The patient reports episodes of sleepwalking to the nurse. Through understanding of the sleep cycle, the nurse recognizes that sleepwalking occurs during which sleep phase? - Rapid eye movement (REM) sleep - Stage 1 non rapid eye movement (NREM) sleep - Stage 4 NREM sleep - Transition period from NREM to REM sleep
- Stage 4 NREM sleep Stage 4 NREM sleep is the deepest stage of sleep. It is difficult to rouse the sleeper in this stage. During this stage sleepwalking and enuresis (bed-wetting) sometimes occur.
The nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? Select all that apply. - Take brief, 20-minute naps during the day. - Drink a glass of wine with dinner. - Eat the large meal at lunch rather than dinner. - Establish a regular exercise program. - Teach the patient about the side effects of modafinil (Provigil).
- Take brief, 20-minute naps during the day. - Establish a regular exercise program. - Teach the patient about the side effects of modafinil (Provigil). Taking short naps, no longer than 20 minutes, during the day and regular exercise are management strategies that help reduce the feeling of sleepiness. Modafinil is a stimulant used to treat narcolepsy; therefore it is important for patients to understand its side effects.
A patient complains of fatigue. Upon assessment of the patient's sleep patterns, the nurse discovers the adult patient is sleeping 10 hours/night. What is the nurse's best recommendation to reduce fatigue? - Encourage patient to continue sleeping 10 hours or more per night. - Advise patient to include more carbohydrates and fat in the diet. - Teach patient that moderate stress can help to promote alertness. - Tell patient to remain active longer to encourage quality sleep.
- Tell patient to remain active longer to encourage quality sleep. It is important for an individual to balance nutrition, sleep, stress, and psychological coping skills. For example, every individual should get an adequate amount of sleep. Adequate amount of sleep varies with different age groups but it is usually 7-8 hours per night for adults, 9 hours for adolescents, and 11-12 hours for toddlers. When helping patients with sleep hygiene, discourage oversleeping because it will increase fatigue. Patient teaching in the areas of nutrition and stress management are also interventions geared to minimize contributory factors for fatigue. Moderate stress can increase alertness, but will lead to an increase in fatigue.
An obese patient is scheduled to begin treatment with continuous positive airway pressure (CPAP). When developing the plan of care, what outcome would be appropriate for this patient? - The patient will be calm. - The patient will have no airway collapse. - The patient will have increased gas exchange. - The patient will breathe through the nose rather than mouth.
- The patient will have no airway collapse. CPAP maintains sufficient positive pressure (5-25 cm H2O) in the airway during inspiration and expiration to prevent airway collapse. CPAP does not exclusively require the patient to breathe through his or her nose.
A nurse is explaining why collaboration is valued to a new nurse during her orientation to the unit. Which of the following outcomes is a key patient care outcome that occurs when collaboration is correctly used? - Governmental accrediting agencies give more favorable reviews to the agency. - There are fewer errors that occur in patient care. - Agencies can offer higher salaries due to the cross-training of staff. - Ongoing education is not needed, because other specialties contribute to care decisions.
- There are fewer errors that occur in patient care. Collaboration results in fewer errors in patient care due to the interactions between health providers of all disciplines and patient involvement in planning. A positive accreditation review benefits the agency directly and the patient only indirectly. Collaboration is not the same as cross-training, and ongoing education is an expectation of all professions.
A patient who is Spanish-speaking does not appear to understand the nurse's information on wound care. Which action should the nurse take? - Arrange for a Spanish-speaking social worker to explain the procedure - Ask a fellow Spanish-speaking patient to help explain the procedure - Use a professional interpreter to provide wound care education in Spanish - Ask the patient to write down questions that he or she has for the nurse
- Use a professional interpreter to provide wound care education in Spanish Professional certified interpreters can help with simple or complex health care communications such as teaching instructions, test results, or education related to surgical consent. Other health care workers who are not certified interpreters cannot be relied on to provide clear and effective communication of health care information or teaching.
A patient informs the nurse that he is working the night shift and has difficulty sleeping during the day. What suggestions can the nurse offer to assist him with sleeping in the daylight hours? - Make the bedroom warmer. - Use room-darkening window shades. - Drink warm tea at the end of the shift. - Go to the gym to work out before going home to sleep.
- Use room-darkening window shades. Light is the strongest time cue for the sleep-wake rhythm. Darkening the room will help the hypothalamus to adjust to this change in sleep pattern. Measures to facilitate sleep include a quiet and cool room, no caffeine intake 4 to 6 hours before bedtime, and avoiding exercise 6 hours before bedtime. Scheduling sleep and waking time to just before going to work may also increase alertness and vigilance at work.
The nurse acknowledges which leading theories explaining the etiology of fatigue? Select all that apply. - Psychosomatic misconception - Waste product accumulation - Insufficient supply of substances - False reporting of physical ailment - An inflammatory process
- Waste product accumulation - Insufficient supply of substances - An inflammatory process Three leading theories include (1) waste product accumulation, (2) insufficient supply of substances, and (3) an inflammatory process. Some forms of fatigue result from the accumulation of waste products within the body. As an example, patients with end stage renal disease experience extreme fatigue and have difficulty concentrating on tasks of daily living. Fatigue can also result from insufficient supply of necessary substances (such as carbohydrates, fat, protein, adenosine triphosphate, protein, oxygen, etc.) for optimal metabolism and bodily function. For example, individuals who have anemia have decreased oxygen carrying capacity resulting in reduced oxygenation to tissues. Another general cause of fatigue is thought to be associated with an inflammatory process causing central nervous system-mediated fatigue. The hypothalamus and the basal ganglia of the brain are involved and this process involves a complex interaction of neurotransmitters and immune factors.
A nurse has been gathering physical assessment data on a patient and is now listening to the patient's concerns. The nurse sets a goal of care that incorporates the patient's desire to make treatment decisions. This is an example of the nurse engaged in which phase of the nurse-patient relationship? - Working phase - Preinteraction phase - Termination phase - Orientation phase
- Working phase The nurse helps the patient identify goals and express feelings during the working phase of the helping relationship.
Strategies to reduce sleepiness during nighttime working include a. exercising before work. b. taking melatonin before working the night shift. c. sleeping for at least 2 hours immediately before work time. d. walking for 10 minutes every 4 hours during the night shift.
c. sleeping for at least 2 hours immediately before work time. For night shift work, scheduling the sleep period just before going to work increases alertness and vigilance and improves reaction.
