NURS (FUNDAMENTAL): Ch 33 NCLEX Rest & Sleep

A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest? a) involves all the body systems b) decrease in motor response to stimuli c) decrease in awareness of environment d) decrease in cognitive response to stimuli

c) decrease in awareness of environment There is a decrease in the awareness of the environment in sleep; this does not happen during rest. Motor and cognitive response to stimuli may be decreased in both sleep and rest. Sleep is a whole body phenomenon; whereas, rest may involve the whole body system or only a part.

Which of these is a physiological change during NREM sleep? a) sympathetic nerve activity increases from wakefulness b) body temperature is not regulated c) decreased brain activity from wakefulness d) muscle tone absent

c) decreased brain activity from wakefulness Brain activity decreases from wakefulness. During slow-wave sleep (SWS), muscles are relaxed, but muscle tone is maintained during NREM. Sympathetic nerve activity decreases from wakefulness and body temperature is regulated at a lower level from wakefulness.

The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is: a) auscultate the lung fields and perform neuro checks. b) measure the client's weight and assess visual acuity. c) observe client's hours of sleep and review client's sleep diary. d) measure neck circumference and auscultate the abdomen.

c) observe client's hours of sleep and review client's sleep diary.

Which factor has the most influence on an individual's sleep-wake patterns? a) the body's need for 8 hours of sleep b) daylight and darkness c) the inner biologic clock d) bedtime rituals

c) the inner biologic clock The inner biologic clock is the regulating mechanism for the body's sleep-wake patterns. No formula exists for the duration of sleep. Although light and dark appear to be powerful regulators of the sleep-wake pattern, they do not exert primary control.

A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because: a) they are the age group least likely to use prescribed sleep medications. b) they nap in the afternoon, which lessens their hours of sleep at night. c) they may be disoriented on awakening. d) they are typically prone to sleep walking.

c) they may be disoriented on awakening.

What are characteristics of rapid eye movement sleep? Select all that apply. a) Sleepwalking and bed-wetting are most likely to occur during this stage. b) Muscles are relaxed but muscle tone is maintained. c) Theta waves often have a sawtooth or notched appearance. d) Blood pressure and pulse rate show wide variations and may fluctuate rapidly. e) A person is unable to move during this stage.

c, d, e During REM sleep, blood pressure and pulse rate show wide variations and may fluctuate rapidly, a person is unable to move, and theta waves often have a sawtooth or notched appearance. Muscles are relaxed but muscle tone is maintained. Sleepwalking and bed-wetting are most likely to occur during NREM.

A nurse observes a slight increase in a patient's vital signs while he is sleeping during the night. According to the patient's stage of sleep, the nurse expects what conditions to be true? Select all that apply. a) He is aware of his surroundings at this point. b) He is in delta sleep at this time. c) It would be most difficult to awaken him at this time. d) This is most likely an NREM stage. e) This stage constitutes around 20% to 25% of total sleep. f) The muscles are relaxed in this stage.

c, e This scenario describes REM sleep. During REM sleep, it is difficult to arouse a person, and the vital signs increase. REM sleep constitutes about 20% to 25% of sleep. In stage I NREM sleep, the person is somewhat aware of surroundings. Delta sleep is NREM stages III and IV sleep. In stage IV NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.

A nurse is instructing her students on the role of hormones in sleep patterns. Which statement would indicate to the nursing instructor that the student needs additional education? a) Hypothyroidism may contribute to a lack of slow-wave sleep." b) "A hyperactive thyroid can make the client sleepy all the time." c) "Women often experience fatigue due to loss of estrogen." d) "Estrogen has been shown to decrease sleep latency."

b) "A hyperactive thyroid can make the client sleepy all the time." Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow-wave sleep.

The nurse knows that a client understands the purpose of a sleep diary when the client states: a) "I will write down all my morning activities." b) "I will record the time I go to bed and how long it takes me to fall asleep." c) "I will keep track of my sleep information for 2 months." d) "I will only keep track of my sleep habits at home, not when I am traveling out of town."

b) "I will record the time I go to bed and how long it takes me to fall asleep."

Parents tell the nurse that their 5-year-old is only sleeping 10 hours now and is refusing to take an afternoon nap. The nurse should teach the parents: a) "It might be a problem. You should discuss this with your pediatrician." b) "This is normal development for children in this age group." c) "Five-year-olds sleep only 10 to 12 hours at night, but napping is very important at this stage." d) "Don't let your child eat any candy or chocolate after dinner."

b) "This is normal development for children in this age group."

A nurse is visiting the home of a first-time mother and her newborn. The nurse is teaching the mother about the newborn's sleep needs. The nurse would inform the mother that newborns sleep approximately how many hours per day? a) 10 to 12 hours b) 14 to 20 hours c) 18 to 22 hours d) 8 to 10 hours

b) 14 to 20 hours

The nurse is completing a sleep history on a client who reports sleeping problems. Which of the client's regular behaviors will cause the client to have difficulty with sleep? a) drinking 2 cups of coffee every morning b) taking a diuretic at 9 a.m. and 5 p.m. daily c) exercising immediately after getting off work at 5 p.m. d) using a white noise machine to mask outside noise

b) taking a diuretic at 9 a.m. and 5 p.m. daily

The mother reports her 4-year-old child wakes up frequently at night screaming. She also reports this occurs shortly after her son has fallen asleep. The nurse determines that the child takes a tub bath and the mother reads a story to her son prior to bedtime at 8 p.m. The nurse intervenes by stating what to the mother? Select all that apply. a) "Put the child in your bed to sleep when this occurs." b) "It is common for this to occur in this age group." c) "Comforting your child when this occurs may help." d) "You may find a nightlight in his room is helpful." e) "You will need to change your child's bedtime routine."

b, c, d The description is a preschooler experiencing nightmares or night terrors, which is common in this age group. Nursing interventions include teaching the parents to comfort the child and provide a nightlight. The preschooler should not be placed in the parents' bed when this occurs as this will become a regular routine. The preschooler's bedtime routine appears satisfactory, and this should be continued.

The nurse is educating a client about nonpharmacologic measures to alleviate restless leg syndrome (RLS). Which education points would the nurse include in her plan? Select all that apply. a) an alcoholic drink is recommended before bed to relax the client b) massaging the legs may relieve symptoms c) applying heat or cold to the extremity can help relieve the symptoms d) Biofeedback and TENS can help relax the client and relieve symptoms e) drinking a cup of coffee before bed can help relieve the tingling sensations f) A mild analgesic before bed can help relieve symptoms

b, c, d The nurse would instruct the client that applying heat or cold to the extremity can help relieve the symptoms of restless leg syndrome (RLS). The nurse would instruct the client that biofeedback and TENS can help relax the client and relieve symptoms. The nurse would instruct the client that massaging the legs may relieve RLS symptoms. Caffeine and alcohol should be avoided by the client before bed. A mild analgesic before bed will not help relieve RLS symptoms.

A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep? Select all that apply. a) A patient who is taking iron supplements for anemia b) A patient with Parkinson disease who is taking dopamine c) An elderly patient taking diuretics for congestive heart failure d) A patient who is taking antibiotics for an ear infection e) A patient who is prescribed antidepressants f) A patient who is taking low-dose aspirin prophylactically

b, c, e Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems.

A nurse is instructing her students on the role of hormones in sleep patterns. Which statement would indicate to the nursing instructor that the student needs additional education? a) Hypothyroidism may contribute to a lack of slow-wave sleep." b) "Estrogen has been shown to decrease sleep latency." c) "A hyperactive thyroid can make the client sleepy all the time." d) "Women often experience fatigue due to loss of estrogen."

c) "A hyperactive thyroid can make the client sleepy all the time."

A nurse is discussing with an older female patient the factors that affect sleep. What fact does the nurse teach her? a) Drinking a cup of regular tea at night induces sleep. b) Using alcohol moderately promotes a deep sleep. c) Aging decreases the amount of REM sleep a person experiences. d) Exercising decreases REM and NREM sleep.

c) Aging decreases the amount of REM sleep a person experiences. The nurse would teach the patient that the amount of REM sleep decreases with age. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity increases both REM and NREM sleep.

A nurse is caring for a patient who states he has had trouble sleeping ever since his job at a factory changed from the day shift to the night shift. Which diagnosis would be most appropriate for this patient? a) Ineffective Coping: Multiple Stressors of New Job b) Sleep Deprivation: Difficulty Falling Asleep c) Disturbed Sleep Pattern: Altered Sleep-Wake Pattern d) Risk for Injury: Activity Intolerance/Sleep Deprivation

c) Disturbed Sleep Pattern: Altered Sleep-Wake Pattern

Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening? a) Smoke a cigarette to relax and calm down at bedtime. b) Exercise vigorously for 30 minutes before bedtime. c) Eat some crackers with peanut butter at bedtime. d) Eat a bar of a favorite chocolate before bedtime.

c) Eat some crackers with peanut butter at bedtime.

An older adult client with mild hypothermia has been admitted to the health care facility. What should the nurse do to provide an appropriate environment to an older adult client? a) Use a bright light at night for safety. b) Keep an attendant with the client. c) Ensure that the environment is warmer. d) Raise the side rails of the bed.

c) Ensure that the environment is warmer.

A client who previously was a smoker has recently stopped smoking but reports having much trouble sleeping at night. How would the nurse respond? a) "Since you were a smoker, this will always be a problem." b) "If you are sleep deprived, it might be better to smoke." c) "You have to decide what is more important: smoking or sleep." d) "Sleep problems from stopping smoking are temporary."

d) "Sleep problems from stopping smoking are temporary."

Most authorities agree that an individual's sleep-wake cycle is fully developed by what age? a) 4 to 6 years b) 9 months to 1 year c) 1 year to 18 months d) 2 to 3 years

d) 2 to 3 years

The nurse is instructing a parent on how to promote restful sleep for a child. The food that would serve as the best bedtime snack for the child is? a) Tuna salad b) Almonds c) Chocolate bar d) Apple slices

d) Apple slices

A nurse on the night shift notices that a client is grinding his teeth while sleeping. How should the nurse document the diagnosis for the client? a) Narcolepsy b) Insomnia c) Cataplexy d) Bruxism

d) Bruxism

Which is not a lifespan consideration for sleep cycles? a) Newborns can sleep up to 16 to 18 hours per day. b) Getting the toddler and preschooler to fall asleep is a common problem. c) In adolescents, there is a shift to late evening bedtime and late morning rise time. d) By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases.

d) By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases. By middle age, the frequency of nocturnal awakenings increases, and satisfaction with sleep quality decreases. Situational variables such as job-related stress, pregnancy, parenting, family caregiving responsibilities, and illness may explain these changes in sleep patterns.

The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects a nursing diagnosis of: a) Anxiety related to hospitalization. b) Mobility, Impaired Physical related to Restless Leg Syndrome (RLS). c) Sleep Pattern Disturbance related to acute pain. d) Role Performance, Ineffective related to inability to work at occupation.

c) Sleep Pattern Disturbance related to acute pain.

A maternity nurse is instructing new parents on the proper sleeping position for their newborn child. In what position does the nurse instruct the parents to place the infant? a) Side-lying position b) Prone position c) Supine position d) High-Fowler's position

c) Supine position

A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage? a) Midbrain b) Medulla c) Cerebral cortex d) Hypothalamus

d) Hypothalamus The hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleeping and waking. Injury to the hypothalamus may cause a person to sleep for abnormally long periods. The medulla and midbrain are part of the reticular activating system (RAS), which plays a part in the cyclic nature of sleep. The cerebral cortex does not have any role in the sleep process.

The nurse has entered the room of a newly admitted client and observed a continuous positive airway pressure (CPAP) on the client's bedside table. The nurse would recognize that this client likely has a history of what condition? a) Somnambulism b) Narcolepsy c) Insomnia d) Obstructive sleep apnea

d) Obstructive sleep apnea CPAP is a common treatment for sleep apnea that helps to maintain the patency of the client's airway. It does not address the signs and symptoms of insomnia, narcolepsy, or somnambulism (sleepwalking).

Which factors affect sleep and rest? Select all that apply. a) Shift work b) Medications c) Nutrition and metabolism d) Relationships e) Vigilance

All of these factors affect sleep and rest. Relationships can include parents' frequent awakenings while caring for infants. These awakenings contribute to chronic sleep loss and disturbances in a primary relationship. Food affects people differently. Some people will awaken from hunger while others cannot fall asleep if they have just eaten. Vigilance is the perceived need to create a protective role, such as parents that create an arousal threshold so they can hear their small child wandering down the hall in the middle of the night. Shift work affects sleep; frequent changes in the sleep-wake schedule contribute to the misalignment of the internal circadian clock.

A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which condition is a manifestation of depression in an older client? a) Insomnia b) Somnambulism c) Nocturnal enuresis d) Nightmares

a) Insomnia Insomnia and hypersomnia are often manifestations of depression in older clients. Nightmares, somnambulism (sleepwalking), and nocturnal enuresis are examples of parasomnias. These are conditions associated with activities that cause arousal, or partial arousal, usually during transitions in NREM periods of sleep. However, these are not manifestations of depression in an older adult client.

A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep? a) 14 to 20 hours each day b) 12 to 14 hours each day c) 9 to 12 hours each day d) 8 to 9 hours each day

a) 14 to 20 hours each day

Which client could be diagnosed with insomnia? a) A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m. b) A 20-year-old man who is reporting excessive drowsiness at work to the point that he falls asleep while at his computer. He goes to bed at 11 p.m. and wakes up at 7 a.m. without difficulty. Twice in the last year he passed out after getting extremely angry. c) A 45-year-old woman who has been reporting fatigue for the last year. When asked about her sleep schedule she states that she usually goes to bed around 1 a.m. and gets up at 7 a.m. when her 5-year-old daughter gets up. She describes herself as a night owl. d) A 40-year-old obese man who is reporting fatigue. He states that he goes to bed around 9 p.m. every night and wakes up between 5 and 6 in the morning. He feels like he gets a good night's sleep but his wife says that she constantly has to poke him throughout the night because he "stops breathing."

a) A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m. The 50-year-old woman appears to be suffering from early-awakening insomnia. Because it has been longer than 1 month it is considered a chronic insomnia. The 45-year-old woman appears to be suffering from insufficient sleep syndrome. She does not have an adequate amount of time for sleep each night, as seen with insomnia, but it is a self-imposed restriction of sleep. The 40-year-old man is not getting enough sleep because he has some form of sleep-disordered breathing (SDB). Although he might think he is allowing enough time for sleep, his quality of sleep is disrupted by these periods of apnea. The 20-year-old man appears to be suffering from narcolepsy. Along with the two episodes of cataplexy, he is excessively sleepy throughout the day and falls asleep at inappropriate times.

To promote sleep in a patient, a nurse suggests what intervention? a) Follow the usual bedtime routine if possible. b) Drink two or three glasses of water at bedtime. c) Have a large snack at bedtime. d) Take a sedative-hypnotic every night at bedtime.

a) Follow the usual bedtime routine if possible.

A nurse caring for patients in a long-term care facility is implementing interventions to help promote sleep in elderly patients. Which action is recommended for these patients? a) Increase physical activities during the day. b) Encourage short periods of napping during the day. c) Increase fluids during the evening. d) Dispense diuretics during the afternoon hours.

a) Increase physical activities during the day.

A nurse is explaining to an insomniac client the effect of a prescribed medication and the different phases of sleep. Which statement is true for non-rapid eye movement (NREM) sleep? a) It is called slow wave sleep. b) It is called active sleep. c) It is called paradoxical sleep. d) It is the deepest stage of sleep.

a) It is called slow wave sleep. Non-rapid eye movement sleep, which progresses through four stages, is also called slow wave sleep, because during this phase, electroencephalographic (EEG) waves appear as progressively slower oscillations. The REM phase of sleep is referred to as paradoxical sleep because the EEG waves appear similar to those produced during periods of wakefulness, but it is the deepest stage of sleep. NREM sleep is characterized as quiet sleep and REM sleep as active sleep.

For the last 3 weeks, a nurse in a long-term care facility has administered a sedative-hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation? a) Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration. b) The client's daily activity is interfering with the drug. c) The client is eating carbohydrates prior to bedtime. d) The nurse needs to administer another drug such as diphenhydramine for effectiveness.

a) Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration. Although most sedative-hypnotic drugs provide several nights of excellent sleep, the medication often loses its effects after 1 or 2 weeks. Alcohol and diphenhydramine should not be administered with a sedative-hypnotic drug. Increased activity assists the client in sleeping. Foods such as protein and carbohydrates have been shown to help a client sleep.

The nurse is implementing nursing interventions to promote sleep on a busy hospital ward. Which intervention is the best choice for these clients? a) Offer clients a small carbohydrate and protein snack before bedtime. b) Have the clients set an alarm clock so they are not worried about getting up. c) Create a warm, dark environment in the clients' rooms. d) Encourage the clients to take a shower prior to bedtime.

a) Offer clients a small carbohydrate and protein snack before bedtime. Offering a client a small carbohydrate and protein snack before bedtime would be the best choice. Peanut butter on toast or cheese and crackers would be an example of an appropriate snack. The temperature of the room should be cool, not warm. An alarm clock would not be necessary for a client who is an inpatient in the hospital. A shower could possibly be helpful, but it is not the best answer

A nurse working in a health clinic assesses sleep patterns during each health assessment. Based upon the nurse's knowledge regarding sleep needs, the nurse recognizes which age group as generally needing the least amount of sleep? a) Older adults b) Adolescents c) Infants d) Young adults

a) Older adults As people age, the number of hours of needed sleep decreases. An average of 5 to 7 hours of sleep is usually adequate for the older adult age group.

A nurse understands the client's stage of sleep that requires the greatest stimulus to awaken a client is: a) REM sleep b) REM rebound period c) Stage IV NREM sleep d) Stage I NREM sleep

a) REM sleep

A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client? a) Sleep Deprivation b) Impaired Bed Mobility c) Relocation Stress Syndrome d) Risk for Injury

a) Sleep Deprivation

A client begins snoring and is sleeping lightly. The stage of sleep is: a) Stage 2 b) Stage 4 c) Stage 3 d) Stage 1

a) Stage 2

A nurse observes some involuntary muscle jerking in a sleeping patient. The nurse determines that the patient is most likely in which stage of sleep? a) Stage I NREM sleep b) Stage II NREM sleep c) Stage IV NREM sleep d) REM sleep

a) Stage I NREM sleep Involuntary muscle jerking occurs in stage I NREM sleep. In the other stages, the muscles proceed from a relaxed state to large muscle immobility.

The nurse should obtain a sleep history on which clients as a protocol? a) all clients admitted to a health care agency b) clients who suffer from a sleep disorder or who are spending time in the CCU c) only clients who have been suffering from a sleep disorder d) only clients who suffer from a sleep disorder or have been unconscious

a) all clients admitted to a health care agency

The nurse is performing an intake assessment of a 60-year-old client who admits to having a "nightcap" of 4 to 6 ounces of scotch whisky each night. What effect might this alcohol be having on the client's sleep? a) decreased REM sleep b) shorter sleep cycles c) increased stage IV NREM sleep (delta sleep) d) increased amount of total sleep

a) decreased REM sleep Alcohol is known to decrease the amount of REM and delta sleep an individual experiences.

A factory worker has a work schedule involving rotating work hours between days, evenings, and nights. The client tells the nurse he is a "morning" person, and is not sleeping well when he has to work nights. The nurse recommends: a) modifying the sleep environment to simulate quiet and darkness. b) increasing caffeine intake on days when he feels fatigued. c) applying for a promotion to a day shift supervisor position. d) obtaining a prescription for methylphenidate, a nervous system stimulant.

a) modifying the sleep environment to simulate quiet and darkness. The factory worker needs interventions that will promote natural, restful sleep. Caffeine and stimulant medications will exacerbate the problem. Applying for a different job may be possible, but is more of a long-term solution.

Which factor necessitates the need for more sleep in the adolescent population? a) rapid growth b) part-time employment c) increased nutritional needs d) increased life stresses

a) rapid growth

A nurse is caring for a client with insomnia. The nurse is explaining the importance of sleep to the client. Which role is sleep supposed to play? a) reduce fatigue b) decrease pain tolerance c) reduce protein synthesis d) eliminate fat accumulation

a) reduce fatigue Sleep is believed to play an important role in reducing fatigue, stabilizing mood, and improving blood flow to the brain, among other things. Sleep increases, not reduces, protein synthesis. Sleep does not eliminate accumulation of fat in a person's body. Regular exercise or physical activity reduces fat accumulation. Sleep increases pain tolerance in a person, whereas sleep deprivation decreases pain tolerance.

The nurse makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep are unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to: a) use caution when driving an automobile. b) ingest a small amount of alcohol prior to bedtime. c) drink at least 1 cup of coffee with the evening meal. d) change bedtime to later in the evening.

a) use caution when driving an automobile. The client is describing hypersomnia and is at increased risk for a motor vehicle accident when drowsy while driving an automobile. The client is to avoid alcohol, caffeine, and late night activities.

The client reports unpleasant sensation in the legs with an urge to move his legs. The nurse intervenes by instructing the client to do what? Select all that apply. a) Apply either heat or cold to the legs. b) Massage the legs when symptoms occur. c) Avoid use of tobacco products. d) Take an over-the-counter antihistamine. e) Monitor for sensation in the arms.

a, b, c An unpleasant sensation in the legs with an urge to move legs are symptoms of restless leg syndrome (RLS). The nurse should instruct the client who has restless leg syndrome to avoid use of tobacco products and antihistamines. Both of these items can exacerbate the symptoms. Interventions that may provide relief include massaging the legs and applying either heat or cold to the legs. Symptoms do not manifest in the arms.

A nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? Select all that apply. a) A patient who has uncontrolled hypothyroidism b) A patient with coronary artery disease c) A patient who has gastroesophageal reflux (GERD) d) A patient who is HIV positive e) A patient who is taking corticosteroids for arthritis f) A patient with a urinary tract infection

a, b, c. A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has gastroesophageal reflux (GERD) may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.

A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? Select all that apply. a) Daily mental activities b) Daily physical activities c) Morning and evening body temperature d) Daily measurement of fluid intake and output e) Presence of anxiety or worries affecting sleep f) Morning and evening blood pressure readings

a, b, e A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is not usually kept in a sleep diary.

A middle-aged client reports to the nurse that he has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. The nurse provides the following instructions to the client: a) Establish a set time to go to sleep each night. b) Participate in an enjoyable activity each day. c) Eat a snack that contains a small amount of fat. d) Drink one or two ounces of alcohol before bedtime. e) Perform moderate exercise three or four times each week.

a, b, e Behaviors that will promote sleep include establishing a regular routine, such as time, for bedtime, exercising three to four times each week, and participating in an activity that is enjoyable each day. The client should avoid alcohol and eat a small carbohydrate snack prior to bedtime.

A nurse formulates the following diagnosis for an elderly patient who is having trouble getting to sleep at night: Disturbed Sleep Pattern: Initiation of Sleep. Which of the following nursing interventions would the nurse perform related to this diagnosis? Select all that apply. a) Arrange for assessment for depression and treatment. b) Discourage napping during the day. c) Decrease fluids during the evening. d) Administer diuretics in the morning. e) Encourage patient to engage in some type of physical activity. f) Assess medication for side effects of sleep pattern disturbances.

a, b, e, f For patients who are having trouble initiating sleep, the nurse should arrange for assessment for depression and treatment, discourage napping, promote activity, and assess medications for sleep disturbance side effects. Limiting fluids and administering diuretics in the morning are appropriate interventions for Disturbed Sleep Pattern: Maintaining Sleep.

A nurse is caring for a client who has been diagnosed with a disturbed sleep pattern. What measures should the nurse implement to promote sleep? Select all that apply. a) Assisting with progressive relaxation b) Administration of diuretics c) Increasing the intake of stimulating chemicals d) Promoting daytime exercises e) Providing a back massage

a, d, e In order to promote sleep in a client, the nurse could use the following measures: promoting daytime exercise, providing a back massage, and assisting the client with progressive relaxation. However, the nurse should reduce the intake of stimulating chemicals to promote sleep in a client. Diuretics may awaken those who take them with a need to empty the bladder. For this reason, diuretics generally are administered early in the morning so that the peak effect has diminished by bedtime.

During an orientation class for new RN graduates, the nurse educator identifies which conditions as potential risks for clients to experience sleep pattern disturbance? Select all that apply. a) Stroke b) Glaucoma c) Type 1 diabetes mellitus (DM) d) Depression e) Constipation f) Substance abuse

a, d, e, f People engaged in changing shift work, particularly overnights, can be prone to higher risk of depression, loneliness, substance abuse, type 2 DM, and gastrointestinal and cardiovascular symptoms. Type 1 DM and glaucoma are not related to sleep-cycle disruption.

The nurse is providing client education for the parents of an obese child diagnosed with obstructive sleep apnea. What treatment measures would the nurse explain during the education session? Select all that apply. a) use of a mandibular advancement device (MAD) b) treatment with intranasal antibiotics c) counseling for depression d) treatment with sleeping pills e) a weight loss plan f) use of a continuous passive airway pressure (CPAP) machine

a, e, f A weight loss plan, use of a continuous passive airway pressure (CPAP) machine, and the use of a mandibular advancement device (MAD) are treatment measures that the nurse would explain during the education session on obstructive sleep apnea. The use of antibiotics and sleeping pills would not be included. Counseling for depression is not necessary as the question is written.

For which of the following clients would the nurse most likely administer a benzodiazepine-like drug? a) A client who has insomnia combined with restless leg syndrome b) A client who is being treated for short-term insomnia c) A client who needs long-term therapy for chronic insomnia d) A client who has insomnia and awakens in the middle of the night

b) A client who is being treated for short-term insomnia Although most benzodiazepine-like drugs provide several nights of excellent sleep, the medication often loses its effect after 1 or 2 weeks. These drugs should be used for the client who is being treated for short-term insomnia. Zolpidem tartrate sublingual tablets have recently been approved by the FDA for insomnia associated with middle-of-the-night awakening. It is intended for use when at least 4 hours of sleep time remain. Eszopiclone is prescribed for longer-term treatment of chronic insomnia. Ropinirole and pramipexole dihydrochloride are drugs that have been approved by the U.S. Food and Drug Administration (FDA) to treat restless leg syndrome (RLS). Two additional medications have been approved for treatment of moderate to severe RLS: gabapentin enacarbil (extended-release tablets) and rotigotine transdermal system. Both are sustained-release medications that have proved effective for relief of the symptoms of RLS.

What factor has been hypothesized by researchers regarding current thoughts on sleep? a) Population is healthier due to sleep. b) Chronic sleep deprivation is present. c) More sleep is obtained through napping. d) The current population requires less sleep.

b) Chronic sleep deprivation is present. Most recently, researchers have hypothesized that much of the population in industrialized nations may be chronically sleep deprived.

Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern? a) What do you usually do to help yourself fall asleep? b) Do you usually go to bed and wake up about the same time each day? c) How much sleep do you think you need to feel rested? d) In what way does the sleep you get each day affect your everyday living?

b) Do you usually go to bed and wake up about the same time each day? The best interview question for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern would be to ask if the client usually goes to bed and wakes up about the same time each day. The other questions are possible to ask the client, but are not related to recent changes in the client's sleep-wakefulness pattern.

During the morning assessment the client reports to the nurse he is experiencing a hangover from his sleeping pill. The nurse reviews the Medication Administration Record. Which of the following medications is more likely to cause the client's complaint? a) Eszopiclone (Lunesta) b) Flurazepam (Dalmane) c) Ramelteon (Rozerem) d) Zolpidem (Ambien)

b) Flurazepam (Dalmane) All of the listed medications are ones that promote sleep. Flurazepam is the drug most likely to cause the client's complaint of a morning hangover.

Which statement about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents? a) Most toddlers fall asleep easily. b) Getting the child to sleep can be difficult. c) Nightmares are rare in toddlers. d) Slow-wave sleep occurs less in toddlers than in adults.

b) Getting the child to sleep can be difficult. Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.

A nurse is caring for a client diagnosed with sleep apnea. Which nursing diagnosis should the nurse include in her nursing care plan? a) Impaired Bed Mobility b) Impaired Gas Exchange c) Risk For Injury d) Relocation Stress Syndrome

b) Impaired Gas Exchange

A nurse caring for patients in a busy hospital environment should implement which recommendation to promote sleep? a) Keep the room light dimmed during the day. b) Keep the room cool. c) Keep the door of the room open. d) Offer a sleep aid medication to patients on a regular basis.

b) Keep the room cool.

A nurse is performing a sleep assessment on a patient being treated for a sleep disorder. During the assessment, the patient falls asleep in the middle of a conversation. The nurse would suspect which disorder? a) REM behavior disorder b) Narcolepsy c) Enuresis d) Sleep apnea

b) Narcolepsy

A nurse assesses a patient's body temperature in the late afternoon as 37.2°C (99°F). What would be the nurse's best action related to this slight elevation in temperature? a) Assess the patient for infection. b) Record the temperature as a normal finding. c) Call the physician for an order for antipyretics. d) Decrease the room temperature.

b) Record the temperature as a normal finding. A slight increase in body temperature in the late afternoon is the result of a normal circadian rhythm and does not need to be reported unless it becomes higher. This slight variation from normal does not necessarily mean an infection is present. A warm environment might cause an elevation in body temperature, but the most likely cause is normal circadian rhythm.

A nurse attempts to wake a client who is scheduled for tests and is able to arouse him relatively easily. Which stage of sleep is this client most likely experiencing? a) Stage III b) Stage II c) Stage IV d) Stage I

b) Stage II The client is most likely experiencing Stage II sleep. Stage II sleep is when the client is aroused with relative ease. This stage constitutes 50% to 55% of sleep. Stage I is a transitional stage between wakefulness and sleep. The client is still somewhat aware of the surroundings. Involuntary muscle jerking may occur and waken the person. This stage normally lasts only minutes.

The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to: a) take prescribed sedative before trying to sleep. b) anticipate sleeping overnight at a health care center. c) insert an oral appliance prior to attempting sleep. d) apply facial mask that will deliver positive air pressure.

b) anticipate sleeping overnight at a health care center. Polysomnography is a sleep study. The client will be scheduled for the study at a health care center and sleep overnight as part of the study. The client should avoid sedatives as this will aggravate OSA. Interventions for OSA include inserting an oral appliance or applying a facial mask for continuous positive airway pressure.

Which activity for rest break should not be incorporated into care planning for clients to aid in healing and recovery? a) stretching exercises b) drinking an 8 oz cup of a caffeinated beverage c) going for a short walk d) focusing thoughts on a pleasant scene away from work e) taking a short 15- to 30-minute nap

b) drinking an 8 oz cup of a caffeinated beverage Drinking a caffeinated beverage is not as energizing as a short 15- to 30-minute nap, stretching exercises, or taking a short walk.

A new client in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis? a) Help the client maintain normal bedtime routine and time for sleep. b) Bring the client a warm glass of milk at bedtime. c) Use tactile relaxation techniques, such as a back massage. d) Provide an opportunity for the client to talk about concerns.

d) Provide an opportunity for the client to talk about concerns. Stress and anxiety interfere with a person's ability to relax, rest, and sleep. The client is scheduled for a surgical procedure in the morning. The nursing diagnosis addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other options are incorrect because the options do not address the situation at hand, or the nursing diagnosis that is noted.

A nurse understands the client's stage of sleep that requires the greatest stimulus to awaken a client is: a) REM rebound period b) Stage IV NREM sleep c) Stage I NREM sleep d) REM sleep

d) REM sleep The NREM arousal threshold is usually greatest in stage IV NREM, but it is harder to arouse a person who is in REM sleep than NREM sleep. REM rebound is the term for accumulating REM sleep in balance over time.

A nurse working the night shift in a pediatric unit observes a 10-year-old male patient walking the hallway in a sleep state. The child is unaware of his environment and doesn't recall the incident in the morning. Which sleep disorder would the nurse expect? a) Bruxism b) Cataplexy c) Restless leg syndrome d) Somnambulism

d) Somnambulism

What is a possible outcome criterion that addresses the goal that the client will demonstrate physical signs of being rested? a) The client reports less anxiety regarding falling asleep. b) The client reports drinking only one cup of coffee a day. c) The client reports a decrease in sleep latency to 10-15 minutes. d) The client has decreases in circles under her eyes and excessive yawning by 1 week. e) The client verbalizes feeling less fatigued by 1 week.

d) The client has decreases in circles under her eyes and excessive yawning by 1 week. This outcome criterion addresses the goal by stating physical, objective signs that the person is better rested. It also mentions a time frame, which makes it measurable and easier to evaluate.

Which client condition indicates the presence of a parasomnia? a) a woman whose restless leg syndrome often awakens her b) a child who awakens with nightmares three to four times a week c) a man who takes several hours to fall asleep each night d) a child who wets his bed each night

d) a child who wets his bed each night Enuresis is considered a parasomnia. Insomnia and RLS are classified as dyssomnias.

The nurse educator is discussing sleep interventions with students. Sleep restriction can best be defined as: a) never allowing sleep in a new environment. b) purposefully shortening sleep time over several nights to reach a point when lengthy sleep is necessary. c) taking prescribed stimulant medication to counteract narcolepsy. d) limiting time in bed to actual sleep time.

d) limiting time in bed to actual sleep time. Sleep restriction is the concept of limiting time in bed, so that sleep does not become fragmented. Shortening sleep time on purpose will promote sleep deprivation. Never sleeping in a new environment is unrealistic. Stimulants may be used to treat narcolepsy, but that is not related to sleep restriction.

In Stage 4 sleep, the: a) respirations are irregular b) blood pressure is elevated c) temperature increases d) pulse rate is slow

d) pulse rate is slow During slow-wave sleep, the muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle all decrease.

A client calls a sleep clinic "helpline" and describes her 46-year-old husband's sleep patterns: snoring loudly, then becoming startled and waking up 5 or 6 times a night. The wife is asking how to improve his sleep patterns. The nurse concludes: a) the husband should only eat a small carbohydrate snack before bed. b) the wife should consider wearing ear plugs to bed. c) the wife needs interventions to promote Stage II sleep for herself. d) the husband may be exhibiting signs of sleep apnea.

d) the husband may be exhibiting signs of sleep apnea.

When evaluating a client's sleep plan success, the nurse would expect the client to: a) explain the direct actions of the hypnotic he has been prescribed. b) identify how many NREM cycles he progressed through. c) describe the dreams he had. d) verbalize feeling rested.

d) verbalize feeling rested.

A nurse working the night shift at a hospital observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply. a) REM sleep constitutes much of the sleep cycle of a preschool child. b) By the age of 8 years, most children no longer take naps. c) Sleep needs usually decrease when physical growth peaks. d) Many adolescents do not get enough sleep. e) Total sleep decreases in adults with a decrease in stage IV sleep. f) Sleep is less sound in older adults and stage IV sleep may be absent.

d, e, f Many adolescents do not get enough sleep due to the stresses of school, activities, and part-time employment causing restless sleep. Total sleep time decreases during adult years, with a decrease in stage IV sleep. Sleep is less sound in older adults, and stage IV sleep is absent or considerably decreased. REM sleep constitutes much of the sleep cycle of a young infant, and by the age of 5 years, most children no longer nap. Sleep needs usually increase when physical growth peaks.