Sleep 24

Which class of drugs does the nurse anticipate administering to a patient with narcolepsy to prevent sleep attacks? 1 Hypnotics 2 Stimulants 3 Anticonvulsants 4 Benzodiazepines

2 Stimulants help improve alertness and prevent sleep attacks. In narcolepsy, the patient falls asleep uncontrollably at inappropriate times. These are called sleep attacks. Therefore stimulants increase wakefulness and reduce sleep attacks. Hypnotics, anticonvulsants, and benzodiazepines increase drowsiness and sleeping time; therefore these medicines are contraindicated for patients with narcolepsy.

Which information is true regarding sleep regulation? 1 L-tryptophan controls wakefulness in the body. 2 The hypothalamus is the major sleep center of the body. 3 The homeostatic process influences internal organization of sleep. 4 Circadian rhythms regulate the length and depth of sleep.

2 The following information is true: the hypothalamus is the major sleep center of the body. L-tryptophan controls sleep; this chemical does not promote wakefulness. The circadian rhythm (not homeostatic process) influences the internal organization of sleep. The homeostatic process (not circadian rhythms) regulates the length and depth of sleep.

Which information is true about gender disparities in patients with sleep disorders? 1 Sleep apnea is more common in women than in men. 2 Insomnia is the most common sleep disorder in women. 3 Restless legs syndrome (RLS) is more common in men than in women. 4 Excessive sleepiness is common in women with menopausal symptoms.

2 The following is a true statement: insomnia is the most common sleep disorder in women. Sleep apnea is more common in men, not women. RLS is more common in women than in men. Insomnia rather than excessive sleepiness is common in women with menopausal symptoms.

Which sleep disturbance is the nurse likely to observe in the patient with hyperthyroidism? 1 Sleep-related bruxism 2 Enuresis 3 Sleepwalking 4 Difficulty falling asleep

4 Difficulty falling asleep occurs with hyperthyroidism. Sleep-related bruxism (teeth grinding), enuresis, and sleepwalking do not occur in hyperthyroidism but are parasomnias that occurs in older children.

Which characteristic occurs in both N1 and N2 of nonrapid eye movement (NREM) sleep? 1 Lasts for 10 to 20 minutes 2 Includes a light level of sleep 3 Muscles are completely relaxed 4 Sleeper can be easily awakened

4 In both stages of N1 and N2 of NREM sleep, the sleeper can be easily awakened. N1 lasts for a few minutes, not 10 to 20 minutes. N1 is the lightest level of sleep; N2 is a period of sound sleep. Muscles are completely relaxed in N3, not in N1 and N2.Test-Taking Tip: Whether you are taking a written or clinical examination, budget your time. Remember that some tasks or questions may require more time than others.

Which sleep disorder is classified as a sleep-related breathing disorder? 1 Narcolepsy 2 Nightmare disorder 3 Sleep-related bruxism 4 Primary central sleep apnea

4 Primary central sleep apnea is classified as a sleep-related breathing disorder. Narcolepsy is classified as a hypersomnia that is not caused by a sleep-related breathing disorder; it is not classified as a sleep-related breathing disorder. Nightmare disorder is classified as a parasomnia that is usually associated with rapid eye movement (REM) sleep; it is not classified as a sleep-related breathing disorder. Sleep-related bruxism is classified as a sleep-related movement disorder, not a sleep-related breathing disorder.

Which type of anemia will likely lead to restless legs syndrome? 1 Folate 2 Cobalamin 3 Vitamin B12 4 Iron

4 Rhythmical movements of the feet and legs and an itching sensation in the muscles before sleep are symptoms of restless legs syndrome, which is caused by iron deficiency anemia. Folate and cobalamin (vitamin B12) do not lead to restless legs syndrome.

Stage 4 of nonrapid eye movement (NREM) sleep is almost absent in which age-group? 1 Infants 2 Toddlers 3 Adolescents 4 Older adults

4 Stage 4 of NREM sleep is almost absent in older adults because it begins its decline in middle adults. In infants, toddlers, and adolescents, stage 4 of NREM sleep is present and important because human growth hormone is released in this stage.

According to the American Academy of Sleep Medicine, which stage of nonrapid eye movement (NREM) sleep is the deepest stage of sleep, is very difficult to arouse the sleeper from, and are vital signs lower than during normal waking hours? Record your answer using a whole number. N __________

N3 is the deepest stage of sleep, is very difficult to arouse the sleeper from, and vital signs are lower than during normal waking hours.

In a patient with narcolepsy, rapid eye movement (REM) sleep occurs within how many minutes of falling asleep? Record your answer using a whole number. _________ minutes

15 In a patient who has narcolepsy, REM sleep occurs within 15 minutes of falling asleep.

Which feature is similar for both obstructive sleep apnea (OSA) and central sleep apnea (CSA)? 1 Loud snoring 2 Decreased oxygen saturation level 3 No movement of the chest wall 4 Relaxed throat muscles

2 Both OSA and CSA decrease the oxygen saturation level. OSA causes loud snoring; CSA causes mild and intermittent snoring. CSA ceases the movement of the chest wall; patients with OSA show chest wall movement. OSA occurs when muscles of the throat relax during sleep; CSA involves a dysfunction in the respiratory control center of the brain.

Which physiological change increases when a patient is asleep? 1 Heart rate 2 Cell division 3 Basal metabolic rate 4 Muscular contractions

2 Cell division increases during sleep and helps in the renewal of tissues. Heart rate, basal metabolic rate, and muscular contractions decrease (not increase) during sleep. The heart rate decreases during sleep; this action benefits the cardiac function. The basal metabolic rate decreases during sleep; this action conserves the body's energy supply. Muscular contractions decrease during sleep; this action preserves chemical energy for cellular processes.

Which drug classification or substance causes suppressed rapid eye movement (REM) sleep and increased daytime drowsiness? 1 Alcohol 2 Opiates 3 Nicotine 4 Hypnotics

2 Opiates suppress REM sleep and increase daytime drowsiness. Alcohol and nicotine suppress REM sleep, but do not cause daytime drowsiness. Hypnotics cause drowsiness, but do not interfere with REM sleep.

Which biological function occurs when a patient is dreaming? 1 Cortical activity decreases. 2 Respiratory rate fluctuates. 3 Eye movement slowly fluctuates. 4 Epinephrine release decreases.

2 Respiratory rate fluctuates during dreaming. Cortical activity increases (not decreases) during dreaming. Eye movements are rapid, not slowly fluctuating. Epinephrine release increases (not decreases) during dreaming.

Which parameter does an electromyogram (EMG) monitor in a patient diagnosed with a sleep disorder? 1 Muscle tone 2 Eye movements 3 Electrical activity of the heart 4 Electrical activity in the brain

1 An EMG measures muscle tone. Various instruments are used to measure a patient's sleep pattern. Eye movements are measured by an electrooculogram (EOG), not an EMG. An electrocardiogram (ECG), not an EMG, measures the electrical activity of the heart. An electroencephalogram (EEG), not an EMG, measures electrical activity in the brain.

Which effect will likely occur in a patient who takes an antidepressant for depression? 1 Decreased total sleep time 2 High blood pressure 3 Difficulty breathing 4 Increased daytime sleepiness

1 Antidepressants cause a decrease in total sleep time. Antidepressants can also suppress rapid eye movement (REM) sleep. Antidepressants are not associated with high blood pressure. Difficulty breathing is not a problem with antidepressants. A patient who is taking a benzodiazepine (not an antidepressant) can experience increased daytime sleepiness. Test-Taking Tip: Identifying content and what is being asked about that content is critical to you choosing the correct response. Be alert for words in the question that are the same or similar in nature to those in one or two of the answer choices.

Which class of medication in the patient's prescription does the nurse expect to have caused a patient to report disturbed sleep because of frequent nighttime voiding? 1 Diuretics 2 Hypnotics 3 Benzodiazepines 4 Beta-adrenergic blockers

1 Diuretics cause nocturia, which results in disturbed sleep because of frequent nighttime voiding. Hypnotics, benzodiazepines, and beta-adrenergic blockers do not cause nocturia. Hypnotics cause a hangover during the day, excessive drowsiness, and confusion. Benzodiazepines increase daytime sleepiness and alter rapid eye movement (REM) sleep. Beta-adrenergic blockers cause nightmares and insomnia.

Which information would the nurse include in a teaching session to promote sleep? 1 Exercise 2 hours before bedtime. 2 Consume chocolates in the evening. 3 Have a large and heavy meal at night. 4 Work until excessively fatigued.

1 Exercising 2 hours before bedtime promotes sleep because exercise cools the body and maintains a state of fatigue that promotes relaxation. Chocolate should be avoided in the evening because it contains caffeine and xanthines that cause sleeplessness. A large and heavy meal should be avoided at night because it may result in indigestion that interferes with sleep. Moderate fatigue usually achieves restful sleep. Excessive fatigue resulting from stressful work makes falling asleep difficult. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.

Which complaint is common in patients with obstructive sleep apnea? 1 Fatigue 2 Anxiety 3 Increased sex drive 4 Evening headaches

1 Fatigue is a common complaint of patients with obstructive sleep apnea. Anxiety is not associated with obstructive sleep apnea. Decreased, not increased, sex drive is associated with obstructive sleep apnea. Morning (not evening) headaches are associated with sleep apnea.

Which information would the nurse share with a patient about the major risk factors for obstructive sleep apnea (OSA)? 1 These include obesity and hypertension. 2 Smoking and heart failure are the main ones. 3 Alcohol and type 2 diabetes are the main ones. 4 These include smoking and a family history of OSA.

1 Obesity and hypertension are major risk factors for OSA. Smoking, heart failure, alcohol, type 2 diabetes, and a family history of OSA are not major risk factors for OSA. However, smoking and heart failure do increase the risk of OSA, but they are not major risk factors. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. The key word in this question is major; if you were reading fast, you may have missed this important word.

Which action would the nurse take for a patient who is diagnosed with fatigue? 1 Encourage short naps if possible. 2 Instruct the patient to keep an exercise log. 3 Have the patient keep a sleep log for a week. 4 Suggest sleeping longer during weekends.

1 The nurse would instruct a patient who is diagnosed with fatigue to take short naps. A patient with a sedentary lifestyle (not fatigue) should keep an exercise log. A patient suffering from insomnia (not fatigue) should be asked to keep a sleep log for a week. The nurse would not suggest sleeping longer during weekends; sleeping long hours during weekends disturbs the normal sleep-wake cycle.

Which statement made by the patient needs further follow-up from the nurse? 1 "I always feel tired when I wake up in the morning." 2 "I go to bed at the same time each night." 3 "It takes me about 15 minutes to fall asleep." 4 "Sometimes, I have to get up during the night to urinate."

1 The statement, "I always feel tired when I wake up in the morning" indicates the patient is not experiencing quality sleep, and the statement would be followed up with more extensive questions and assessment of the problem. Patients are the best resource for describing sleep problems and how these problems are a change from their usual sleep and waking patterns. Going to bed at the same time each night, taking about 15 minutes to fall asleep, and sometimes having to get up during the night to urinate are signs of normal and appropriate findings and do not require follow-up from the nurse.

The patient who tells the nurse about a dream that was vivid and colorful would have be in which stage of sleep? 1 Rapid eye movement (REM) 2 N1 3 N2 4 N3

1 Vivid and colorful dreaming occurs during REM sleep. Although dreams occur during both nonrapid eye movement (NREM) and REM sleep, the dreams of REM sleep are more vivid and elaborate; dreams are believed to be functionally important to learning, memory processing, and adaptation to stress.STUDY TIP: Because full-color dreaming creates visual pictures in the patient's mind, it makes sense that it occurs during REM sleep.

Which substance may produce insomnia if consumed in the evening? Select all that apply. One, some, or all responses may be correct. 1 Alcohol 2 Nicotine 3 Caffeine 4 A light meal 5 A protein-rich diet

1, 2, 3 Consumption of alcohol, nicotine, and caffeine in the evening produces insomnia. Nicotine and caffeine act as stimulants and produce sleeplessness. Alcohol interferes with the sleep pattern. A light meal and a protein-rich diet do not cause insomnia.

Which sleep deprivation symptom will the nurse likely find in a patient who has insomnia? Select all that apply. One, some, or all responses may be correct. 1 Irritability 2 Agitation 3 Increased reflexes 4 Decreased sensitivity to pain 5 Decreased visual alertness

1, 2, 5 Irritability, agitation, and decreased visual alertness are symptoms of sleep deprivation. Reflexes are decreased, not increased. Sensitivity to pain is increased, not decreased.

Which physiological symptom is observed in the nurse who has a sleep disorder because of working rotating shifts? Select all that apply. One, some, or all responses may be correct. 1 Blurred vision 2 Increased reflexes 3 Decreased judgment 4 Slowed response time 5 Increased visual alertness

1, 3, 4 As a result of rotating shifts, the nurse has sleep deprivation, which can cause blurred vision, decreased judgment, and slowed response time. Sleep deprivation occurs in this nurse because the human biological clock becomes maladjusted. Sleep deprivation causes decreased (not increased) reflexes and decreased (not increased) visual alertness. Test-Taking Tip: Sleep deprivation makes people less alert. "Increased reflexes" and "Increased visual alertness" can be eliminated when you realize they represent heightened alertness.

Which symptom is likely to be found in the patient who has obstructive sleep apnea? Select all that apply. One, some, or all responses may be correct. 1 Loud snoring 2 Sudden muscle weakness 3 Decreased sex drive 4 Difficulty concentrating 5 Excessive urination during the night

1, 3, 4 Loud snoring, decreased sex drive, and difficulty concentrating are symptoms of obstructive sleep apnea. Sleep apnea occurs because of a lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep. Sudden muscle weakness can occur with narcolepsy, not obstructive sleep apnea. Excessive urination during the night can occur with the use of diuretics, not obstructive sleep apnea.

Which information would the nurse include in a teaching session about the different stages of sleep? Select all that apply. One, some, or all responses may be correct. 1 If awakened in N1 stage, the person feels as though daydreaming has occurred. 2 Dreams occur during rapid eye movement (REM) sleep only. 3 N3 is called slow-wave sleep. 4 Dreams occur during both nonrapid eye movement (NREM) and REM sleep. 5 There is decreased epinephrine release during REM sleep.

1, 3, 4 The information would include if awakened in N1 stage, the person feels as though daydreaming has occurred; N3 is called slow-wave sleep; and dreams occur during both NREM and REM sleep. Dreaming is a phenomenon that occurs both in the NREM and REM stages of sleep. However, the dreams of REM sleep are more vivid and colorful compared to those of NREM sleep. REM sleep is associated with increased (not decreased) epinephrine release.Test-Taking Tip: Do not read too much into the question or worry that it is a trick. If you have nursing experience, ask yourself how an inexperienced classmate would answer this question from only the information provided in the textbooks or given in the lectures.

Which common symptom does the patient likely report when being evaluated for obstructive sleep apnea? Select all that apply. One, some, or all responses may be correct. 1 Morning headache 2 Early wakening 3 Excessive daytime sleepiness 4 Difficulty falling asleep 5 Irritability

1, 3, 5 Common symptoms of obstructive sleep apnea include morning headache, excessive daytime sleepiness, and irritability. Early wakening occurs with hypertension and insomnia, not obstructive sleep apnea. Difficulty falling asleep occurs with insomnia, not obstructive sleep apnea.

Which patient effect can be caused from the noise generated during the delivery of care? Select all that apply. One, some, or all responses may be correct. 1 Delayed healing 2 Increased agitation 3 Decreased heart rate 4 Lowered blood pressure 5 Impaired immune function

1, 3, 5 Noise may cause stress and lead to delayed healing, increased agitation, and impaired immune function. In the health care setting the noise created by the staff, monitor alarms, and equipment may have adverse effects on the patients. Noise increases heart rate and raises blood pressure; noise does not decrease heart rate nor blood pressure.Test-Taking Tip: Think of noise as a stressor and consider what stressors do to the body: They raise the heart rate and blood pressure. This approach eliminates two choices.

Which patient is at risk of developing central sleep apnea (CSA)? Select all that apply. One, some, or all responses may be correct. 1 A patient with encephalitis 2 A patient with nasal polyps 3 A patient with enlarged tonsils 4 A patient with muscular dystrophy 5 A patient with a large neck circumference

1, 4 Patients prone to CSA are one with encephalitis and a patient with muscular dystrophy. CSA involves dysfunction in the respiratory control center of the brain. Patients with encephalitis and muscular dystrophy are at risk of developing CSA because of a fall in blood oxygen saturation levels. Obstructive sleep apnea (OSA) occurs when muscles or structures of the oral cavity or throat relax during sleep. Therefore patients with nasal polyps, enlarged tonsils, and a large neck circumference are at risk of developing OSA and not CSA.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice questions with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

Which advice would the nurse give to a patient who falls asleep uncontrollably at inappropriate times and has vivid dreams during such times? Select all that apply. One, some, or all responses may be correct. 1 Avoid alcohol. 2 Avoid smoking. 3 Avoid chewing gum. 4 Avoid heavy meals. 5 Avoid long-distance driving.

1, 4, 5 Alcohol, heavy meals, and long-distance driving tend to induce drowsiness and should be avoided, because the patient's symptoms indicate narcolepsy. Smoking is not related to narcolepsy. The patient should not avoid chewing gum; in fact, chewing gum is recommended for patient with narcolepsy.STUDY TIP: Remember that being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.

Which physiological implication would the nurse look for in a patient with obstructive sleep apnea? Select all that apply. One, some, or all responses may be correct. 1 Fatigue 2 Cataplexy 3 Sleep paralysis 4 Cardiac dysrhythmias 5 Excessive daytime sleepiness

1, 4, 5 The nurse would look for fatigue, cardiac dysrhythmias, and excessive daytime sleepiness in a patient with obstructive sleep apnea. The nurse would look for cataplexy or sudden muscle weakness and sleep paralysis in a patient in whom narcolepsy is suspected but not for obstructive sleep apnea.

Which instruction does the nurse provide to the patient to reduce sleep attacks when taking armodafinil? Select all that apply. One, some, or all responses may be correct. 1 "Avoid traveling long distances." 2 "Avoid performing regular exercise." 3 "Avoid drinking coffee and tea." 4 "Avoid consuming alcohol and heavy meals." 5 "Avoid sitting in hot, stuffy rooms for long periods."

1, 4, 5 The nurse would tell the patient to avoid the following: traveling long distances; consuming alcohol and heavy meals; and sitting in hot, stuffy rooms for long periods. Armodafinil is a stimulant that only partially increases wakefulness and reduces sleep attacks in patients with narcolepsy. Patients with narcolepsy need to avoid activities that increase drowsiness. The nurse does not instruct the patient to avoid performing regular exercise or to avoid drinking coffee or tea, because these reduce sleep attacks and promote wakefulness.Test-Taking Tip: Read the question carefully before looking at the answers: (1) determine what the question is really asking by looking for key words; (2) read each answer thoroughly and see if it completely covers the material asked by the question; and (3) narrow the choices by immediately eliminating answers you know are incorrect.

Which nursing intervention would the nurse provide to promote sleep in a patient with a sedentary lifestyle? 1 Encourage short naps if possible. 2 Instruct the patient to keep an exercise log. 3 Have the patient keep a sleep log for a week. 4 Suggest exercising 30 minutes before bedtime.

2 The nurse would instruct a patient with a sedentary lifestyle to keep an exercise log. A patient who reports fatigue should take short naps; short naps are not appropriate for a patient who has a sedentary lifestyle. A patient suffering from insomnia should keep a sleep log for a week; the patient with a sedentary lifestyle would not use a sleep log. The patient should exercise at least 2 hours before bedtime, not 30 minutes before bedtime. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

Which measure would the nurse suggest to a parent to promote sleep in a preschooler? 1 Encourage co-sleeping on a soft mattress. 2 Offer warm milk before sleeping. 3 Make sure that the room is dark and quiet. 4 Suggest a small piece of chocolate mint before bedtime.

2 To promote sleep in a preschooler, the nurse would suggest that the parent offer warm milk before sleeping. A dairy product such as warm milk contains L-tryptophan, which helps promote sleep. Co-sleeping should occur on a firm mattress; depending upon the parent's culture, co-sleeping may or may not be advised. Because preschoolers often have bedtime fears, the room should not be completely dark. Chocolate mint can act as a stimulant. Coffee, tea, soda, and chocolate can keep a person awake.

How long before bedtime should a patient take melatonin? Record your answer using a whole number. _______________________ hours

2 hours Melatonin should be taken 2 hours before bedtime.

Which symptom is the most common complaint by patients who have narcolepsy? 1 Sleep paralysis 2 Sudden muscle weakness 3 Excessive daytime sleepiness 4 Vivid dreams while falling asleep

3 Excessive daytime sleepiness is the most common complaint by patients who have narcolepsy. Although sleep paralysis, sudden muscle weakness, and vivid dreams while falling asleep do occur, they are not the most common symptoms associated with narcolepsy.Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; every rule has its exceptions, so answer with care.

Which condition is associated with early morning wakefulness and fatigue? 1 Liver failure 2 Hypertension 3 Hyperthyroidism 4 Restless legs syndrome

3 Hypertension can cause early morning wakefulness and fatigue. Patients with heart (not liver) failure may have frequent sleep disruptions; liver failure is not associated with early morning wakefulness. Hyperthyroidism is associated with taking more time to fall asleep, not early morning wakefulness. Although restless legs syndrome may lead to fatigue, it does not cause early morning wakefulness.Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an examination may trigger your mind with the answer or provide an important clue to an earlier question.

Which stage of the sleep cycle is decreased in the patient who has hypothyroidism? 1 N1 2 N2 3 N3 4 Rapid eye movement (REM)

3 Hypothyroidism decreases the last sleep stage (N3) of nonrapid eye movement (NREM) sleep. N1, N2, and REM stages are not affected.

Which patient's sleep deprivation symptom is psychological? 1 Slowed reflexes 2 Fine-motor clumsiness 3 Increased sensitivity to pain 4 Decreased auditory alertness

3 Increased sensitivity to pain is a psychological symptom in a patient with sleep deprivation. Slowed reflexes, fine-motor clumsiness, and decreased auditory alertness are physiological (not psychological) symptoms of sleep deprivation.

Which chemical promotes sleep? 1 Orexin 2 Hypocretin 3 L-tryptophan 4 Catecholamine

3 L-tryptophan is a natural protein present in foods such as milk, cheese, and meat; this chemical promotes sleep. Orexins and hypocretins promote wakefulness, not sleep. Catecholamines, which are secreted by neurons in a reticular activating system, promote wakefulness, not sleep.Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

Which class of drug does the nurse suspect is responsible for the patient reporting daytime drowsiness and a lack of dreams? 1 Antibiotics 2 Antipyretics 3 Opiates 4 Diuretics

3 Opiates cause increased daytime drowsiness and suppress rapid eye movement (REM) sleep (a lack of dreams). Antibiotics generally do not cause a lack of dreams and daytime drowsiness. Antipyretics generally do not cause daytime drowsiness or suppress REM sleep. Diuretics are not associated with daytime drowsiness or a lack of dreams; however, diuretics can cause nighttime awakenings caused by nocturia.

.Which condition will likely result when a person is moderately fatigued because of exercising 2 hours before bedtime? 1 Insomnia 2 Sleep apnea 3 Restful sleep 4 Excessive daytime sleepiness

3 Restful sleep will result because exercising 2 hours before bedtime cools the body and causes moderate fatigue; this promotes relaxation and restful sleep. Exhausting or stressful work (not being moderately fatigued) makes falling asleep difficult, resulting in insomnia. Sleep apnea is caused by a lack of airflow through the nose and mouth for a period of 10 seconds or longer during sleep; it is not because of moderate fatigue from exercising. Excessive daytime sleepiness is a condition observed in patients with obstructive sleep apnea, not from being moderately fatigued from exercising.

Which statement indicates a correct understanding of sleep disorders? 1 Painful urination is defined as nocturia. 2 Restless legs syndrome (RLS) occurs more often in men. 3 Peptic ulcers predispose a person to wake up in the middle of the night. 4 Nocturia can be seen in people suffering from iron deficiency anemia.

3 The correct statement is as follows: peptic ulcers predispose a person to wake up in the middle of the night. Nocturia is urination during the night; painful urination (dysuria) is not defined as nocturia. RLS occurs more often in women, not men. People suffering from iron deficiency anemia are prone to RLS, not nocturia.

Which condition will the nurse focus the care plan on when caring for a patient who says, "I feel sleepy, fatigued, and depressed during the daytime?" 1 Narcolepsy 2 Parasomnia 3 Chronic insomnia 4 Restless legs syndrome

3 The nurse will focus the care plan on chronic insomnia. Sleepiness, fatigue, and depression during the daytime are symptoms of chronic insomnia. Anxiety can also occur. Narcolepsy is a dysfunction of the sleep-wake cycle, causing people affected by the disease to fall asleep at inappropriate times. It includes daytime sleepiness as a symptom, but it does not cause fatigue and depression. Parasomnias are sleep disturbances such as sleepwalking and are not associated with fatigue and depression. Depression is not associated with restless legs syndrome.

Which statement made by an older adult demonstrates understanding regarding taking a sleep medication? 1 "I'll take the sleep medicine for 4 or 5 weeks, until my sleep problems disappear." 2 "Sleep medicines won't cause any sleep problems once I stop taking them." 3 "I'll talk to my health care provider before I use an over-the-counter sleep medication." 4 "Sleep medicines will make me feel extremely sleepy in the mornings."

3 The older adult stating that he or she will consult a health care provider before using an over-the-counter sleep medication indicates an understanding of the risks of these medications. The other statements indicate a lack of understanding. The use of nonprescription sleep medications is not advisable. Sleep medications are taken short-term (no longer than 2 to 3 weeks), not 4 or 5 weeks. Sleep medicines can cause problems even after taking them, such as rebound insomnia. Sleep medicines should not make one feel extremely sleepy in the mornings.

Which aspect of care would be included when teaching a patient with narcolepsy? 1 The need to perform strenuous exercise 2 The importance of avoiding caffeine 3 The recommendation to take regular naps of no more than 20 minutes 4 The proper method of using Continuous positive airway pressure (CPAP)

3 The recommendation to take regular naps of no more than 20 minutes is advised for a patient with narcolepsy. The patient should avoid strenuous exercise, because performing strenuous exercise can cause drowsiness. Narcolepsy is unrelated to caffeine intake. CPAP is helpful in improving sleep in patients with sleep apnea; it has no role in narcolepsy.

Sleep apnea is classified by how many types? Record your answer using a whole number. _________

3 There are three types of sleep apnea: central apnea, obstructive apnea, and mixed apnea.

Nonrapid eye movement (NREM) sleep is divided into how many stages, according to the American Academy of Sleep Medicine? Record your answer using a whole number. _________ stages

3 stages NREM sleep is divided into three stages: N1, N2, and N3.

Which measure would the nurse suggest to promote sleep in a patient? Select all that apply. One, some, or all responses may be correct. 1 Avoid taking a warm bath. 2 Eat a heavy meal at night. 3 Void before going to sleep. 4 Use extra blankets if necessary. 5 Wear soft, cotton nightclothes.

3, 4, 5 The nurse would suggest the following: void before going to sleep; use extra blankets if necessary; and wear soft, cotton nightclothes. The need to urinate may disturb the patient while sleeping. Voiding before going to sleep prevents sleep disturbances caused by a full bladder. Using extra blankets prevents the patient from feeling chilled. By wearing soft, cotton nightclothes the patient can feel comfortable and warm. A warm bath is also helpful for the patient to feel relaxed and to promote sleep; thus the patient would not avoid taking a warm bath. Consumption of a heavy meal at night should be avoided because it may cause indigestion and sleep disturbances. Consumption of a light meal improves sleep in the patient.

Which patient requires further assessment to determine the risk of developing obstructive sleep apnea? Select all that apply. One, some, or all responses may be correct. 1 Patient with a stroke 2 Patient with iron deficiency anemia 3 Patient with hypertension 4 Patient who is a chronic smoker 5 Patient who is 75 years old

3, 4, 5 The patients with the following conditions require further assessment: patient with hypertension, one who is a chronic smoker, and patient who is 75 years old. Patients with a stroke are prone to central sleep apnea, not obstructive sleep apnea. Anemia from iron deficiency leads to restless legs syndrome, not obstructive sleep apnea.

Which factor may contribute to a patient's fatigue and insomnia from abusing alcohol? Select all that apply. One, some, or all responses may be correct. 1 Nightmares 2 Slow onset of sleep 3 Awakening often during sleep 4 Inability to fall asleep 5 Reduced rapid eye movement sleep

3, 5 Alcohol awakens the person often during sleep and reduces rapid eye movement sleep. Patients who take beta-adrenergic blockers (not alcohol) may have nightmares. Alcohol speeds up, not slows, the onset of sleep; it does not cause an inability to fall asleep.

How many hours of sleep are typically required to prevent fatigue in a 6-year-old child? 1 6 hours 2 8 hours 3 10 hours 4 12 hours

4 12 hours of sleep are required. A 6-year-old child typically requires 11 to 12 hours of sleep to be free of fatigue. An adult (not a 6-year-old child) requires about 6 to 9 hours of sleep for a fatigue-free day. An 11-year-old (not 6-year-old) child requires 9 to 10 hours of sleep to prevent fatigue.

Which type of sleep disorder does the nurse suspect when a patient has jet lag? 1 Disorders of arousal 2 Adjustment sleep disorder 3 Rapid eye movement (REM) sleep-behavior disorder 4 Behaviorally induced circadian rhythm sleep disorder

4 A patient experiences behaviorally induced circadian rhythm sleep disorder when jet lag occurs. Disorders of arousal include sleepwalking and sleep terrors, not jet lag. Adjustment sleep disorder is classified as insomnias, not jet lag. REM sleep-behavior disorder is a parasomnia associated with REM sleep, not jet lag.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

Which patient finding is the nurse likely to observe when performing assessments? 1 A school-age child who sleeps 15 hours a day 2 A teenager with an upcoming final falling asleep promptly at bedtime 3 An adult who falls asleep quickly after vigorous exercise before bedtime 4 An infant taking several naps during the day

4 The assessment the nurse would likely find is an infant taking several naps during the day. A school-age child sleeps from 9 to 12 hours a night, not 15 hours a day. A teenager with an upcoming final will not fall asleep promptly because of the stress; it will take some time for the teenager to fall asleep. Vigorous exercise before bedtime will keep an adult awake because exercise is a stimulant; vigorous exercise will not help an adult fall asleep quickly.

Which event does the nurse discuss while explaining rapid eye movement (REM) sleep? 1 Slow-wave sleep 2 Daydreaming 3 Protein synthesis 4 Muscle atonia

4 The nurse would discuss muscle atonia. During REM sleep there is increased brain activity associated with rapid eye movements and muscle atonia. Slow-wave sleep occurs in N3, not REM. In N1 (not REM) sleep, upon awakening the patient may feel as though daydreaming has occurred. Protein synthesis occurs in nonrapid eye movement (NREM) sleep, not REM.

Which intervention is appropriate to include in the plan of care for a patient experiencing narcolepsy? 1 Instruct the patient to increase carbohydrates in the diet. 2 Have patient limit fluid intake 2 hours before bedtime. 3 Preserve energy by limiting exercise to morning hours. 4 Encourage patient to take one or two 20-minute naps during the day.

4 The nurse would encourage the patient to take one or two 20-minute naps during the day. Brief daytime naps no longer than 20 minutes help reduce subjective feelings of sleepiness. A person with narcolepsy has the problem of falling asleep uncontrollably at inappropriate times. The nurse would instruct the patient to increase light meals high in protein, not carbohydrates. Limiting fluid intake 2 hours before bedtime is not appropriate for narcolepsy; however, it is appropriate for older adults. Following a regular exercise program is appropriate but the goal is to promote wakefulness, not to preserve energy.Test-Taking Tip: Use this mnemonic or make up one of your own: "A person with narcolepsy benefits from a power nap."

Which action by the assistive personnel at bedtime requires the nurse to intervene? 1 Offering the patient a back rub 2 Turning on quiet music 3 Dimming the lights in the patient's room 4 Giving a patient a cup of coffee

4 The nurse would intervene if the assistive personnel gives the patient a cup of coffee,because this is inappropriate. Patients should not drink or ingest caffeine before bedtime. Coffee, tea, soda, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night. Offering a back rub, turning on quiet music, and dimming the lights are all appropriate actions and would not require the nurse to intervene. Test-Taking Tip: Although alcohol is a central nervous system depressant because it acts as a diuretic, it can also disturb sleep by awakening a person in the night to void. Hence, caffeine and alcohol should both be avoided to improve sleep.

Which nursing measure promotes sleep in a school-age child? 1 Encourage late evening exercise. 2 Offer a glass of hot chocolate before bedtime. 3 Make sure that the room is dark and quiet. 4 Use quiet activities consistently before bedtime.

4 The nurse would suggest quiet activities consistently before bedtime to promote sleep in a school-age child. A bedtime routine (e.g., same hour for bedtime, snack, or quiet activity) used consistently helps young children avoid delaying sleep. Quiet activities such as reading stories, coloring, and allowing children to sit in a parent's lap while listening to music or a prayer are routines that are often associated with preparing for bed. Encouraging late evening exercise would act as a stimulant and not promote sleep. Offering a glass of hot chocolate before bedtime would not promote sleep because the chocolate contains caffeine. School-age children like a soft light or night-light during sleep, not a dark room. Test-Taking Tip: Evening exercise disturbs sleep. Chocolate contains caffeine, which is definitely not helpful for sleep. Those two standards, no evening exercise and limiting caffeine intake, apply to all age-groups for sleep hygiene. Many children need a night-light to feel safe enough to relax and fall asleep; that is a difference between children and adults. Thus using quiet activities consistently before bedtime is the clear answer.

Which intervention is priority for the nurse to suggest to the patient who reports fatigue? 1 Revise the daily exercise plan. 2 Drink a cup of warm milk before going to bed. 3 Practice relaxation techniques before going to bed. 4 Plan rest periods in between daily activities for better balance.

4 The nurse would suggest that the patient plan rest periods in between daily activities for better balance to decrease fatigue. Revising or changing the daily exercise plan may improve sleep but not necessarily fatigue; thus it is not the priority. Although encouraging the patient to drink a cup of warm milk and to practice relaxation techniques before going to bed are appropriate, they are not the priority interventions for management of fatigue.

Which nursing intervention would the nurse provide to a patient who is diagnosed with stress overload? 1 Encourage short naps if possible. 2 Instruct the patient to keep an exercise log. 3 Have the patient keep a sleep log for a week. 4 Use active listening when talking to the patient.

4 The nurse would use active listening when talking to a patient who has been diagnosed with stress overload. A patient who reports fatigue should take short naps but not for stress. A patient with a sedentary lifestyle (not stress) should keep an exercise log. A nurse would tell the patient suffering from insomnia (not stress) to keep a sleep log for a week.Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your examination. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory, therefore you will need to relearn it before a comprehensive examination. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.

Which statement made by the patient indicates successful teaching about light sleep? 1 "There is a gradual increase in vital signs." 2 "Light sleep is also called slow-wave sleep." 3 "This type of light sleep lasts about 90 minutes." 4 "The time spent in light sleep increases with age."

4 The statement that indicates successful teaching about light sleep is the following: "The time spent in light sleep increases with age." Time spent in light sleep increases with age because sleep becomes more fragmented with aging. There is a gradual decrease (not increase) in vital signs during light sleep. Deep sleep (not light sleep) is also called slow-wave sleep. Light sleep lasts only a few minutes, not 90.

Which statement by the patient indicates effective learning about the use of herbs for sleep? Select all that apply. One, some, or all responses may be correct. 1 "They can cause insomnia." 2 "Herbal medicines cause sleep apnea." 3 "Herbal medicines always cause allergic reactions." 4 "They may interact with prescribed medication." 5 "Herbal medicines are not regulated by the US Food and Drug Administration."

4, 5 Correct statements include: "They may interact with prescribed medication" and "Herbal medicines are not regulated by the US Food and Drug Administration."Herbal medicines may interact with prescribed medications. While using herbal medicines, precaution should be taken regarding dosing and use because herbal medicines are not regulated by the US Food and Drug Administration. Herbal medicines do not cause insomnia or sleep apnea. Herbal medicines do not always cause allergic reactions.

After how many minutes into the sleep cycle does a sleeper usually reach rapid eye movement (REM) sleep? Record your answer as a whole number. _________ minutes

90 minutes A sleeper usually reaches REM sleep 90 minutes into the sleep cycle.

Which nursing observation of the patient in intensive care indicates the patient is sleeping comfortably during NREM sleep? a. Eyes closed, lying quietly, respirations 12, heart rate 60 b. Eyes closed, tossing in bed, respirations 18, heart rate 80 c. Eyes closed, mumbling to self, respirations 16, heart rate 68 d. Eyes closed, lying supine in bed, respirations 22, heart rate 66

ANS: A During NREM sleep, biological functions slow. During sleep, the heart rate decreases to 60 beats/min or less. The patient experiences decreased respirations, blood pressure, and muscle tone. Heart rates above 60 are too high and respirations of 22 are too high to indicate comfortable NREM sleep.

The nurse is discussing lack of sleep with a middle-aged adult. Which area should the nurse most likely assess to determine a possible cause of the lack of sleep? a. Anxiety b. Loud teenagers c. Caring for pets d. Late night television

ANS: A During middle adulthood, the total time spent sleeping at night begins to decline. Anxiety, depression, and certain physical illnesses can affect sleep, and women can experience menopausal symptoms. Insomnia is common because of the changes and stresses associated with middle age. Teenagers, caring for pets, and late night television can influence the amount of sleep; however, these are not the most common causes of insomnia in this age group.

The nurse is completing an assessment on an older-adult patient who is having difficulty falling asleep. Which condition will the nurse further assess for in this patient? a. Depression b. Mild fatigue c. Hypertension d. Hypothyroidism

ANS: A Older adults and other individuals who experience depressive mood problems experience delays in falling asleep, earlier appearance of REM sleep, frequent awakening, feelings of sleeping poorly, and daytime sleepiness. A person who is moderately fatigued usually achieves restful sleep, especially if the fatigue is the result of enjoyable work or exercise. Hypertension often causes early-morning awakening and fatigue. Alcohol speeds the onset of sleep. Hypothyroidism decreases stage 4 sleep.

22.The nurse is caring for a patient on the medical-surgical unit who is experiencing an exacerbation of asthma. Which intervention will be most appropriate to help this patient sleep? a. Place bed in semi-Fowler's position. b. Offer iron-rich foods for meals. c. Provide a snack before bedtime. d. Encourage the patient to read.

ANS: A Placing the patient in a semi-Fowler's position eases the work of breathing. Respiratory disease often interferes with sleep. Patients with chronic lung disease such as emphysema or asthma are short of breath and frequently cannot sleep without two or three pillows to raise their heads. Iron-rich food may help a patient with restless legs syndrome. Providing a snack and encouraging the patient to read may be good interventions for patients, but the most appropriate would be raising the head of the bed.

21.The nurse is preparing an older-adult patient's evening medications. Which treatment will the nurse recognize as relatively safe for difficulty sleeping in older adults? a. Ramelteon (Rozerem) b. Benzodiazepine c. Antihistamine d. Kava

ANS: A Ramelteon (Rozerem), a melatonin receptor agonist, is well tolerated and appears to be effective in improving sleep by improving the circadian rhythm and shortening time to sleep onset. It is safe for long- and short-term use particularly in older adults. The use of benzodiazepines in older adults is potentially dangerous because of the tendency of the drugs to remain active in the body for a longer time. As a result, they also cause respiratory depression, next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination, which leads to increased risk of falls. Caution older adults about using over-the-counter antihistamines because their long duration of action can cause confusion, constipation, and urinary retention. Kava promotes sleep in patients with anxiety; it should be used cautiously because of its potential toxic effects on the liver.

The nurse is providing an educational session on sleep regulation for new nurses in the Sleep Disorder Treatment Center. Which statement by the nurses will best indicate that the teaching is effective? a. "If the patient has a disease process in the central nervous system, it can influence the functions of sleep." b. "If the patient has a disease process in the cranial nerves, it can influence the functions of sleep." c. "If the patient has an interruption in the urinary pathways, it can influence the functions of sleep." d. "If the patient has an interruption in the spinal reflexes, it can influence the functions of sleep."

ANS: A Sleep involves a sequence of physiological states maintained by the central nervous system. It is associated with changes in the peripheral nervous, endocrine, cardiovascular, respiratory, and muscular systems. A disease process associated with the cranial nerves, urinary pathway, or spinal reflexes may influence a person's ability to sleep, but the best answer is the central nervous system.

15.The nurse is caring for a patient who has been in holding in the emergency department for 24 hours. The nurse is concerned about the patient's experiencing sleep deprivation. Which action will be best for the nurse to take? a. Expedite the process of obtaining a medical-surgical room for the patient. b. Pull the curtains shut, dim the lights, and decrease the number of visitors. c. Obtain an order for a hypnotic medication to help the patient sleep. d. Ask everyone in the unit to try to be quiet so the patient can sleep.

ANS: A The most effective treatment for sleep deprivation is elimination or correction of factors that disrupt the sleep pattern. Obtaining a private room in the medical-surgical unit for the patient will help with decreasing stimuli and promoting more rest than an individual can obtain in an emergency department even with the interventions mentioned.

The nurse is completing a sleep assessment on a patient. Which tool will the nurse use to complete the assessment? a. Visual analog scale b. Cataplexy scale c. Polysomnogram d. RAS scale

ANS: A The visual analog scale is utilized for assessing sleep quality. Cataplexy, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day; there is no cataplexy scale for sleep assessment. A polysomnogram involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep; this is used in a sleep laboratory study. Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness; however, there is no assessment tool called the RAS scale.

24.The nurse is evaluating outcomes for the patient with insomnia. Which key principle will the nurse consider during this process? a. The patient is the best evaluator of sleep. b. The nurse is the best evaluator of sleep. c. Effective interventions are the best evaluators of sleep. d. Observations of the patient are the best evaluators of sleep.

ANS: A With regard to problems with sleep, the patient is the source for evaluating outcomes. The patient is the only one who knows whether sleep problems have improved and what has been successful. Interventions are not the best indicator; achievement of goals according to the patient is the best. Observations do provide needed data, but in the case of insomnia, the patient is the source for evaluating the restfulness of sleep.

27. The nurse is caring for a patient who has not been able to sleep well while in the hospital, leading to a disrupted sleep-wake cycle. Which assessment findings will the nurse monitor for in this patient? (Select all that apply.) a. Changes in physiological function such as temperature b. Decreased appetite and weight loss c. Anxiety, irritability, and restlessness d. Shortness of breath and chest pain e. Nausea, vomiting, and diarrhea f. Impaired judgment

ANS: A, B, C, F The biological rhythm of sleep frequently becomes synchronized with other body functions. Changes in body temperature correlate with sleep pattern. When the sleep-wake cycle becomes disrupted, changes in physiological function such as temperature can occur. Patients can experience decreased appetite, loss of weight, anxiety, restlessness, irritability, and impaired judgment. Gastrointestinal and respiratory/cardiovascular symptoms such as shortness of breath and chest pain are not symptoms of a disrupted sleep cycle.

29. The patient and the nurse discuss the need for sleep. After the discussion, the patient is able to state factors that hinder sleep. Which statements indicate the patient has a good understanding of the teaching? (Select all that apply.) a. "Drinking coffee at 7 PM could interrupt my sleep." b. "Staying up late for a party can interrupt sleep patterns." c. "Exercising 2 hours before bedtime can decrease relaxation." d. "Changing the time of day that I eat dinner can disrupt sleep." e. "Worrying about work can disrupt my sleep." f. "Taking an antacid can decrease sleep."

ANS: A, B, D, E Caffeine, alcohol, and nicotine consumed late in the evening produce insomnia. Worry over personal problems or situations frequently disrupts sleep. Alterations in routines, including changing mealtimes and staying up late at night for social activities, can disrupt sleep. Exercising 2 hours before bedtime actually increases a sense of fatigue and promotes relaxation. Taking an antacid does not decrease sleep.

28. The nurse is caring for a patient in the intensive care unit who is having trouble sleeping. The nurse explains the purpose of sleep and its benefits. Which information will the nurse include in the teaching session? (Select all that apply.) a. NREM sleep contributes to body tissue restoration. b. During NREM sleep, biological functions increase. c. Restful sleep preserves cardiac function. d. Sleep contributes to cognitive restoration. e. REM sleep decreases cortical activity.

ANS: A, C, D Sleep contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration. It allows the body to rest and conserve energy. This benefits the cardiac system by allowing the heart to beat fewer times each minute. During stage 4, the body releases growth hormone for renewal and repair of specialized cells such as the brain. During NREM sleep, biological functions slow. REM sleep is necessary for brain tissue restoration and cognitive restoration and is associated with a change in cerebral blood flow and increased cortical activity.

25.A patient has sleep deprivation. Which statement by the patient will indicate to the nurse that outcomes are being met? a. "I wake up only once a night to go to the bathroom." b. "I feel rested when I wake up in the morning." c. "I go to sleep within 30 minutes of lying down." d. "I only take a 20-minute nap during the day."

ANS: B Being able to sleep and feeling rested would indicate that outcomes are being met for sleep deprivation. Limiting a nap to 20 minutes is an intervention to promote sleep. Going to sleep within 30 minutes indicates a goal for insomnia. Waking up only once may indicate nocturia is improving but does not relate to sleep deprivation.

The nurse is having a conversation with an adolescent regarding the need for sleep. The adolescent states that it is common to stay up with friends several nights a week. Which action should the nurse take next? a. Talk with the adolescent's parent about staying up with friends and the need for sleep. b. Discuss with the adolescent sleep needs and the effects of excessive daytime sleepiness. c. Refer the adolescent for counseling about alcohol abuse problems. d. Take no action for this normal occurrence.

ANS: B Discussion regarding adolescent sleep needs should first occur with the adolescent. Although it may be common for this adolescent to want to visit with friends and experience activities that go late into the night, these activities can and do impact the hours of sleep and the physical needs of the adolescent, no matter the reason for the late nights, and they do need to be addressed. The nurse will address the adolescent, not the parents. Addressing alcohol abuse problems is not the next step but may be required later. While staying up late may be a normal occurrence for this adolescent, action is required.

A community health nurse is providing an educational session at the senior center on how to promote sleep. Which practices should the nurse recommend? (Select all that apply.) a. Take a nap in the afternoon. b. Sleep where you sleep best. c. Use sedatives as a last resort. d. Watch television right before sleep. e. Decrease fluids 2 to 4 hours before sleep. f. Get up if unable to fall asleep in 15 to 30 minutes.

ANS: B, C, E, F The nurse should instruct the patient to sleep where he or she sleeps best, to use sedatives as a last resort, to decrease fluid intake to cut down on bathroom trips, and, if unable to sleep in 15 to 30 minutes, to get up out of bed. Naps should be eliminated if they are not part of the individual's routine schedule, and if naps are taken, they should be limited to 20 minutes or less a day. Television can stimulate and disrupt sleep patterns.

The nurse is beginning a sleep assessment on a patient. Which question will be most appropriate for the nurse to ask initially? a. "What is going on?" b. "How are you sleeping?" c. "Are you taking any medications?" d. "What did you have for dinner last night?"

ANS: B Sleep is a subjective experience. Only the patient is able to report whether or not it is sufficient and restful. Asking patients how they are sleeping is an introductory question. After this beginning question is asked, problems with sleep such as the nature of the problem, signs and symptoms, onset and duration of the issue, severity, predisposing factors, and the effect on the patient can be assessed. What is going on is too broad and open ended for information about sleep to be obtained specifically. Medications and food intake can be part of the detailed assessment of sleep issues.

The nurse is teaching a new mother about the sleep requirements of a neonate. Which comment by the patient indicates a correct understanding of the teaching? a. "I can't wait to get the baby home to play with the brothers and sisters." b. "I will ask my mom to come after the first week, when the baby is more alert." c. "I can get the baby on a sleeping schedule the first week while my mom is here." d. "I won't be able to nap during the day because the baby will be awake."

ANS: B The patient indicates an understanding when asking the mother to come after the first week. The neonate up to the age of 3 months averages about 16 hours of sleep a day, sleeping almost constantly during the first week. The baby will sleep rather than play. The baby will not be on a sleeping schedule the first week home. The mother will be able to nap since the baby sleeps 16 hours a day.

A patient has obstructive sleep apnea. Which assessment is the priority? a. Gastrointestinal function b. Neurological function c. Respiratory status d. Circulatory status

ANS: C In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing nasal airflow or stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status takes priority over gastrointestinal, circulatory, and neurologic functioning.

20.The patient presents to the clinic with reports of irritability, being sleepy during the day, chronically not being able to fall asleep, and being tired. Which nursing diagnosis will the nurse document in the plan of care? a. Anxiety b. Fatigue c. Insomnia d. Sleep deprivation

ANS: C Insomnia is experienced when the patient has chronic difficulty falling asleep, frequent awakenings from sleep, and/or short sleep or nonrestorative sleep. It is the most common sleep-related complaint and includes symptoms such as irritability, excessive daytime sleepiness, not being able to fall asleep, and fatigue. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fatigue is an overwhelming sustained sense of exhaustion with decreased capacity for physical and mental work at a usual level. Sleep deprivation is a condition caused by dyssomnia and includes symptoms caused by illness, emotional distress, or medications.

The nurse is caring for a patient who is having trouble sleeping. Which action will the nurse take? a. Suggest snug-fitting nightwear. b. Provide a favorite beverage. c. Encourage deep breathing. d. Walk with the patient.

ANS: C Relaxation exercises such as slow, deep breathing for 1 or 2 minutes relieve tension and prepare the body for rest. Instruct patients to wear loose-fitting nightwear. Walking and drinking a favorite beverage would not necessarily encourage sleep.

26.An older-adult patient is visiting the clinic after a fall during the night. The nurse obtains information on what medications the patient takes. Which medication most likely contributed to the patient's fall? a. Melatonin b. L-tryptophan c. Benzodiazepine d. Iron supplement

ANS: C The most likely cause is a benzodiazepine. If older patients who were recently continent, ambulatory, and alert become incontinent or confused and/or demonstrate impaired mobility, the use of benzodiazepines needs to be considered as a possible cause. This can contribute to a fall in an older adult. Short-term use of melatonin has been found to be safe, with mild side effects of nausea, headache, and dizziness being infrequent. Iron supplements may be given to patients with restless legs syndrome. Some substances such as L-tryptophan, a natural protein found in foods such as milk, cheese, and meats, promote sleep; while it does promote sleep, it is not the most likely to cause mobility problems.

The patient has just been diagnosed with narcolepsy. The nurse teaches the patient about management of the condition. Which information from the patient will cause the nurse to intervene? a. Takes antidepressant medications b. Naps shorter than 20 minutes c. Sits in hot, stuffy rooms d. Chews gum

ANS: C The nurse will intervene about sitting in a hot, stuffy room as this will make the narcolepsy worse so this needs to be corrected. Patients with narcolepsy need to avoid factors that increase drowsiness (e.g., alcohol, heavy meals, exhausting activities, long-distance driving, and long periods of sitting in hot, stuffy rooms). Patients are treated with antidepressants, and management techniques involve scheduling naps no longer than 20 minutes and chewing gum. Additional management techniques include exercise, light high-protein meals, deep breathing, and taking vitamins.

The nurse is caring for a patient in the sleep lab. Which assessment finding indicates to the nurse that the patient is in stage 4 NREM? a. The patient awakens easily. b. The patient's eyes rapidly move. c. The patient is difficult to awaken. d. The patient's vital signs are elevated.

ANS: C The patient is difficult to arouse, vital signs are significantly lower, and this stage lasts about 15 to 30 minutes. Stage 4 NREM is the deepest stage of sleep. Lighter sleep is seen in stages 1 and 2, where the patient awakens easily. REM sleep is characterized by rapid eye movement.

23.A young mother has been hospitalized for an irregular heartbeat (dysrhythmia). The night nurse makes rounds and finds the patient awake. Which action by the nurse is mostappropriate? a. Inform the patient that it is late and time to go to sleep. b. Ask the patient if she would like medication for sleep. c. Recommend a good movie that is on television tonight. d. Take time to sit and talk with the patient about her inability to sleep.

ANS: D A nurse on the night shift needs to take time to sit and talk with patients unable to sleep. This helps to determine the factors keeping patients awake. Assessment is the first step of the nursing process; therefore assessment needs to be done first and involves ascertaining the cause of the patient's inability to sleep. Patients who are admitted to the hospital for uncertain diagnoses can be stressed and worried about the testing and outcomes. In addition, a young mother can be worried about the care of her children and those caring for the children. This uncertainty and change in routine can cause difficulty in resting or falling asleep. A distraction such as a television may or may not work for the patient. After assessment is completed, a sedative may or may not be in order. Telling the patient that it is late and time to go to sleep is not a therapeutic response for an adult who is under stress.

The nurse is caring for an adolescent with an appendectomy who is reporting difficulty falling asleep. Which intervention will be most appropriate? a. Close the door to decrease noise from unit activities. b. Adjust temperature in the patient's room to 21° C (70° F). c. Ensure that the night-light in the patient's room is working. d. Encourage the discontinuation of a soda and chocolate nightly snack.

ANS: D Discontinuing the soda and chocolate nightly snack will be most beneficial for this patient since it has two factors that will cause difficulty falling asleep. Coffee, tea, colas, and chocolate act as stimulants, causing a person to stay awake or to awaken throughout the night. Personal preference influences the temperature of the room, as well as the lighting of the room. Noise can be a factor in the unit and can awaken the patient, but caffeine can make it difficult to fall asleep.

18.The nurse adds a nursing diagnosis of ineffective breathing pattern to a patient's care plan. Which sleep condition caused the nurse to assign this nursing diagnosis? a. Insomnia b. Narcolepsy c. Sleep deprivation d. Obstructive sleep apnea

ANS: D Obstructive sleep apnea (OSA) occurs when the muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing airflow or stopping it for as long as 30 seconds. The person still attempts to breathe because chest and abdominal movements continue, resulting in snoring or snorting sounds. With narcolepsy, the person feels an overwhelming wave of sleepiness and falls asleep. Insomnia is characterized by chronic difficulty falling asleep. Sleep deprivation is a condition caused by dyssomnia. OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe

A nurse is teaching the staff about the sleep cycle. Which sequence will the nurse include in the teaching session? a. NREM Stage 1, 2, 3, 4, REM b. NREM Stage 1, 2, 3, 4, 3, 2, 1, REM c. NREM Stage 1, 2, 3, 4, REM, 4, 3, 2 REM d. NREM Stage 1, 2, 3, 4, 3, 2, REM

ANS: D The cyclical pattern usually progresses from stage 1 through stage 4 of NREM, followed by a reversal from stages 4 to 3 to 2, ending with a period of REM sleep. The others are incorrect sequences.

A single parent is discussing the sleep needs of a preschooler with the nurse. Which information will the nurse share with the parent? a. "Most preschoolers sleep soundly all night long." b. "It is important that the 5-year-old get a nap every day." c. "On average, the preschooler needs to sleep 10 hours a night." d. "Preschoolers may have trouble settling down after a busy day."

ANS: D The preschooler usually has difficulty relaxing or settling down after long, active days. By the age of 5, naps are rare for children, except those for whom a siesta is a custom. Preschoolers frequently awaken during the night. On average, a preschooler needs about 12 hours of sleep.

19.The nurse is caring for a postpartum patient. The patient's labor has lasted over 28 hours within the hospital; the patient has not slept and is disoriented to date and time. Which nursing diagnosis will the nurse document in the patient's care plan? a. Insomnia b. Impaired parenting c. Ineffective coping d. Sleep deprivation

ANS: D This patient has been deprived of sleep by staying awake during a 28-hour labor. Disorientation is one potential sign of sleep deprivation. In this scenario, there is a clear cause for the patient's lack of sleep, and it is a one-time episode. Insomnia, on the other hand, is a chronic disorder whereby patients have difficulty falling asleep, awaken frequently, or sleep only for a short time. This scenario does not indicate that this has been a chronic problem for this patient. Although ineffective coping can manifest as a sleep disturbance, clear evidence shows that it was labor that deprived this patient of sleep, not an inability to cope. It could be difficult to care for an infant when sleep deprived; however, this scenario gives no evidence that this mother displays impaired parenting and is not caring adequately for her child or lacks the skills to do so.

The nurse is caring for a young-adult patient on the medical-surgical unit. When doing midnight checks, the nurse observes the patient awake, putting a puzzle together. Which information will the nurse consider to best explain this finding? 1 The patient misses family and is lonely. 2 The patient was waiting to talk with the nurse. 3 The patient has been kept up with the noise on the unit. 4 The patient's sleep-wake cycle preference is late evening.

ANS: D This patient is awake and alert enough to do a puzzle. The individual's sleep-wake preference is probably late evening. All persons have biological clocks that synchronize their sleep-wake cycle. This explains why some individuals fall asleep in the early evening, whereas others go to bed at midnight or early morning. Waiting to talk with the nurse, being lonely, and noise on the unit may contribute to lack of sleep, but the best explanation for the patient being awake is the biological clock.

What percentage of sleep time in young adults is rapid eye movement (REM) sleep? Record your answer using a whole number. _____________ %

About 20% of sleep time in young adults is rapid eye movement (REM) sleep

A sleeper whose random eye movement (REM) sleep is around 30% of the sleep time is in which age-group? 1 Infants 2 Neonates 3 Young adults 4 Preschoolers

In infants, around 30% of the sleep time is REM sleep. In neonates, around 50% of the sleep time is REM sleep, not 30%. In young adults and preschoolers, around 20% (not 30%) of the sleep time is REM sleep.Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation.