CH 17 Review Qs

A parent of a 14-year-old male expresses concern over the late hours the teen keeps. Which of the following responses by the nurse best explains a possible etiology for the late hours? a) "The onset of puberty often lengthens the circadian rhythm, causing an increase in evening wakefulness." b) "Your teenager is likely responding to pressure from his peers to stay up late." c) "Your teen needs to be prescribed sleep medications to regulate his sleep patterns." d) "Teenagers often rebel against parental rules; his body will assure he gets the sleep he needs."

a) "The onset of puberty often lengthens the circadian rhythm, causing an increase in evening wakefulness." Circadian rhythms control the sleep-wake patterns; hormonal changes during puberty affect the length of these rhythms accounting for the changes in sleep patterns. The need for medication is not supported. While teenagers are susceptible to peer pressure and often engage in rebellious behavior, that is not the etiology for the change in adolescent sleep patterns.

An older adult is likely to experience which sleep-related issues as a result of the normal aging process? a) Appears to "hold" his or her breath while sleeping b) Being quite "jumpy" while sleeping c) Shorter periods of "deep" sleep d) Awaking several times during the night e) Awakened by the slightest noise

a) Appears to "hold" his or her breath while sleeping c) Shorter periods of "deep" sleep d) Awaking several times during the night e) Awakened by the slightest noise Complaints of sleep disorders are common in older adults. The sleep- wake cycle changes that occur with aging are evidenced by more fragmented sleep and shorter duration of stage 3 and 4 sleep, as well as sleep apnea. They have more night-time arousals. Environmental influences, particularly auditory stimuli, are often more disruptive in older adults. Awakening by the slightest noise is an example of this. Being jumpy is a problem associated with stage 1 sleep and is not associated with the normal aging process.

Which statements are true concerning sleepwalking? Select all that apply. a) Common in children between ages of 5 and 12 b) May urinate in odd places like closets or waste baskets c) Individual is unaware of leaving the bed to walk d) Individual will return to bed when verbally encouraged to do so e) More likely to occur in Stage 1 of the sleep cycle

a) Common in children between ages of 5 and 12 b) May urinate in odd places like closets or waste baskets c) Individual is unaware of leaving the bed to walk Sleepwalking, common in children, involves repeated episodes of complex motor movements that lead to leaving the bed and walking without the child being conscious of the episode or remembering that it occurred. As with sleep terrors, it normally occurs in NREM sleep stages 3 and 4 during the first third of the sleep period. Commonly, individuals are unresponsive to the efforts of others to communicate with them. Confusion and disorientation are typical of the events, and on awakening there is no memory of the event. There may be manifestations of extreme autonomic nervous system activity such as urinating in closets or waste baskets.

A nurse working the night shift is unable to fall asleep when morning comes and the shift is over. Which activities may promote sleep for a night-shift worker? Select all that apply. a) Darkening the bedroom b) Drinking hot tea c) Ask for a prescription for an antidepressant. d) Exercise after work before going to bed e) Beginning sleep at noon rather than earlier in the morning

a) Darkening the bedroom e) Beginning sleep at noon rather than earlier in the morning Beginning sleep at noon rather than earlier in the morning may produce a more normal sleep period in relation to shift onset. Sleeping in absolute darkness during daytime by using blackout shades or eye masks may benefit the night worker's sleep. Exercise immediately before going to bed is not recommended. Tea contains caffeine which may inhibit sleep. A number of drugs can lead to poor-quality sleep. Drugs commonly related to poor sleep are caffeine, nicotine, stimulating antidepressants, alcohol, and recreational drugs.

A nurse has a patient who is undergoing a sleep laboratory study. Which of the following events would the nurse expect to be measured? Select all that apply. a) Heart rate b) Muscle movement c) Eye movement d) Urine output e) Oxygen level

a) Heart rate b) Muscle movement c) Eye movement e) Oxygen level A typical sleep study involves the use of the electro-oculogram (records eye movement), electromyogram (records muscle movement), electrocardiogram (heart rate), and pulse oximetry. Urine output is not measured.

The spouse of a blind client calls the nurse practitioner to ask what is causing the client such a difficult time sleeping and what can be done. What might the client be suffering from, and which would be the most accurate response? a) Non-24 hour sleep-wake syndrome; regulate wake and sleep times. b) Free-running sleep disorder; get a prescription for a sleep aid. c) Chronic insomnia; use bright light therapy prior to sleep. d) Obstructive sleep apnea; administer melatonin daily.

a) Non-24 hour sleep-wake syndrome; regulate wake and sleep times. Sleep-wake cycle disturbance is a circadian rhythm disorder and is a common problem for people who are blind. This disturbance is classified as free-running sleep disorder (FRSD) or non-24 hour sleep-wake syndrome. Treatments include regulating the sleep-wake times, bright light therapy, and melatonin.

Which assessment findings would support a diagnosis of obstructive sleep apnea? a) Reports difficulty concentrating b) Morning headaches c) Experiencing sexual dysfunctions d) Feels a need to sleep during the day e) Hypotension

a) Reports difficulty concentrating b) Morning headaches c) Experiencing sexual dysfunctions d) Feels a need to sleep during the day Obstructive sleep apnea is characterized by sexual impotency, morning headaches, excessive daytime sleepiness, and cognitive changes. Hypertension is also commonly noted.

What body function is responsible for the control of the circadian clock with input of light-dark awareness? a) The rotation of the moon b) Anterior pituitary gland c) Suprachiasmatic nucleus (SCN) d) Visual stimulation

c) Suprachiasmatic nucleus (SCN) The SCN is responsible for the control of the circadian clock through receiving light-dark input from the retina. Visual stimulation and the hypothalamus are involved, but the SCN seems to be the control center. The rotation of the moon has little relevance. The anterior pituitary gland is not responsible for circadian rhythm.

A client has been diagnosed with obstructive sleep apnea and is having a discussion about possible treatment options with the primary care provider. Which options will likely be discussed? Select all that apply. a) Weight loss b) Positive airway pressure devices c) Skeletal muscle relaxants d) Nebulized bronchodilators e) Surgery

a) Weight loss b) Positive airway pressure devices e) Surgery Obstructive apnea can be treated in a variety of ways. Weight loss is always beneficial and several surgical procedures have been used to correct airway obstruction. The application of nasal continuous positive airway pressure (NCPAP) at night has proven helpful in treating obstructive sleep apnea. Muscle relaxants and bronchodilators have not been proven beneficial.

A nurse is instructing a client about the medication that will be needed for the treatment of narcolepsy. Which types of medication may be used to treat this disorder? (Select all that apply.) a) armodafinil (Nuvigil) b) Carbamazepine (Tegretol) c) Modafinil (Provigil) d) Methylphenidate (Ritalin) e) Phenytoin (Dilantin)

a) armodafinil (Nuvigil) c) Modafinil (Provigil) d) Methylphenidate (Ritalin) Pharmacological treatment of narcolepsy focuses on the use of stimulant medications such as methylphenidate (Ritalin), ampheatmines (e.g Adderall, Desoxyn), modafinil (Provigil), and armodafinil (Nuvigil), which are FDA approved for the treatment of narcolepsy. Dilantin and Tegretol are used for patients with seizure activity and other neurological conditions.

When an older client is prescribed a hypnotic to help manage a disrupted sleep pattern, the nurse identifies which as the primary risk diagnosis for this client? a) Risk for injury related to anticholinergic effects of medication therapy b) Risk for injury related to medication-induced falls c) Risk for injury related to medication-induced cognitive impairment d) Risk for injury related to daytime sleepiness related to medication therapy

b) Risk for injury related to medication-induced falls Falls and fractures are more frequent in people using hypnotic or other psychotherapeutic agents. Adverse effects of antihistamines include daytime sleepiness, cognitive impairments, and anticholinergic effects.

In order to best treat transient insomnia, it is suggested that the client adopt which of the following sleep habits? a) Taking a warm bath at night to promote good hygiene b) Setting up a normal bedtime and wake up time. c) Taking a prescribed dosage of sedatives routinely d) Watching television or reading until falling asleep

b) Setting up a normal bedtime and wake up time. Good sleep hygiene includes setting normal sleep and wake-up times to help set the circadian clock, sleeping only as long as needed to feel refreshed, and providing a quiet sleep environment. The other options are not recommended for developing good sleep hygiene.

A person with advanced sleep phase syndrome (ASPS) would likely display which symptoms? a) Sleeping 10 to 12 hours per day and awakening with feelings of sadness b) Trouble staying awake in the evening and waking up early in the morning feeling rested c) Trouble staying awake and falling asleep at inappropriate times d) Difficulty falling asleep at night and awakening in the morning

b) Trouble staying awake in the evening and waking up early in the morning feeling rested With ASPS a person has trouble staying awake in the evening, goes to bed early, and wakes up early in the morning feeling rested. Falling asleep at inappropriate times is more related to narcolepsy, and waking up feeling sad is most related to depression. Having trouble going to sleep and trouble waking in the morning is related to DSPS.

A person who has a lack of synchronization between internal sleep-wake rhythms and the external 24-hour day may be experiencing which type of circadian rhythm disorder? a) Change in sleep phase disorder b) Acute shifts in the sleep-wake cycle c) Non-24-hour sleep-wake syndrome d) Time zone change syndrome

c) Non-24-hour sleep-wake syndrome The non-24-hour sleep-wake syndrome consists of a lack of synchronization between the internal sleep-wake rhythm and the external 24-hour day. Most persons with this disorder need to be evaluated for a brain lesion. The correct option is the only one is used to describe the sleep dysfunction described in the question.

Which sleep stage is characterized by an increase in brain activity? a) Stage 1 b) Stage 4 c) REM sleep d) Stage 3

c) REM sleep Brain activity increases in REM sleep while decreasing in all other stages.

In which stage of sleep does dreaming occur most frequently? a) Non-rapid eye movement sleep b) Stage I c) Rapid eye movement sleep d) Stages 3 and 4

c) Rapid eye movement sleep Most dreaming occurs in rapid eye movement (REM sleep). Stages 1, 3, and 4 are parts of non-REM sleep, and dreaming does occur in most stages of sleep.

Which of the following parasomnias occurs primarily in children in the non-REM stage and may result in emotional experiences that are frightening? a) Sleepwalking b) Confusional arousals c) Sleep terrors d) Nightmares

c) Sleep terrors Sleep terrors occur primarily in children and in the non-REM sleep stage, resulting in frightening thoughts. Nightmares occur in the REM sleep stage. The other options are not necessarily related to the non-REM stage or to only children.

At what age is an infant typically able to sleep through the night and have consistent nap times? a) 1 month b) 12 months c) 2 months d) 9 months

d) 9 months By 9 months of age, most infants can sleep through the night and nap at predictable times during the day.

A nurse is caring for a patient who experiences a compelling urge to move limbs during the evening or night, with the condition worsening at rest and inactivity. Which of the following supplements can the nurse anticipate administering to this client? a) Phosphorus b) Calcium c) Vitamin E d) Iron

d) Iron The client is experiencing symptoms of restless leg syndrome (RLS), which is characterized by an urge to move the limbs with or without sensations, worsening at rest or inactivity, improving with activity or movement, and worsening in the evening or night. RLS may be a symptom of iron deficiency. The other supplements are not treatments for RLS.

A patient with a history of snoring and tiredness in the morning would most likely be diagnosed with which type of apnea? a) Central sleep apnea b) Noise apnea c) Obese apnea d) Obstructive sleep apnea

d) Obstructive sleep apnea Obstructive sleep apnea is most associated with patients who snore related to the respiratory muscles' continued function. Tiredness is associated with all types of apnea.