Exam 5 Rest & Sleep

A client has sought care because of insomnia that has been increasing in severity and frequency in recent months. What questions should the nurse include in an assessment of this client's health problem? Select all that apply. A) "Do you have a family history of sleep disturbances?" B) "Do you smoke?" C) "What medications are you currently taking?" D) "Do you have a consistent routine around getting ready for bed and going to bed?" E) "How would you characterize your mood lately?"

"Do you smoke?" "What medications are you currently taking?" "Do you have a consistent routine around getting ready for bed and going to bed?" "How would you characterize your mood lately?" - Sleep is a multifaceted phenomenon that is affected by many variables. Among these are cigarette smoking, medications, sleep routines, and mood; the nurse should assess each of these areas. Sleep problems do not normally have a genetic basis.

The client is a male who states his wife complains that his snoring awakens her at night. The spouse is present. To obtain further data, the nurse asks the spouse what? A) "How loud is his snoring?" B) "Is there silence after snoring which then is followed with a snort?" C) "How long does he snore each night?" D) "How often are you awakened at night due to his loud snoring?"

"Is there silence after snoring which then is followed with a snort?" -Snoring that is followed by silence and then a snort may be a sign of obstructive apnea. Snoring is not considered a sleeping disorder and is often more disturbing to the sleep partner.

A client in his 40s has asked the nurse how much sleep he should be getting in order to maximize his health and well-being. How should the nurse respond? A) "Most adults need between seven and nine hours, but everyone is different." B) "It's important to get a minimum of eight hours sleep each night." C) "More sleep equals better health, so the more sleep you can fit into your schedule, the better." D) "Sleep needs depend a lot on age, and at your age, six to seven hours usually suffice."

"Most adults need between seven and nine hours, but everyone is different." - Sleep needs and routines are highly individual, but most adults require between seven and nine hours of sleep.

A new mother is discussing her 6-month-old infant's sleep habits and expresses concern about the infant obtaining too much sleep. The mother reports the infant's circadian cycle as: Time period - Activity 0600-0900 - awake 0900-1100 - sleep 1100-1300 - awake 1300-1600 - sleep 1600-1900 - awake 1900-2200 - sleep 2200-2400 - awake 2400-0600 - sleep The best statement by the nurse is: A) "Your infant requires more time asleep during the day hours." B) "You need to awaken your infant during the 2400 to 0600 time period." C) "Your infant is obtaining the average hours of sleep per day for an infant." D) "Your infant is actually obtaining too little sleep for one day."

"Your infant is obtaining the average hours of sleep per day for an infant." - Infants usually require 14 to 20 hours of sleep per day. This infant is obtaining 14 hours of sleep each day.

What are the stages of sleep?

- Non-rapid eye movement (NREM) - 75% - Rapid eye movement (REM) - 20-25%

What is the sleep cycle?

- person passes consecutively through four stages of NREM - the pattern is then reversed returning from stage IV, to III to II then back to REM again, doesn't go all the way back to stage I

Which of the following clients likely faces a risk for the nursing diagnosis of Disturbed Sleep Pattern: Difficulty Remaining Asleep? A) A client who receives IV antibiotics every three hours B) A client whose opioid analgesics result in central nervous system depression C) A client who is receiving corticosteroids that make her feel restless and agitated D) A client whose physical therapy has been scheduled in the late evening

A client who receives IV antibiotics every three hours - A client who requires medications throughout the night is likely to experience the frequent awakenings associated with Disturbed Sleep Pattern: Difficulty Remaining Asleep. Drowsiness or agitation as a result of medications may affect sleep, but are less likely to result in mid-sleep awakenings. A client who performs physical activity prior to bedtime may have difficulty falling asleep.

Which group of terms best describes sleep? A) Decreased state of activity, refreshed B) Altered consciousness, relative inactivity C) Comatose, immobility D) Alert, responsive

Altered consciousness, relative inactivity - Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Rest is a condition in which the body is in a decreased state of activity.

Which medication is least likely to affect sleep quality? A) Diuretic B) Steroid C) Antidepressant D) Ambien

Ambien - Sleep quality is influenced by drugs. Drugs that decrease sleep include diuretics, steroids, and antidepressants. Ambien and chloral hydrate appear to influence the quality of sleep least and promote normal sleep.

A nurse is caring for a client diagnosed with sleep apnea. What should the nurse do in order to promote sleep in the client? A) Encourage the client to lose weight. B) Avoid sedatives for sleeping. C) Encourage deep breathing exercises. D) Provide good ventilation in the room.

Avoid sedatives for sleeping. -The nurse should avoid sedatives in the client because sedatives may depress respiration. The client with sleep apnea already has decreased ventilation and low blood oxygenation; the condition may become worse if the respiration is further depressed by sedatives. Losing weight is a long-term measure and is not applicable in this case. Encouraging deep breathing exercises and providing good ventilation may help the client, but they are secondary measures.

A nurse is caring for a client who complains about sleep apnea. Which of the following delivery devices should the nurse use to administer oxygen to this client? A) Nasal catheter B) Oxygen tent C) Transtracheal oxygen D) CPAP mask

CPAP mask - The nurse should use a CPAP mask for a client with complaints of sleep apnea. A CPAP mask maintains positive pressure within the airway throughout the respiratory cycle. Clients generally wear this type of mask at night to maintain oxygenation when they experience sleep apnea. A nasal catheter is a tube for delivering oxygen that is inserted through the nose into the posterior nasal pharynx. It is used for clients who tend to breathe through the mouth or experience claustrophobia when a mask covers their face. An oxygen tent is a clear plastic enclosure that provides cooled, humidified oxygen, which is used for active toddlers. Transtracheal oxygen is a hollow tube inserted within the trachea to deliver oxygen to clients who require long-term oxygen therapy.

What name is given to the rhythmic biologic clock that exists in humans? A) Sleep-wake cycle B) Alert-unaware process C) Circadian rhythm D) Yo-yo theory

Circadian rhythm - Rhythmic biologic clocks are known to exist in plants, animals, and humans. Circadian rhythms complete a full cycle every 24 hours and in humans affect heart rate, blood pressure, body temperature, hormone secretions, and metabolism, as well as performance and mood.

A nurse working the night shift assesses a client's vital signs at 4 a.m. (0340). What would be the expected findings, based on knowledge of NREM sleep? A) Decreased TPR and BP B) Increased TPR and BP C) No change from daytime readings D) Highly individualized, cannot predict

Decreased TPR and BP - Throughout the stages of NREM sleep, the parasympathetic nervous system dominates; decreases in temperature, pulse, respirations, and blood pressure occur.

A middle-age adult man has just started an exercise program. What would the nurse teach him about timing of exercise and sleep? A) Exercising immediately before bedtime enhances ability to sleep B) Exercising within two hours of bedtime can hinder ability to sleep C) The time of day does not matter; exercise facilitates sleep D) The fatigue from exercise may be a hindrance to sleep

Exercising within two hours of bedtime can hinder ability to sleep - Moderate exercise is a healthy way to promote sleep, but exercise that occurs within a two-hour interval before normal bedtime can hinder sleep.

What independent nursing action can be used to facilitate sleep in hospitalized clients who are on bedrest? A) Administering prescribed sleep medications B) Changing the bed with fresh linens C) Encouraging naps during the daytime D) Giving a back massage

Giving a back massage -Simple interventions, such as offering a back massage, can promote comfort and sleep in hospitalized clients on bedrest.

A client reports that her naps after lunch often stretch to three hours in length and that she has great difficulty rousing herself after a nap. This condition is best termed as which of the following? A) Hypersomnia B) Insomnia C) Parasomnia D) Sleep apnea

Hypersomnia - Hypersomnia is a condition characterized by excessive sleep, particularly during the day. Insomnia is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep. Parasomnias are patterns of waking behavior that appear during sleep. Sleep apnea is a condition in which a person experiences the absence of breathing, or diminished breathing efforts, during sleep (between snoring intervals).

Which expected outcome demonstrates the effectiveness of a plan of care to promote rest and sleep? A) Verbalizes inability to sleep without medications B) Continues to read in bed for hours each night C) Identifies factors that interfere with normal sleep pattern D) Reports minimal improvement in quality of rest and sleep

Identifies factors that interfere with normal sleep pattern - The nurse evaluates the effectiveness of the plan of care to promote rest and sleep by evaluating if the client has met the expected outcomes of the plan. If the client is able to identify factors that interfere with normal sleep patterns, this illustrates achievement of one expected outcome.

Which of the following is the most common sleep disorder? A) Hypersomnia B) Parasomnia C) Insomnia D) Dyssomnia

Insomnia -Insomnia is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep. It is the most common of all sleep disorders.

A sedative-hypnotic has been prescribed to help a client sleep. What should the nurse teach the client about this medication? A) It should be taken every night for several months B) It is useful for sleep but is better taken with alcohol C) It loses its effectiveness after one or two weeks D) It should be taken in the morning for long-term effects

It loses its effectiveness after one or two weeks - Although most sedative-hypnotics provide several nights of excellent sleep, the medication often loses its effect after one or two weeks. Caution the client not to increase the dose or take the drug with alcohol to try to increase effect.

A nurse is caring for a client who has been diagnosed with insomnia. What nursing intervention would help the nurse relieve the client's condition? A) Maintain a calm and quiet environment free from noise. B) Administer sedatives as prescribed by the physician. C) Motivate the client to sleep because it may affect his health. D) Engage the client in some diversional activities.

Maintain a calm and quiet environment free from noise. - Maintaining a calm and quiet environment is the most appropriate nursing activity to relieve insomnia. Motivating the client to sleep by telling him that it may affect his health may cause anxiety in the client. Engaging the client in diversional activities at bedtime may increase sleeplessness. Sedatives can be administered as prescribed, but they should be used as last resort. These activities may not relieve insomnia in the client.

Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing which chemical? A) Neonephrine B) Seratonin C) Melatonin D) Dopamine

Melatonin - Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing melatonin (a natural chemical produced at night that decreases wakefulness and promotes sleep).

Which natural chemical does the body produce at night to decrease wakefulness and promote sleep? A) Melatonin B) Serotonin C) Endorphins D) Dopamine

Melatonin -Melatonin is a natural chemical produced at night that decreases wakefulness and promotes sleep.

What condition have studies confirmed occurs when adults and children do not get recommended hours of sleep at night? A) Obesity B) Anxiety C) Diabetes D) Hypertension

Obesity -The fact that children and adults are getting less sleep has been implicated as a contributing factor to the obesity epidemic in the United States (CDC, 2008, Goldsmith, 2007). Various studies confirm that adults and children who slept less than their recommended hours per night were more likely to be overweight. This sleep-weight link is possibly related to two hormones: leptin and ghrelin. Leptin signals the brain to stop eating, whereas ghrelin promotes continued eating. Research suggests that sleep deprivation lowers leptin levels and elevates ghrelin levels, thus increasing one's appetite.

What is the rationale for using CPAP to treat sleep apnea? A) Positive air pressure holds the airway open. B) Negative air pressure holds the airway closed. C) Delivery of oxygen facilitates respiratory effort. D) Alternating waves of air stimulate breathing.

Positive air pressure holds the airway open. - Continuous positive airway pressure (CPAP) is used to treat sleep apnea. The device, worn at night, delivers positive air pressure through a facemask to hold the airway open.

The nurse manager in an acute care facility has received client evaluations in which the clients have complained about excessive noise that interfered with their rest. The nurse manager and nursing staff plan to do the following. Which activity will most assist clients in obtaining rest? A) Post signs for quiet and turn down hall lights during formal quiet times. B) Ensure clients are offered prescribed sleeping medications at bedtime. C) Provide a small carbohydrate snack or juice prior to hours of sleep. D) Adjust the temperature of the room to 74 degrees and provide a blanket.

Post signs for quiet and turn down hall lights during formal quiet times. -All of the options may be helpful in promoting rest. However, the client complaints are about excessive noise, and posting signs for quiet and turning down hall lights during formal quiet times is the only option that directly addresses noise. Also, some clients cannot rest if the room temperature is not to their liking. The room temperature needs to be adjusted to client preference.

A nurse educates a young couple on putting their newborn on his back to sleep. What is the rationale for this information? A) Prone position increases the risk for sudden infant death syndrome. B) Prone position decreases the risk for sudden infant death syndrome. C) Supine position may alter the size and shape of the infant's head. D) Supine position makes changing diapers and feeding difficult.

Prone position increases the risk for sudden infant death syndrome. - Newborns sleep an average of 16 out of every 24 hours. It is important to teach parents to position an infant on the back. Sleeping in the prone position increases the risk for sudden infant death syndrome (SIDS).

Which drug normalizes sleep cycles by enabling the body's supply of melatonin to naturally promote sleep? A) Flurazepam (Dalmane) B) Temazepam (Restoril) C) Eszopiclone (Lunesta) D) Ramelteon (Rozerem)

Ramelteon (Rozerem) - The most recently approved sleep medication is Ramelteon (Rozerem). This drug is classified as a melatonin receptor agonist and it normalizes sleep cycles by enabling the body's supply of melatonin to naturally promote sleep (Goldsmith, 2007).

The parents of a boy 10 years of age are worried about his sleepwalking (somnambulism). What topic should the nurse discuss with the parents? Sleep deprivation B) Privacy C) Schoolwork D) Safety

Safety -Somnambulism (sleepwalking) is a parasomnia, a pattern of waking behaviour that appears during sleep. It is more commonly seen in children and is commonly outgrown before adulthood. Safety and prevention of injury are paramount concerns.

A nurse is caring for a client who is sleeping for abnormally long periods of time. This condition may be caused by injury to which of the following body structures? A) Spinal cord B) Pancreas C) Hypothalamus D) Thyroid

Spinal cord - 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.

An individual awakens from a sound sleep in the middle of the night because of abdominal pain. Why does this happen? A) Stimuli from peripheral organs to the RAS B) Stimuli to the wake center in the cerebral cortex C) Messages from chemoreceptors to the brain D) Messages from baroreceptors to the spinal cord

Stimuli from peripheral organs to the RAS -The reticular activating system (RAS) facilitates reflex and voluntary movements as well as cortical activities related to a state of alertness. Wakefulness occurs when the RAS experiences stimuli (including pain) from peripheral organs and cells.

A client with a sleep disorder experiences cataplexy. Which is a feature of this condition? A) Irresistible urge to sleep, regardless of the type of activity in which the client is engaged B) Sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion C) Nightmare or vivid hallucinations experienced during sleep time D) Skeletal paralysis that occurs during the transition from wakefulness to sleep

Sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion - Cataplexy is the sudden loss of motor tone that may cause the person to fall asleep; this is usually experienced during a period of strong emotion. Sleep attacks are irresistible urges to sleep, regardless of the type of activity in which the client is engaged. Hypnagogic hallucinations involve nightmares or vivid hallucinations. In sleep-onset REM periods, during a sleep attack, the person moves directly into REM sleep. Sleep paralysis is skeletal paralysis that occurs during the transition from wakefulness to sleep.

Which of the following guidelines does the nurse apply to discussion of sleep patterns with older adult clients? A) Circadian rhythms become more prominent as clients age. B) The amount of stage 4 sleep increases as clients age. C) Total sleep time decreases as the clients age. D) Older clients fall asleep more quickly than younger ones.

Total sleep time decreases as the clients age. - As people age, the amount of stage 4 sleep decreases significantly. Sleeping patterns may become polyphasic, with a shorter nocturnal period plus daytime naps.

A client is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder? A) Waking during sleep B) Restless leg syndrome C) Uncontrollable desire to sleep D) Decrease in the amount or quality of sleep

Uncontrollable desire to sleep - Narcolepsy is a condition characterized by an uncontrollable desire to sleep. Narcolepsy is considered a neurologic disorder.

A client who has a sleep disorder is trying stimulus control to improve amount and quality of sleep. What is recommended in this type of therapy? A) Use the bedroom for sleep and sex only. B) Use the bedroom for reading and eating. C) Go to bed at the same time every night. D) Sleep alone with minimal coverings.

Use the bedroom for sleep and sex only. - Stimulus control involves using the bedroom for sleep and sex only. If not asleep within 15 to 20 minutes, the person should leave the room and return only when he or she feels sleepy. Getting up at the same time every day is also recommended.

A client's bed partner reports the client often has irregular snoring and silence followed by a snort. Does this warrant further assessment? A) No, snoring has varied patterns B) No, this is a description of normal snoring C) Yes, this is an indicator of obstructive apnea D) Yes, the bed partner is unable to sleep at night

Yes, this is an indicator of obstructive apnea - Snoring is caused by an obstruction to airflow through the nose and mouth. When snoring changes from the characteristic sawing wood sound to a more irregular silence followed by a snort, this indicates obstructive apnea.

Which individual is likely to require more hours of sleep? A) a person 75 years of age B) a person 43 years of age C) a person 25 years of age D) a person 15 years of age

a person 15 years of age -Despite individual variations, growing children, especially adolescents who are in a tremendous growth period, require from 10 to 14 hours of sleep per night. This is in comparison with the accepted standard for adults, which is 8 hours. Older adults often require less sleep.

During NREM the parasympathetic nervous system is in control does the heart rate, blood pressure, body temperature and metabolism increase or decrease?

decrease

Characteristics of REM sleep

eyes dart back and forth small muscle twitching large muscle immobility respirations irregular rapid or irregular pulse blood pressure increases or fluctuates increase in gastric secretions metabolism increases body temperature increases encephalogram tracings active 20-25% of sleep time REM sleep enters from stage II of NREM sleep

During REM the skeletal muscle tone and deep tendon reflexes are depressed and dreaming occurs does the heart rate, blood pressure, body temperature and metabolism increase or decrease?

increase

What is the most common method for ordering sleep medications? A) Stat B) p.r.n C) Single order D) Daily dose

p.r.n Sleep medications are often ordered on a p.r.n. (as needed) basis. These medications should be administered only when indicated, and always with the full knowledge of their limitations.

What stage of NREM describes the following? relaxed but somewhat aware involuntary muscle jerking stage only lasts minutes can be easily aroused

stage I

What are the stages of non-rapid eye movement (NREM)

stage I - 5% light sleep stage II - 50% light sleep stage III - 10% deep sleep stage IV - 10% delta sleep

In which state of NREM sleep does the person fall into a stage of sleep but can be aroused with relative ease?

stage II

What stage of NREM describes the following? peaches deep sleep called delta sleep arousal is difficult muscles are relaxed metabolism slows and body temperature is low

stage IV