Mental Health Ch. 19_Sleep-Wake Disorders

Which statement by a patient who was educated about the importance of acquiring adequate sleep indicates a need for further teaching? a. "I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can." b. "Getting less than 6 hours of sleep at night may increase my risk for medical problems." c. "Getting enough sleep will increase my productivity at work." d. "Since I have to drive for my job, getting enough sleep will help me avoid accidents."

a. "I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can." Sleeping more than 8 hours per night is associated with up to a twofold increased risk of obesity, diabetes, hypertension, incident cardiovascular disease, stroke, depression, and substance abuse. The other options are all true.DIF: Cognitive Level: Analyze (Analysis)REF: page 4TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

One criterion for the diagnosis of primary insomnia is met when the client makes which statement? a. "I've actually missed work because I'm too tired to go." b. "I was diagnosed with depression 2 months ago." c. "I've had problems falling asleep for 3 weeks now." d. "I have these terrible nightmares when I fall asleep."

a. "I've actually missed work because I'm too tired to go." A criterion for primary insomnia listed in the DSM-5 is disruption of the normal routine as a result of the sleep disturbance. None of the other options relate to the stated criteria.REF: 360, DSM-5 Box Insomnia Disorder

What is the most effective nursing intervention regarding the accurate assessment of sleep disorders? a. A sleep diary b. Information regarding sleep cycles c. Client description of the symptomatology d. Assessment for substance abuse

a. A sleep diary Self-reported sleep patterns may be biased, and so clinical tools such as a sleep diary are helpful in accurately estimating total sleep time.REF: Page 365

A depressed client is likely to report a sleep disorder that includes which characteristics? a. Frequent awakenings during the night b. Nightmares c. Difficulty falling asleep d. Sleepwalking

a. Frequent awakenings during the night Depressed clients often report normal sleep onset, followed by repeated awakenings during the second half of the night. While the other options may occur, they are not the most frequent characteristic.REF: 360-361

When providing possible interventions to promote the safety of a client reporting symptoms of somnambulism, the nurse should include which intervention? a. Gating the stairways b. Sleeping on a mattress placed on the floor c. Regular bedtime dose of a benzodiazepine d. Avoiding the use of serotonergic medications

a. Gating the stairways Somnambulism or sleep walking can result in falls; gating the stairways may minimize that risk. None of the other options are associated with the dangers presented by sleepwalking.REF: 362

A client reports to the nurse that falling asleep can often take hours. Which intervention should the nurse implement? a. Teach the client how to do progressive relaxation. b. Advise the client to drink an ounce or two of brandy at bedtime. c. Suggest that the client seek a referral for polysomnography. d. Point out that reducing stress at work would be advisable.

a. Teach the client how to do progressive relaxation. Progressive relaxation relaxes muscle groups sequentially and generates a state of pleasant comfort and ease, a natural prelude to sleep. It is inappropriate to encourage the use of alcohol as a sleep aid since it is known to decrease stage 3 sleep. A referral for a sleep test is premature. While stress reduction is appropriate, concentrating only on work-related stress is not effective.REF: 367

A client reports symptomatology that supports the diagnosis of sleep paralysis. The nurse effectively assesses the client by asking which question? a. "Do you ever have nightmares?" b. "Have you ever fallen asleep while driving?" c. "Do you have a history of obsessive compulsive behavior?" d. "Is it difficult for you to fall asleep?"

b. "Have you ever fallen asleep while driving?" Clients with sleep paralysis can often also exhibit symptoms of narcolepsy such as extreme sleepiness resulting in falling asleep at inappropriate times. None of the other questions are directed toward this disorder.REF: 361-362

A 38-year-old patient referred for sleep studies reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. These symptoms support which sleep-related diagnosis? a. Circadian rhythm disorder b. Hypersomnolence c. REM sleep behavior disorder d. Breathing-related sleep disorder

b. Hypersomnolence The patient with hypersomnolence reports recurrent periods of sleep or unintended lapses into sleep, frequent napping, nonrefreshing nonrestorative sleep regardless of the amount of time slept, and difficulty with full alertness during the wake period. Circadian rhythm sleep disorders occur when there is a misalignment between the timing of the individual's normal circadian rhythm and external factors that affect the timing or duration of sleep. Patients with REM sleep disorder display elaborate motor activity associated with dream mentation. Breathing-related sleep disorder is characterized by frequent upper airway obstruction.DIF: Cognitive Level: Apply (Application)REF: page 13TOP: Nursing Process: DiagnosisMSC: NCLEX: Physiological Integrity

A slightly obese client reports falling asleep during the daytime even though she has slept all night. Her husband says she snores, and her blood pressure is noted to be in the low hypertensive range. The nurse anticipates that the client will be scheduled for which diagnostic test? a. Hypertension screening b. Polysomnography c. Glycosylated hemoglobin d. Positron emission tomography

b. Polysomnography Polysomnography consists of an electroencephalogram that records respirations, eye movements, and muscle tone during sleep. Sleep apnea becomes apparent if respirations cease frequently during sleep. None of the other options are focused on these behaviors.REF: 359-360

What non-habit-forming melatonin receptor agonist is often prescribed for insomnia? a. Zolpidem (Ambien) b. Ramelteon (Rozerem) c. Eszopiclone (Lunesta) d. Zaleplon (Sonata)

b. Ramelteon (Rozerem) Ramelteon (Rozerem) is a short-acting melatonin receptor agonist that has been approved by the FDA for insomnia and is not habit forming.REF: 368; Table 19-2

A client tells the nurse, "I just don't sleep more than 5 hours at night." The nurse assesses the client best for individual sleep requirements by asking which question? a. "Are you aware that some people require less sleep than others?" b. "When did this pattern of sleep start for you?" c. "Do you usually feel rested and alert when you get up?" d. "Are you taking any medication that could affect your sleep?"

c. "Do you usually feel rested and alert when you get up?" The most accurate way to determine an individual's sleep requirements is to ask if the person feels fully awake and functions effectively on the sleep he or she is getting. None of the other options address the issue from the client's perspective.REF: 366

A client newly diagnosed with hypersomnolence asks about what medication will be prescribed to manage this disorder. The nurse will base his/her response based on what knowledge? a. There is no effective medication treatment for hypersomnolence disorder. b. Medication therapy with benzodiazepines may be initiated. c. A stimulant will most likely be prescribed. d. The client will be started on an anticholinesterase inhibitor.

c. A stimulant will most likely be prescribed. Pharmacotherapy with long-acting amphetamine-based stimulants such as methylphenidate and non-amphetamine-based stimulants such as modafinil are helpful in hypersomnolence disorder. The other options are incorrect because there is effective medication treatment; benzodiazepines are sedating and addictive; and anticholinesterase inhibitors are used for the treatment of dementia.DIF: Cognitive Level: Apply (Application)REF: page 12TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

A client reports insomnia and shares that a friend has recommended a nonprescription hormone product that can be purchased at the local health food store. The nurse suspects that the medication contains which component? a. A benzodiazepine b. A tranquilizer c. Melatonin d. Lithium

c. Melatonin The use of melatonin appears to be helpful in treating sleep problems in the elderly. However, this practice is not without risk. Melatonin products are not approved by the U.S. Food and Drug Administration; therefore, variation may exist in the purity, safety, and effectiveness of the products. None of the other options can be purchased over the counter.REF: 368

A client asks the nurse to explain what basal sleep requirement is. What is the nurse's best response? a. The basal temperature of your body needed to induce the best sleep. b. The sleep time by your body needed to repair cellular damage. c. The amount of sleep needed to be fully awake and perform well in the daytime. d. The amount of sleep needed to transition to rapid eye movement (REM) sleep.

c. The amount of sleep needed to be fully awake and perform well in the daytime. Basal sleep requirement is the amount of sleep required to feel fully awake and able to sustain normal levels of performance during the periods of wakefulness. The other options do not describe basal sleep requirement.DIF: Cognitive Level: Apply (Application)REF: page 4TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

What factors are consistently observed to increase the risk for sleep disturbances? a. Gender and race b. Diet and exercise c. alcohol and tobacco d. income and education

c. alcohol and tobacco There is a strong correlation between alcohol and tobacco use with sleep latency and efficiency problems. None of the other factors are as consistently observed as risk factors.REF: 367; Box 19-2

The nurse appropriately assesses an obese, hypertensive, Type 2 diabetic client when asking: a. "Do you regularly have nightmares?" b. "Is getting to sleep a problem for you?" c. "Do you snooze when you sleep?" d. "How much sleep do you usually get each night?"

d. "How much sleep do you usually get each night?" Short sleep duration has been associated with obesity, cardiovascular disease, hypertension, and diabetes. Neither nightmares nor snoring are as directly associated with short sleep duration. The remaining option is a general assessment question.REF: 364

A client diagnosed with a chronic sleep disorders begins to cry and states, "I can't keep going like this! I work in a bank and if I can't function correctly I'll lose my job. I just don't think I'll get better." Which statement provides a therapeutic response to the client's concerns? a. "Don't worry! I'm sure with treatment everything will get better." b. "You are not alone. Many people who come for sleep studies are going through the same thing." c. "You seem so sad. May I ask if something else is troubling you?" d. "There is much hope for improvement through treatment. Let's talk about some strategies for your problems at work."

d. "There is much hope for improvement through treatment. Let's talk about some strategies for your problems at work." This response instills hope regarding the ability of the patient to improve and suggests positive strategies for daily functioning. The other responses are nontherapeutic.DIF: Cognitive Level: Apply (Application)REF: page 25TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

What is the usual time period that medications to treat insomnia are usually prescribed? a. 1 to 2 days b. 1 to 2 months c. 3 weeks d. 2 weeks

d. 2 weeks Nurses frequently provide education about the benefits of a particular sleep medication, the side effects, untoward effects, and the fact that medications are usually prescribed for no longer than 2 weeks because tolerance and withdrawal may result.REF: 367

An older adult client is reporting symptomatology that suggests REM sleep behavior disorder (RSBD). Which comorbid condition should the nurse assess for? a. Lymphoma b. Hypertension c. Acute renal failure d. Parkinson's disease

d. Parkinson's disease RSBD is seen in elderly males as they begin to develop neurological pathologies such as Parkinson's disease. None of the other options are directly associated.REF: 363