NCHP Exam 1: Sleep

A nurse is teaching a patient about the effects of medication on sleep. Which statement indicates a need for further teaching? "Asthma medications may affect sleep." "Amphetamines decrease rapid eye movement (REM) sleep." "Beta blockers can cause nightmares." "Barbiturates increase REM sleep."

"Barbiturates increase REM sleep."

Which statement by the patient regarding foods that promote sleep indicates the need for further education from the nurse? "A glass of milk before bed stimulates the production of serotonin, enhancing sleep." "Coffee should be avoided prior to bed as the caffeine is a stimulant, which interferes with sleep." "I should limit my intake of fluid in the evening as it may cause the need to urinate while sleeping." "I should drink a few glasses of red wine in the evening to enhance the sleep I get overnight."

"I should drink a few glasses of red wine in the evening to enhance the sleep I get overnight."

Sleep deprivation can lead to an increased risk for which diseases? Select all that apply. Depression Obesity Cardiovascular disease Parkinson disease Diabetes Asthma

Depression Obesity Cardiovascular disease Diabetes

5. Which statement made by the patient indicates an understanding of sleep-hygiene practices? 1. "I usually drink a cup of warm milk in the evening to help me sleep." 2. "If I exercise right before bedtime, I will be tired and fall asleep faster." 3. "I know it does not matter what time I go to bed as long as I am tired." 4. "If I use hypnotics for a long time, my insomnia will be cured."

1. "I usually drink a cup of warm milk in the evening to help me sleep."

2. Which statements from a patient indicate an understanding of behaviors that will promote sleep? (Select all that apply.) 1. "I will not watch television in bed." 2. "I will not drink caffeine later in the day." 3. "A short nap late in the evening will lead to a more restful night of sleep." 4. "I am going to start eating dinner closer to my bedtime" 5. "I will start to exercise regularly during the day."

1. "I will not watch television in bed." 2. "I will not drink caffeine later in the day." 5. "I will start to exercise regularly during the day."

8. Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? 1. "I'll give the baby a bottle to help her fall asleep." 2. "We'll place the baby on her back to sleep." 3. "We put the baby's stuffed animals in the crib to make her feel safe." 4. "I know the baby will not need to be fed until morning."

2. "We'll place the baby on her back to sleep."

10. Which sleep-hygiene actions at bedtime can the nurse delegate to assistive personnel? (Select all that apply.) 1. Giving 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 5. Monitoring for the effect of the sleeping medication that was given

1. Giving the patient a back rub 2. Turning on quiet music 3. Dimming the lights in the patient's room

6. Which nursing interventions are appropriate to include in a plan of care to promote sleep for patients who are hospitalized? (Select all that apply.) 1. Give patients a cup of coffee 1 hour before bedtime. 2. Plan vital signs to be taken before the patients are asleep. 3. Turn television on 15 minutes before bedtime. 4. Have patients follow at-home bedtime schedule. 5. Close the door to patients' rooms at bedtime.

2. Plan vital signs to be taken before the patients are asleep. 4. Have patients follow at-home bedtime schedule. 5. Close the door to patients' rooms at bedtime.

9. A nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? 1. "I feel refreshed when I wake up in the morning." 2. "I use soft music at night to help me relax." 3. "It takes me about 45 to 60 minutes to fall asleep." 4. "I take the pain medication for my leg pain about 30 minutes before I go to bed."

3. "It takes me about 45 to 60 minutes to fall asleep."

A person suffering from mild obstructive sleep apnea (OSA) would have how many apneic or hypopneic episodes per hour? Greater than 30 15 to 30 5 to 15 Fewer than 5

5 to 15

Which individual would require the least amount of sleep? 2-year-old 9-year-old 16-year-old 70-year-old

70-year-old

Which patient is most likely in the rapid eye movement (REM) sleep stage? Adult who has been asleep for 40 minutes Adolescent who awakens from a night terror Child who wets the bed Adult who is "resting his eyes"

Adolescent who awakens from a night terror

Which medications may be effective in managing sleep disorders? Select all that apply. Antiemetics Benzodiazepines Anticoagulants Antidepressants Antibiotics

Benzodiazepines Antidepressants

In which way are sleep deprivation and narcolepsy similar? Both carry a risk factor for obesity. Both disorders can cause hallucinations. Both are neurologic disorders. Both disorders cause a person to stop breathing during sleep.

Both disorders can cause hallucinations.

Which nonpharmacologic interventions would the nurse provide to an inpatient as part of evening care to promote uninterrupted sleep? Select all that apply. Offering a large meal Changing bed linens Providing skin care Providing oral care Performing a partial bath

Changing bed linens Providing skin care Providing oral care Performing a partial bath

Which foods or drinks are examples of nervous system stimulants that disrupt the sleep cycle? Select all that apply. Cheese Coffee Soda Nuts Chocolate

Coffee Soda Chocolate

Which cues support the nursing hypothesis Impaired Sleep(quality) related to lifestyle factors and sleep apnea? Select all that apply. Daytime fatigue Excessive yawning Paranoia Dark circles around puffy eyes Nightmares

Daytime fatigue Excessive yawning Dark circles around puffy eyes

Which characteristics may a sleep-deprived person experience? Select all that apply. Hyperactivity Violent behavior Decreased concentration Difficulty making decisions Irritability

Decreased concentration Difficulty making decisions Irritability

Which question would the nurse ask when assessing for narcolepsy? Do you sleepwalk? Do you use an alarm clock? Do you fall asleep unexpectedly at random times? Do family members tell you that you snore?

Do you fall asleep unexpectedly at random times?

Which nonpharmacologic intervention is most appropriate to promote rest in a patient with restless legs syndrome (RLS)? Using aromatherapy each evening Suggesting several glasses of red wine each night Encouraging deep knee bends Providing a light meal high in protein

Encouraging deep knee bends

Which factors are measured by polysomnography? Select all that apply. Eye movements Brain activity Heart rate Oxygen level Blood pressure

Eye movements Brain activity Heart rate Oxygen level

A patient has been diagnosed with obstructive sleep apnea (OSA) and is experiencing daytime sleepiness and excessive snoring. Which nursing hypotheses are appropriate for this patient? Select all that apply. Distorted Thinking Process Fatigue Impaired Sleep (quality) Impaired Sleep (quantity) Risk for Impaired Sleep

Fatigue Impaired Sleep (quality)

Which interventions related to sleep would the nurse recommend to the parent of a pediatric patient? Select all that apply. Give a warm bath Read a bedtime story Provide a favorite soft toy or blanket Offer a large glass of water Play soft, soothing music

Give a warm bath Read a bedtime story Provide a favorite soft toy or blanket Play soft, soothing music

Which nonpharmacologic intervention would the nurse initiate for a patient who is having difficulty falling asleep because of mild back pain? Giving the patient a massage Providing the patient with a warm cloth to wash the face Changing the patient's bed linens Asking the family to sit with the patient

Giving the patient a massage

Which nighttime snack is appropriate for a patient with a history of insomnia? Chips and salsa Chocolate ice cream Graham crackers Pizza

Graham crackers

Which effects on sleep can be attributed to alcohol use? Select all that apply. Increased wakefulness in the last half of the night Limited rapid eye movement (REM) sleep Nightmares and insomnia Hypoxia Nocturnal emissions

Increased wakefulness in the last half of the night Limited rapid eye movement (REM) sleep

Which disorder is the most common type of dyssomnia? Insomnia Narcolepsy Hypersomnia Restless legs syndrome

Insomnia

Which disorders are potential causes of hypersomnia? Select all that apply. Kidney disorders Diabetic ketoacidosis Heart disease Central nervous system damage Hyperthyroidism Airway collapse

Kidney disorders Diabetic ketoacidosis Central nervous system damage

Which interventions would the nurse take to reduce noise and promote sleep for a hospitalized patient? Select all that apply. Lower volume of telephone ringtones. Limit overhead pages to emergencies only at night. Monitor equipment frequently. Conduct shift reports inside the patient's room. Provide privacy by drawing curtains between patients.

Lower volume of telephone ringtones. Limit overhead pages to emergencies only at night. Monitor equipment frequently Provide privacy by drawing curtains between patients.

Which components would be included in a sleep diary? Select all that apply. Meal times Bedtime routine Caffeine intake Pain level Prescription medication Naps

Meal times Caffeine intake Naps

Which pharmacologic interventions would the nurse suggest for a patient with chronic insomnia who prefers to use supplements over medications? Select all that apply. Melatonin Valerian Amitriptyline Diphenhydramine Doxylamine

Melatonin Valerian

A patient displaying small muscle jerks is in which stage of sleep? Nonrapid eye movement (NREM) 1 NREM 2 NREM 3 Rapid eye movement (REM)

NREM 2

During which sleep stage can sleepwalking occur? Rapid eye movement (REM) Nonrapid eye movement (NREM) 1 NREM 2 NREM 3

NREM 3

A patient with no known medical conditions reports constant fatigue and inability to stay awake. The patient also reports falling asleep while at work, having vivid hallucinations upon awakening, and brief episodes of paralysis at the beginning of sleep. The nurse suspects that this patient is suffering from which condition? Apnea Insomnia Narcolepsy Hypersomnia

Narcolepsy

Which physical signs indicate potential sleep problems? Select all that apply. Nasal polyps Thin neck Deviated septum Shortness of breath Low body mass index

Nasal polyps Deviated septum Shortness of breath

Which patient has the greatest risk of developing obstructive sleep apnea (OSA)? Underweight, adult male with decreased neuromuscular coordination Thin, female child with a recessed chin who has a family history of OSA Obese, older adult female who has been hospitalized several times within the past year Obese, adult male smoker with a large neck circumference

Obese, adult male smoker with a large neck circumference

Which outcome is most appropriate for a patient who snores during sleep and reports feeling very tired after awakening? Patient experiences fewer apneic-hypopneic episodes per night. Patient will report increased memory function. Patient will have fewer days obtaining less than 6 hours of sleep per night. Patient will reduce score on Insomnia Severity Index.

Patient experiences fewer apneic-hypopneic episodes per night.

Which outcome is appropriate for a patient with a nursing hypothesis of Impaired Sleep (quality)? Patient will take two 20-minute naps each day. Patient will report increased memory function. Patient will reduce score on Pittsburgh Sleep Quality Index. Patient will sleep for at least 90 minutes at a time during hospitalization.

Patient will sleep for at least 90 minutes at a time during hospitalization.

Which bedtime snack would be appropriate for the nurse to offer a patient to promote sleep? Chips with salsa Cup of black tea Chocolate pudding Piece of oat bran toast

Piece of oat bran toast

Which sleep instrument is used to assess sleep quality and disturbance over a 1-month period? Epworth Sleepiness Scale Pittsburgh Sleep Quality Index Sleep Hygiene Index STOP-BANG questionnaire

Pittsburgh Sleep Quality Index

A patient with a fluctuating heart rate is in which stage of sleep? Nonrapid eye movement (NREM) 1 NREM 2 NREM 3 Rapid eye movement (REM)

Rapid eye movement (REM)

Which behavioral cues may validate a sleep disturbance? Select all that apply. High energy level Slow speech Frequent yawning Normal strength Increased affect

Slow speech Frequent yawning

Which nonpharmacologic interventions would the nurse suggest to a patient for a healthy bedtime routine? Select all that apply. Taking a warm bath Reading for 20 minutes Going for a jog Aromatherapy Drinking a glass of wine

Taking a warm bath Reading for 20 minutes Aromatherapy

Which type of exercise would the nurse suggest a patient perform just before bed to promote sleep? Yoga Weight lifting Brisk walking Basketball

Yoga

Which structures of the central nervous system are affected by a light or dark environment? Select all that apply. Basal forebrain Hypothalamus Amygdala Thalamus Pineal gland Brain stem

Hypothalamus Pineal gland Brain stem

A female patient with tremors and circadian rhythm disorder complains that she is having difficulty sleeping and is often awakened. She frequently works nights during shift rotation. Which questions by the nurse are appropriate? Select all that apply. "Have you thought about taking a vacation to get some rest?" "Have you considered switching to days permanently?" "Are you taking any medications that may be causing you to have trouble sleeping?" "How do you feel about a care plan to reduce awakenings?" "Have you been tested for Parkinson disease?"

"Have you considered switching to days permanently?" "Are you taking any medications that may be causing you to have trouble sleeping?" "How do you feel about a care plan to reduce awakenings?" "Have you been tested for Parkinson disease?"

Which statements made by the patient would indicate a sleep medication was ineffective? Select all that apply. "It took a lot longer to fall asleep than normal." "I am a lot less tired today than yesterday." "I slept several more hours last night than I usually do." "I woke up more frequently in the night." "My mind was very active last night after taking the medication."

"It took a lot longer to fall asleep than normal." "I woke up more frequently in the night." "My mind was very active last night after taking the medication."

Which statement made by a patient after education regarding the safe administration of common sleep medications indicates a need for further teaching? "I must read the warnings to help me understand the potential severe allergic reactions and dangerous sleep behaviors, such as sleep-driving." "I understand that long-term use of benzodiazepine medications may actually cause additional sleep problems." "Since I am an older adult, I will take the medicine with care so as to lessen my risk of side effects." "Maybe I should take a higher dose of antidepressants since it is my first time taking them for my sleep problems."

"Maybe I should take a higher dose of antidepressants since it is my first time taking them for my sleep problems."

Which statement regarding common side effects would the nurse include in a teaching session for a patient who is prescribed an antidepressant for insomnia? "An increased sexual desire often occurs while taking this medication." "Headache and nausea often occur; however, these side effects will improve within several months of taking this medication." "Nervousness often occurs; however, this should improve within several weeks." "Skin rashes often occur while taking this medication."

"Nervousness often occurs; however, this should improve within several weeks."

4. Which nursing intervention(s) best promote(s) effective sleep in an older adult? (Select all that apply.) 1. Limit fluids 2 to 4 hours before sleep. 2. Ensure that the room is completely dark. 3. Ensure that the room temperature is comfortably cool. 4. Provide warm covers. 5. Encourage walking an hour before going to bed.

1. Limit fluids 2 to 4 hours before sleep. 3. Ensure that the room temperature is comfortably cool. 4. Provide warm covers.

1. A nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? (Select all that apply.) 1. Take brief, 20-minute naps no more than twice a day. 2. Drink a glass of wine with dinner. 3. Eat a large meal at lunch rather than dinner. 4. Establish a regular exercise program. 5. Teach the patient about the side effects of modafinil.

1. Take brief, 20-minute naps no more than twice a day. 4. Establish a regular exercise program. 5. Teach the patient about the side effects of modafinil.

3. A 72-year-old patient asks the nurse about using an over-the-counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse's best response? 1. "Antihistamines are better than prescription medications because prescription medications can cause a lot of problems." 2. "Antihistamines should not be used because they can cause confusion and increase your risk of falls." 3. "Antihistamines are effective sleep aids because they do not have many side effects." 4. "Over-the-counter medications when combined with sleep-hygiene measures are a good plan for sleep."

2. "Antihistamines should not be used because they can cause confusion and increase your risk of falls."

7. The nurse is contacting the health care provider about a patient's sleep problem. Place the steps of the SBAR (situation, background, assessment, recommendation) in the correct order. 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 2. "Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 3. "I'm calling to ask if you would order a hypnotic such as zolpidem to use on a prn basis." 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1°C (98.8°F).

2. "Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1°C (98.8°F). 3. "I'm calling to ask if you would order a hypnotic such as zolpidem to use on a prn basis."

Recurring patterns of sleep last approximately how many minutes? Record your answer as a whole number. _________ minutes.

90

Which outcome is appropriate for a patient with a nursing hypothesis of Fatigue? Patient will reduce score on Epworth Sleepiness Scale. Patient will report fewer episodes of hallucinations and delusions. Patient will have fewer days obtaining less than 6 hours of sleep per night. Patient will sleep for at least 90 minutes at a time during hospitalization.

Patient will reduce score on Epworth Sleepiness Scale.

Which outcome would the nurse include in the plan of care for a patient who frequently sleepwalks? Patient will remain injury-free during hospitalization. Patient will sleep at least 90 minutes at a time during hospitalization. Patient will exercise vigorously 1 hour prior to going to bed each night. Patient will identify factors in his work environment that disrupt sleep in 3 weeks.

Patient will remain injury-free during hospitalization.

A hospitalized patient reports disturbed sleep caused by the nurse monitoring vital signs at regular intervals in the night. Which outcome is appropriate for this patient with the nursing hypothesis Impaired Sleep (quality)? Patient will fall asleep within 15 minutes of going to bed while hospitalized. Patient will take daily naps during hospitalization. Patient will sleep for at least 90 minutes at a time during hospitalization. Patient will demonstrate sleep hygiene modifications during hospitalization.

Patient will sleep for at least 90 minutes at a time during hospitalization.

Which physiologic changes occur during sleep? Select all that apply. Heart rate decreases Respiratory rate increases Body temperature drops Blood pressure decreases Muscle tone increases

Heart rate decreases Body temperature drops Blood pressure decreases

Match the hormone to its role in the onset and duration of sleep. Helps maintain homeostasis Released in response to light Decreases rapid eye movement (REM) sleep when released in high levels Increases alertness when released in response to stress Cortisol Hypocretin Dopamine Norepinephrine Melatonin Adrenaline

Helps maintain homeostasis - Cortisol Released in response to light - Melatonin Decreases rapid eye movement (REM) sleep when released in high levels - Norepinephrine Increases alertness when released in response to stress - Adrenaline

Which statement made by the adult patient, while providing a sleep history, needs further follow-up? I go to bed at the same time every day. It takes me about 10 minutes to fall asleep at night. I usually feel tired in the mornings. I typically get up once during the night to urinate.

I usually feel tired in the mornings.

Which hypothesis would the nurse select for a patient whose sleep is not progressing properly through sleep cycles? Distorted Thinking Process Fatigue Impaired Sleep (quality) Impaired Sleep (quantity)

Impaired Sleep (quality)

Which symptoms caused by low estrogen levels may interfere with a woman's sleep? Select all that apply. Gastric reflux Frequent vomiting Night sweats Daytime fatigue Pain Nocturia

Night sweats Daytime fatigue

A patient admitted to the hospital with a concussion after falling while sleepwalking is currently alert and oriented. Which outcomes are appropriate when planning care for this patient? Select all that apply. Patient will remain injury-free during hospitalization. Patient will fall asleep within 15 minutes of going to bed within 2 weeks. Patient will take two 20-minute naps daily. Patient will reduce the number of sleepwalking episodes prior to discharge. Patient will repeat medication instruction prior to discharge.

Patient will remain injury-free during hospitalization. Patient will reduce the number of sleepwalking episodes prior to discharge.

Which solutions would be appropriate for a patient with a nursing hypothesis of Fatigue? Select all that apply. Patient education about sleep hygiene Patient will visit with a mental health professional Patient education about sleep needs during various life stages Adjusting work schedule to allow for healthy sleep schedule Patient education about stress management

Patient education about sleep hygiene Adjusting work schedule to allow for healthy sleep schedule Patient education about stress management

Which solutions would be appropriate for a patient with a nursing hypothesis of Impaired Sleep (quantity)? Select all that apply. Patient education about sleep hygiene Patient will visit with a mental health professional Patient education about sleep needs during various life stages Adjusting work schedule to allow for healthy sleep schedule Patient education about stress management

Patient education about sleep hygiene Patient education about sleep needs during various life stages Adjusting work schedule to allow for healthy sleep schedule Patient education about stress management

Which outcome is appropriate for the nurse to include in the plan of care for an older patient who feels sleepy during the day despite getting enough sleep at night? Patient should be able to sleep for 6 to 7 hours consistently within 1 month. Patient should be able to fall asleep within 15 minutes of going to bed within 2 weeks. Patient should maintain a sleep journal daily. Patient should take two 20-minute naps daily.

Patient should take two 20-minute naps daily.

Which example is an appropriate long-term goal for the nurse to include in a plan of care for a patient who is suffering from insomnia related to psychological job stress? Patient will identify factors in the immediate home environment that disrupt sleep in 2 weeks. Patient will achieve 6 to 7 hours of sleep each night within 4 weeks. Patient will sleep for at least 90 minutes at a time. Patient will sleep 6 hours per night within a week.

Patient will achieve 6 to 7 hours of sleep each night within 4 weeks.

Match the central nervous system structure to its role in sleep. Relays sensory information Secretes melatonin Secretes hypocretins Processes emotions Hypothalamus Thalamus Basal forebrain Brain stem Amygdala Pineal gland

Relays sensory information - Thalamus Secretes melatonin - Pineal gland Secretes hypocretins - Hypothalamus Processes emotions - Amygdala

Match the medication prescribed for sleep with the corresponding category. Sedative-hypnotic Benzodiazepine Melatonin receptor agonist Antidepressant Ramelteon Amitriptyline Zolpidem Diphenhydramine Alprazolam Doxylamine

Sedative-hypnotic - Zolpidem Benzodiazepine - Alprazolam Melatonin receptor agonist - Ramelteon Antidepressant - Amitriptyline

Which functions of the human body are impacted by the circadian rhythm? Select all that apply. Sleep Blood production Digestion Body temperature Endocrine function

Sleep Digestion Body temperature Endocrine function

Which patient assessment cues support a nursing hypothesis of Impaired Sleep (quantity)? Select all that apply. Sleep duration insufficient for patient age Delusions High score on the Sleep Hygiene Index Daytime drowsiness High score on the Pittsburgh Sleep Quality Index High score on the Apnea-Hypopnea Index

Sleep duration insufficient for patient age Delusions Daytime drowsiness High score on the Pittsburgh Sleep Quality Index

Which parasomnia may be associated with self-injury and sleep-related violence? Bruxism Sleep terrors Somnambulism Nocturnal enuresis

Somnambulism

Which patients would most likely suffer from sleep disturbances? Select all that apply. Young adult female with marital problems Young adult male who lives alone Older adult male who recently lost his wife in death Child who is spending the summer away from home at camp Adult female caring for a family member with a chronic illness

Young adult female with marital problems Older adult male who recently lost his wife in death Child who is spending the summer away from home at camp Adult female caring for a family member with a chronic illness