Sleep & Rest

The postpartum nurse is preparing a teaching plan for the first-time mother for discharge to home. What information should be included in the teaching plan? 1. Try to reduce work-related stress to promote sleep. 2. Nap frequently during the day when you can. 3. Avoid fluids in the evening to reduce nocturia. 4. Avoid vigorous-intensity exercise to reduce fatigue.

2

The nurse in a rehabilitation center is providing care to a client who complains of insomnia. The client states that the room is noisy, and that they often take naps during the day because they are a "night owl" from working the nightshift for several years. The nurse develops a care plan that allows the client to start their rehab therapy later in the day, provides the client with a sleep aide and a white noise fan in the room, and allows the client to nap during the day when tired. Which of the following would be a priority for this plan? 1. Allowing the client to sleep later in the day 2. Providing a white noise fan in the room 3. Providing a sleep aide, as prescribed 4. Promoting frequent naps during the day

1

The nurse is assessing the 19-month-old client in the family clinic. The mother states that she is concerned that the child doesn't sleep enough, as the child has stopped taking their usual morning nap. What is the nurse's best response to this concern? 1. Oftentimes, most toddlers take only one nap per day and require about 12 to 14 hours of sleep in a 24-hour period. 2. Oftentimes, most toddlers take at least two naps and need approximately 12 to 16 hours of sleep in a 24-hour period. 3. Oftentimes, most toddlers should be sleeping approximately 8 to 10 hours in a 24-hour period. 4. Oftentimes, most toddlers need approximately 7 to 9 hours of sleep in a 24-hour period, without any naps.

1

The nurse is caring for a client newly diagnosed with narcolepsy. What is the priority teaching point the nurse would share with the client? 1. Do not drive or operate heavy equipment. 2. Men are more likely to be diagnosed than women. 3. There is no treatment; symptoms must be managed. 4. Getting more sleep will correct narcolepsy.

1

The nurse is developing a plan of care for a client admitted following a motor vehicle accident (MVA) who reports regularly sleeping only 2 to 3 hours per night. The client says this is the third MVA he's been involved in this year. The client thinks he might have been asleep when he got into the accident. What is the most appropriate nursing diagnosis for this client? 1. Insomnia 2. Sleep Deprivation 3. Disturbed Sleep Pattern 4. Risk for Injury

1

The nurse is providing care to client in the long-term care facility. The nurse notes that the night shift staff have reported that the client has appeared to have been sleepwalking this past week. What is the medical term for this behavior? 1. Parasomnias 2. Dyssomnias 3. Insomnia 4. Hypersomnia

1

The nurse recognizes that the client with anxiety has the potential for sleep disorders. Which of the following would be an explanation for the physiological factors in this sleep disorder? 1. Anxiety increases norepinephrine levels. 2. Anxiety can decrease insulin production. 3. Anxiety alters the central nervous system. 4. Anxiety can cause malfunction of melatonin.

1

The primary focus of the nursing interventions for a 6-year-old client who experiences somnambulation (sleep walking) would be to: 1. Maintain client safety during episodes of somnambulation 2. Administer and teach about medications to suppress stage III sleep 3. Encourage the client to verbalize feelings regarding sleep pattern 4. Provide a quiet environment for nighttime sleep

1

The nurse is caring for a client admitted to the hospital's hospice unit with terminal cancer and acute cancer pain. What factors does this client have that will interrupt circadian rhythms? Select all that apply. 1. Poorly controlled pain 2. Fear of the unknown 3. Nursing rounds at night 4. Extraneous lights in room 5. Cool, dark room

1,2,4

The nurse is providing care to the older adult client who complains of sleep issues. Which of the following statements are factors that may help resolve the client's sleep issues? Select all that apply. 1. "I use a fan on low to help me sleep." 2. "I take my thyroid medicine every morning." 3. "I have had Parkinson's disease for over 10 years." 4. "I have 4 beers a night to help me sleep." 5. "I take a small dose of melatonin to help me sleep."

1,2,5

A client complains of trouble falling asleep at night despite extreme fatigue. A review of symptoms reveals no physical problems or a history of medications. The client has recently quit smoking, is trying to eat healthier foods, and has started a moderate-intensity exercise program. The client's sleep history reveals no changes in bedtime routine, stress level, or environment. Based on this information, the most appropriate nursing diagnosis would be Disturbed Sleep Pattern related to: 1. Increased exercise 2. Nicotine withdrawal 3. Caffeine intake 4. Environmental changes

2

The nurse is performing a sleep assessment for a newly admitted client. He says his sleep habits are satisfactory and that he normally feels well rested. What question would the nurse ask next? 1. "Would you be willing to complete a sleep diary?" 2. "What time do you usually go to bed and awaken?" 3. "How many times do you usually awaken?" 4. "Do you have trouble falling asleep at night?"

2

The nurse is providing teaching to the client who comes to the sleep clinic. The nurse instructs the client to start a sleep diary. What is the rationale of using a sleep diary? 1. Identify sleep-rest patterns over a 1-year period. 2. Note the trend in sleep-wakefulness patterns over a 2-week period. 3. Note typical sleep habits and most common daily routines. 4. Examine the preparation, preferences, and routines surrounding sleep.

2

The nurse is teaching the client about foods that promote sleep versus those that may disrupt sleep. Which diet chosen by the client demonstrates understanding of foods that promote sleep? 1. Hamburger, potato fries, and a milkshake 2. Turkey fettuccini, whole wheat bread, and a glass of milk 3. Chicken salad sandwich, pineapple salad, and a diet cola 4. Fish, broccoli, applesauce, and a cup of tea

2

The nurse teaches a class for new parents promoting safe sleep for infants. The nurse determines a participant understood the important safety points when a parent makes which statement? 1. "I will gently lay my son down on his back with a soft pillow to support his head." 2. "I will put my son on a firm crib mattress on his back and remove all padding." 3. "I will position my son to sleep on his back and place soft pads around the crib to prevent injury." 4. "I will have my son sleep in my bed so I can be sure he is safe at night."

2

The client tells the nurse, "I've always been able to maintain a steady weight by exercising and watching what I eat, but lately I seem to be steadily gaining weight." The nurse then collects a thorough sleep history. Why will the nurse ask the client about her sleep habits? Select all that apply. 1. Lack of sleep causes increased insulin production. 2. Lack of sleep reduces activity levels. 3. Lack of sleep increases appetite. 4. Lack of sleep leads to poor glucose tolerance. 5. Lack of sleep reduces total energy expenditure.

2,3,4,5

A mother expresses concern that her 7-year-old has episodes of nocturnal enuresis approximately three to four times per week. The nurse's best response would be which of the following? Select all that apply. 1. "Your child's bladder is still developing at this point in life." 2. "Be patient; most children outgrow enuresis." 3. "Wake your child every 4 hours to use the bathroom." 4. "You might consider purchasing protective pads for the bed." 5. "Try a bed alarm when the child starts wetting the bed at night."

2,4

A client states that many of his friends told him to ask for Valium or Ativan to help him sleep while hospitalized. The nurse knows that nonbenzodiazepines (e.g., Ambien) are often preferred over benzodiazepines (Ativan or Valium). Why is this? 1. The benzodiazepine Ativan has a shorter half-life and provides a full night of sleep. 2. The nonbenzodiazepine Ambien alters the sleep cycle and causes daytime sleepiness. 3. The benzodiazepine Ativan can alter the sleep cycle and produce daytime sleepiness. 4. The nonbenzodiazepine Ambien has a longer half-life and produces daytime sleepiness.

3

The client asks the nurse for suggestions to promote rest. Which of the following would be the most appropriate intervention suggestions to promote rest? 1. Take routine benzodiazepine as prescribed. 2. Avoid caffeine for several hours after meals. 3. Meditate for 30 to 60 minutes in the evening. 4. Avoid watching television in the bedroom.

3

The nurse is assessing the client in the family clinic, who asks about the difference between rest and sleep. Which of the following statements would explain the main difference between sleep and rest? 1. In sleep, the body may respond to external stimuli. 2. Short periods of sleep do not restore the body as much as short periods of rest. 3. Sleep is characterized by an altered level of consciousness. 4. The metabolism slows less during sleep than during rest.

3

The nurse is performing a sleep assessment and suspects a client is experiencing sleep apnea. What will be implemented next to confirm the diagnosis? 1. Instruct the client to start a sleep diary. 2. Assess the client's sleep history. 3. Arrange for a polysomnography. 4. Arrange for continuous positive airway pressure (CPAP) therapy.

3

When making rounds on the night shift, the nurse observes her client to be in a deep sleep. His muscles are very relaxed. When he arouses as the nurse changes the intravenous (IV) tubing, he is confused. What stage of sleep was the client most likely experiencing? 1. NREM I 2. NREM II 3. NREM III 4. REM

3

The nurse is providing care to the client that has recently been diagnosed with obstructive sleep apnea (OSA). Which of the following are symptoms associated with OSA? Select all that apply. 1. Bruxism 2. Enuresis 3. Daytime fatigue 4. Snoring 5. Drooling

3,4

A 6-year-old boy is admitted to the hospital for a surgical procedure associated with a hospital stay. When the nurse asks his mother about the boy's sleep patterns, she says, "Sometimes he will get out of bed, walk into the kitchen, and get the cereal out of the cabinet. Then he just turns around and goes back to bed." The nurse explains that he is sleepwalking. The best nursing diagnosis for the boy would be: 1. Risk for Insomnia related to sleepwalking 2. Risk for Fatigue related to sleepwalking 3. Disturbed Sleep Pattern related to dyssomnia 4. Risk for Injury related to sleepwalking

4

A person who is deprived of rapid eye movement (REM) sleep for several nights in succession will usually experience: 1. Extended non-rapid eye movement (NREM) sleep 2. Insomnia 3. Parasomnia 4. REM rebound

4

The client tells the nurse, "After a couple of glasses of wine, I sleep very soundly." After assessing further about the client's alcohol history, what response by the nurse is most accurate? 1. "Although alcohol helps you fall asleep, you will be more likely to awaken during the night and have trouble falling back to sleep." 2. "If you quit drinking, you will find falling asleep more difficult, but you'll feel more rested when you awaken." 3. "I know alcohol helps you to sleep, but you could take a sleeping pill instead to help you fall asleep." 4. "Is there anything else that you do on a regular basis that helps you to fall asleep and stay asleep?"

4

The client tells the nurse, "I have terrible insomnia. It seems as though I am exhausted all the time." What question is most appropriate for the nurse to ask this client? 1. "What time do you go to bed at night?" 2. "Are you experiencing much stress right now?" 3. "Have you tried meditation to help you relax?" 4. "Do you have trouble falling asleep or staying asleep?"

4

The nurse is developing a care plan for the client experiencing poor sleep patterns. Which of the following would be an expected outcome (goal) for a client with Disturbed Sleep Pattern? The client will: 1. Limit exercise to 1 hour per day early in the day 2. Consume only one caffeinated beverage per day 3. Demonstrate effective guided imagery to aid relaxation 4. Verbalize that she is sleeping better and feels less fatigued

4

The nurse is providing education to the client who has difficulty sleeping. Which of the following teachings would be most therapeutic for this client with sleep disturbance? 1. "Give yourself at least 60 minutes to fall asleep." 2. "Avoid eating carbohydrates before going to sleep." 3. "Catch up on sleep by napping or sleeping in, when possible." 4. "Do not go to bed feeling upset about a conflict."

4

The pediatric nurse is assessing the 3-year-old client when the mother states the child is having sleep disturbances lately. The pediatric nurse recognizes the most likely cause of sleep disturbances would be which of the following? 1. Concerns about friends 2. Staying up to watch television 3. Side effect of medication 4. Fear of imaginary monsters

4

The spouse of a client recently diagnosed with cancer reports feeling anxious and is having trouble sleeping at night despite feeling tired. The spouse says sleep was never previously a problem. What type of interventions would be first priority for the spouse? 1. Promote physical comfort. 2. Support bedtime routines. 3. Create a restful environment. 4. Promote relaxation.

4

When developing a care plan for the sleep-deprived client, the nurse should consider major factors that regulate sleep. Which is a major factor regulating sleep? 1. Electrical impulses transmitted to the cerebellum 2. Level of sympathetic nervous system stimulation 3. Individual patterns for amounts of sleep 4. Amount of light received through the eyes

4

Which of the following clients with inadequate or poor quality of sleep would be the best choice for a nursing diagnosis of Disturbed Sleep Patterns? 1. An adolescent diagnosed with somnambulism 2. A client with obstructive sleep apnea 3. An attorney who says she has no time for sleep 4. A new mother of twins

4

Dysomnia

Dyssomnias—Sleep disorders characterized by insomnia or excessive sleepiness. They include insomnia, sleep-wake schedule (circadian) disorders, sleep apnea, restless legs syndrome, hypersomnia, and narcolepsy.

Hypersomnia

Hypersomnia is excessive sleeping, especially in the daytime. Symptoms. People with excessive daytime sleepiness doze, nap, or fall asleep at times and in situations when they need or wish to be awake and alert. Etiologies. Common causes of hypersomnia are OSA and narcolepsy; disorders of the central nervous system, kidney, or liver; and metabolic disorders (e.g., diabetic acidosis and hypothyroidism). Hypersomnia can also be a symptom of depression.

Insomnia

Insomnia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), is the predominant complaint of dissatisfaction with sleep quantity, associated with the inability to fall asleep, remain asleep, or go back to sleep. The sleep disturbance causes significant distress or impairments in social, occupational, academic, behavioral, and other important areas of functioning. True insomnia occurs at least three nights per week and is present for 3 months or longer, even when there is ample opportunity for sleep (American Psychiatric Association, 2013). Sleep difficulty may be transient/short term (less than a month) or chronic (longer than a month). People with sleep difficulty usually report an insufficient quantity and quality of sleep and wake without feeling refreshed, even though they are often observed to sleep more than they perceive that they do.

Difference between sleep and rest?

Sleep is a cyclically occurring state of decreased motor activity and perception. Body functions slow, and metabolism slows considerably to conserve energy for bodily restoration and healing. Rest is a condition in which the body is inactive or engaging in mild activity, after which the person feels refreshed. A person at rest is calm, at ease, relaxed, and free of stress and exertion

Parasomnia

The parasomnias include sleepwalking, sleeptalking, bruxism, night terrors, REM sleep behavior disorders, and nocturnal enuresis. Patterns of waking behavior that appear during sleep (e.g., sleepwalking).

Narcolepsy

is a chronic disorder caused by the brain's inability to regulate sleep-wake cycles normally. The distinction between being asleep and being awake is blurred. At various times, the person with narcolepsy experiences a sudden, uncontrollable urge to sleep lasting from seconds to minutes, even though the person sleeps well at night. The person cannot avoid the sleep episodes but awakens easily. Narcolepsy is controlled by central nervous system stimulants, such as methylphenidate (Ritalin), with little evidence of tolerance, dependence, or abuse.