Sleep UNIT

What would be the primary focus of interventions for a 6-year-old client who sleepwalks? 1)Maintain patient safety during episodes of somnambulism. 2)Administer and teach about medications to suppress stage III sleep. 3)Encourage the child to verbalize feelings regarding sleep pattern. 4)Provide a quiet environment for nighttime sleep.

1)Maintain patient safety during episodes of somnambulism.

Which is a pattern of waking behavior that appears during sleep? 1)Parasomnias 2)Dyssomnias 3)Insomnia 4)Hypersomnia

1)Parasomnias

A client appears sleepy immediately after dinner. What should the nurse do to enhance this client's sleep and rest? 1)Provide a sleep aid. 2)Turn on the television. 3)Encourage the client to walk in the hall. 4)Provide a cup of caffeinated coffee.

1)Provide a sleep aid.

Which factor has the greatest positive effect on sleep quality? 1)Sleeping hours in synchrony with circadian rhythm 2)Sleeping in a quiet environment 3)Spending additional time in stage NIII of the sleep cycle 4)Napping frequently during the day hours

1)Sleeping hours in synchrony with circadian rhythm

During which developmental stage does a person tend to need the most hours of sleep? 1)Toddler 2)Adolescence 3)Middle adulthood 4)Older adulthood

1)Toddler

Which factor is known to affect sleep? Select all that apply.. 1) Age 2) Environment 3) Lifestyle 4) State of health 5) Ethnicity

1,2,3,4

A middle-aged client is overwhelmed with work and says, "Sleep is optional." What should the nurse explain about the importance of sleep to this client's physical, mental, and spiritual health? Select all that apply. 1) Sleep impacts learning. 2) Sleep and illness are not related. 3) Sleep reduces stress and anxiety. 4) Sleep regulates energy metabolism. 5) Sleep affects almost every tissue in the body.

1,3,4,5

The nurse is caring for a group of patients who have sleeping disruptions. Match the condition to the intervention the nurse will use. a. Use continuous positive airway pressure. b. Offer a small meal several hours before bedtime. c. Administer antidepressants. d. Administer modafinil e. Do not startle. f. Administer benzodiazepine-like drug 1. Cataplexy 2. Narcolepsy 3. Insomnia 4. Hiatal hernia 5. Sleepwalking 6. Obstructive sleep apnea

1. ANS: C 2. ANS: D 3. ANS: F 4. ANS: B 5. ANS: E 6. ANS: A

A client seeks medical attention for a new onset of a sleep disturbance. For which health problem should the nurse assess this client? 1)Diabetes 2)Allergies 3)Heart disease 4)Urinary tract infection

2)Allergies

A patient has difficulty falling asleep despite being very tired. The patient has no physical problems, takes no medications, has quit smoking, eats healthy foods, exercises, and has no changes in sleep routine, stress level, or environment. To what should the nurse relate this patient's Disturbed Sleep Pattern? 1)Increased exercise 2)Nicotine withdrawal 3)Caffeine intake 4)Environmental changes

2)Nicotine withdrawal

What is the purpose 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 patterns of sleep during the night and naps during the day.

2)Note the trend in sleep-wakefulness patterns over a 2-week period.

REM Sleep

20%-25% of sleep time; also known as paradoxic sleep. Occurs every 90 minutes beginning after 1-2 hours of sleep

What is the impact of benzodiazepines and nonbenzodiazepines on sleep? 1)Benzodiazepines are eliminated from the body faster than are nonbenzodiazepines, so they do not provide a full night of sleep. 2)Nonbenzodiazepines cause daytime sleepiness, allowing people to rest throughout the day. 3)Benzodiazepines produce daytime sleepiness and alter the sleep cycle. 4)Nonbenzodiazepines remain in the body longer than do benzodiazepines.

3)Benzodiazepines produce daytime sleepiness and alter the sleep cycle.

A client becomes confused when aroused so the nurse can provide a treatment. Which stage of sleep was this client most likely experiencing? 1)NI 2)NII 3)NIII 4)REM

3)NIII

From what stage of sleep are people typically most difficult to arouse? 1)NREM, alpha waves 2)NREM, sleep spindles 3)NREM, delta waves 4)REM

3)NREM, delta waves

The nurse notes that a client has been prescribed a polysomnography. For which health problem should the nurse plan care for this client? 1)Diabetes 2)Restless legs syndrome 3)Obstructive sleep apnea (OSA) 4)Chronic obstructive pulmonary disease (COPD)

3)Obstructive sleep apnea (OSA)

Which is 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 do 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)Sleep is characterized by an altered level of consciousness.

The patient is diagnosed with obstructive sleep apnea. What should the nurse expect to assess in this patient? Select all that apply. 1) Bruxism 2) Enuresis 3) Daytime fatigue 4) Snoring 5) Drooling

3,4

Which is a major factor regulating sleep? 1)Electrical impulses transmitted to the cerebellum 2)Level of sympathetic nervous system stimulation 3)Amount of sleep to which a person has become accustomed 4)Amount of light received through the eyes

4)Amount of light received through the eyes

Which patient teaching would be most therapeutic for someone 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)Do not go to bed feeling upset about a conflict.

A patient asks for a carton of milk at bedtime. What action should the nurse take? 1)Withhold the milk because it disrupts REM and slow-wave sleep. 2)Withhold the milk because it interferes with sleep. 3)Withhold the milk because it is a stimulant and will interfere with sleep. 4)Provide the milk because it converts adenosine into serotonin to induce sleep

4)Provide the milk because it converts adenosine into serotonin to induce sleep

A 6-year-old client has a history of sleepwalking at home. Which would be the best nursing diagnosis for this client? 1)Sleep Deprivation related to sleepwalking 2)Fatigue related to sleepwalking 3)Disturbed Sleep Pattern related to dyssomnia 4)Risk for Injury related to sleepwalking

4)Risk for Injury related to sleepwalking

What would be an expected outcome for a client with Disturbed Sleep Pattern? 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 sleeping better and feeling less fatigued.

4)Verbalize sleeping better and feeling less fatigued.

NREM Sleep

75%-80% of sleep time; three stages evaluated by EEG: Stage I, Stage II, Stage III

he nurse is caring for a patient who has not been able to sleep well while in the hospital, leading to a disrupted sleep-wake cycle. Which assessment findings will the nurse monitor for in this patient? (Select all that apply.) a. Changes in physiological function such as temperature b. Decreased appetite and weight loss c. Anxiety, irritability, and restlessness d. Shortness of breath and chest pain e. Nausea, vomiting, and diarrhea f. Impaired judgment

A, B, C, F

Secondary Sleep Disorders

Alterations in the quality and/or quantity of sleep caused by primary disease; i.e. depression, pain, sleep apnea syndromes, alterations in thyroid hormone secretion

The nurse is completing an assessment on an older patient who is having difficulty falling asleep. Which factor has the potential to contribute to this difficulty? a. Depression b. Smoking c. Alcohol d. Fatigue

ANS: A Older adults and other individuals who experience depressive mood problems experience delays in falling asleep, earlier appearance of REM sleep, frequent awakening, increased total bed time, feelings of sleeping poorly, and early awakening. Smoking (nicotine) decreases the total sleep time and REM and causes awakening or difficulty staying asleep. Alcohol speeds the onset of sleep. A person who is moderately fatigued usually achieves restful sleep

The nurse knows an appropriate goal for the nursing diagnosis Sleep deprivation is: a. the patient will remain asleep for 6 to 7 hours consistently for 1 week. b. the patient will fall asleep within 15 minutes of going to bed. c. the patient will report an ability to concentrate on tasks. d. the patient will repeat medication instructions on discharge.

ANS: A The patient remaining asleep for 6 to 7 hours consistently for 1 week is an appropriate goal for Sleep deprivation. The patient falling asleep within 15 minutes of going to bed is a goal for Insomnia. The patient reporting an ability to concentrate on tasks is a goal for Anxiety. The patient repeating medication instructions on discharge is an appropriate goal for Disturbed thought processes.

The patient and the nurse discuss the need for sleep. After the discussion, the patient is able to state factors that hinder sleep. Which statements indicate that the patient has a good understanding of sleep? (Select all that apply.) a. Drinking coffee at 7 PM could interrupt my sleep. b. Worry about work can disrupt my sleep. c. Exercising 2 hours before bedtime can decrease relaxation. d. Changing the time of day that I eat dinner can disrupt sleep. e. Taking an antacid can decrease sleep. f. Staying up late for a party can interrupt sleep patterns.

ANS: A, B ,D, F Caffeine, alcohol, and nicotine consumed late in the evening produce insomnia. Worry over personal problems or situations frequently disrupts sleep. Alterations in routines, including changing mealtimes and staying up late at night for social activities, can disrupt sleep. Exercising 2 hours before bedtime actually increases a sense of fatigue and promotes relaxation. Taking an antacid does not decrease sleep

The nurse is caring for a patient who has not been able to sleep well while in the hospital. The nurse recognizes that lack of sleep can manifest in which of the following signs and symptoms? (Select all that apply.) a. Changes in physiological function such as temperature b. Decreased appetite and weight loss c. Anxiety, irritability, and restlessness d. Impaired judgment e. Nausea, vomiting, and diarrhea f. Shortness of breath and chest pain

ANS: A, B, C, D The biological rhythm of sleep frequently becomes synchronized with other body functions. Changes in body temperature correlate with sleep pattern. When the sleep-wake cycle becomes disrupted, changes in physiological function such as temperature can occur. Patients can experience decreased appetite, loss of weight, anxiety, restlessness, irritability, and impaired judgment. Gastrointestinal and respiratory/cardiovascular symptoms such as shortness of breath and chest pain are not symptoms of a disrupted sleep cycle

The nurse knows that during rapid eye movement (REM) sleep, the following occur: (Select all that apply.) a. Memories are stored b. Increase in cerebral blood flow c. Slow rhythmic scanning eye movements d. release of acetylcholine e. Repair of brain cells

ANS: A, B, D Rapid eye movement (REM) sleep occurs during deep sleep and is manifested by quick scanning movements of the eyes that are associated with dreaming. REM sleep is associated with memory storage, learning, increased cerebral blood flow, and acetylcholine release. Repair of brain cells occurs during non-REM sleep.

The nurse is caring for a patient in the intensive care unit who is having trouble sleeping. The nurse explains the purpose of sleep and its benefits. Which information will the nurse include in the teaching session? (Select all that apply.) a. NREM sleep contributes to body tissue restoration. b. During NREM sleep, biological functions increase. c. Restful sleep preserves cardiac function. d. Sleep contributes to cognitive restoration. e. REM sleep decreases cortical activity.

ANS: A, C, D Sleep contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration. It allows the body to rest and conserve energy. This benefits the cardiac system by allowing the heart to beat fewer times each minute. During stage 3, the body releases growth hormone for renewal and repair of specialized cells such as the brain. During NREM sleep, biological functions slow. REM sleep is necessary for brain tissue restoration and cognitive restoration and is associated with a change in cerebral blood flow and increased cortical activity

The nurse is caring for a patient in the intensive care unit who is having trouble sleeping. The nurse explains the purpose of sleep and its benefits. What points should the nurse include in her teaching? (Select all that apply.) a. NREM sleep contributes to body tissue restoration. b. During NREM sleep, biological functions increase. c. Restful sleep preserves cardiac function. d. Sleep contributes to cognitive restoration. e. REM sleep decreases cortical activity. f. REM sleep assists with memory storage and learning.

ANS: A, C, D, E Sleep contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration. It allows the body to rest and conserve energy. This is beneficial for the cardiac system by allowing the heart to beat fewer times each minute. During stage 4, the body releases growth hormone for renewal and repair of specialized cells such as the brain. REM sleep is necessary for brain tissue restoration and cognitive restoration and is associated with a change in cerebral blood flow and increased cortical activity. Sleep assists with memory storage and learning.

The nurse is having a conversation with an adolescent regarding the need for sleep. The adolescent states that it is common to stay up with friends several nights a week. Which nursing action should the nurse take? a. Discuss with the adolescent's parent staying up with friends and the need for sleep. b. Discuss with the adolescent sleep needs and the effects of excessive daytime sleepiness. c. This is a normal occurrence for adolescents and action is not required. d. Explore the reason for staying up late with friends several nights a week.

ANS: B On average, a teenager needs about 9-10 hours of sleep per night. Many activities at school, social activities, and jobs can reduce the number of sleep hours, resulting in excessive daytime sleepiness. This can lead to decreased performance at school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol. Discussion regarding adolescent sleep needs should first occur with the adolescent. Although it may be common for this adolescent to want to visit with friends and experience activities that go late into the night, these activities can and do impact the hours of sleep and the physical needs of the adolescent, no matter the reason for the late nights, and they do need to be addressed

A parent is the primary caregiver for a child with multiple disabilities requiring constant care. The parent reports sleeping in 45 minute blocks during the night, having trouble concentrating, and being increasingly irritable. The nurse recognizes that this parent is consistently missing what stage of sleep? a. Nonrapid eye movement (NREM) stage 2 b. Rapid eye movement (REM) stage c. Sleep latency stage d. Sleep arousal stage

ANS: B The rapid eye movement stage of sleep is needed to complete the restorative function of sleep and is needed to prevent cognitive effects of sleep deprivation. Nonrapid eye movement stages begin the sleep cycles, and reset with stage one if sleep is interrupted. Sleep latency occurs prior to sleep occurring, and sleep arousal is prior to awakening; neither is a specific stage of sleep.

The nurse is caring for an adolescent who is complaining of difficulty falling asleep. Which intervention would be most appropriate? a. Adjust the temperature in the patient's room to 21 C (70 F). b. Ensure that the night light in the patient's room is working. c. Encourage the discontinuation of soda and chocolate nightly snack. d. Close the door to decrease noise from unit activities.

ANS: C Cola and chocolate contain caffeine, which interferes with the ability to fall asleep. Personal preference influences the temperature of the room, as well as the lighting of the room. Noise can be a factor in the unit and can awaken the patient, but caffeine can make it difficult to fall asleep

MSC: Physiological Integrity: Basic Care and Comfort 12. The nurse is caring for an adolescent who is complaining of difficulty falling asleep. Which intervention would be most appropriate? a. Adjust the temperature in the patient's room to 21 C (70 F). b. Ensure that the night light in the patient's room is working. c. Encourage the discontinuation of soda and chocolate nightly snack. d. Close the door to decrease noise from unit activities.

ANS: C Cola and chocolate contain caffeine, which interferes with the ability to fall asleep. Personal preference influences the temperature of the room, as well as the lighting of the room. Noise can be a factor in the unit and can awaken the patient, but caffeine can make it difficult to fall asleep.

Which of the following would be most important for the nurse to monitor in a patient who has obstructive sleep apnea? a. Gastrointestinal function b. Circulatory status c. Respiratory status d. Neurological function

ANS: C In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing airflow and stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status take priority

The nurse assigns a nursing diagnosis of ineffective breathing pattern. Which of the following sleep conditions would support this diagnosis? a. Insomnia b. Narcolepsy c. Obstructive sleep apnea d. Sleep deprivation

ANS: C Obstructive sleep apnea (OSA) occurs when the muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing airflow or stopping it for as long as 30 seconds. The person still attempts to breathe because chest and abdominal movements continue, resulting in snoring or snorting sounds. With narcolepsy, the person feels an overwhelming wave of sleepiness and falls asleep. Insomnia is characterized by chronic difficulty falling asleep. Sleep deprivation is a condition caused by dyssomnia. OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe

The nurse is caring for a patient in the sleep lab. The nurse recognizes that the patient is in stage 3 NREM from which of the following assessments? a. The patient awakens easily. b. Body functions slow. c. The patient is difficult to awaken. d. Eyes rapidly move.

ANS: C Stage 3 NREM is the deepest stage of sleep. The patient is difficult to arouse, vital signs are significantly lower, and this stage lasts about 15 to 30 minutes. Sleep walking and enuresis sometimes occur. Lighter sleep is seen in stages 1 and 2, where the patient awakens easily. In stage 2, body functions slow and REM sleep is characterized by rapid eye movement

A community health nurse is providing an educational session at the senior center on how to promote sleep. Which practices should the nurse recommend? (Select all that apply.) a. Take a nap in the afternoon. b. Sleep where you sleep best. c. Use sedatives as a last resort. d. Watch television right before sleep. e. Decrease fluids 2 to 4 hours before sleep. f. Get up if unable to fall asleep in 15 to 30 minutes.

B, C, E, F

The patient presents to the clinic with reports of irritability, being sleepy during the day, not being able to fall asleep, and being tired. Select the most appropriate nursing diagnosis. a. Anxiety b. Fatigue c. Sleep deprivation d. Insomnia

ANS: D Insomnia is experienced when the patient has difficulty falling asleep, frequent awakenings from sleep, and/or short sleep or nonrestorative sleep. It is the most common sleep-related complaint and includes symptoms such as irritability, excessive daytime sleepiness, not being able to fall asleep, and fatigue. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fatigue is an overwhelming sustained sense of exhaustion with decreased capacity for physical and mental work at a usual level. Sleep deprivation is a condition caused by dyssomnia and includes symptoms caused by illness, emotional distress, or medications.

The nurse is preparing an older patient's evening medications. Which of the following does the nurse recognize as relatively safe for difficulty sleeping? a. Benadryl (diphenhydramine) b. Melatonin c. Valerian d. Lorazepam

ANS: D One group of medications that are relatively safe are the benzodiazepines such as lorazepam. These medications cause relaxation and antianxiety and hypnotic effects. Caution older adults about using over-the-counter antihistamines because their long duration of action can cause confusion, constipation, and urinary retention. Use of nonprescription sleeping aids is not advisable. Patients need to learn the risks associated with these drugs and should be aware that the U.S. Food and Drug Administration does not regulate herbal products

The nurse knows an appropriate goal for the nursing diagnosis Disturbed sleep pattern during hospitalization is: a. the patient will fall asleep within 15 minutes of going to bed. b. the patient will report an ability to concentrate on tasks. c. the patient will repeat medication instructions on discharge. d. the patient will be able to sleep for at least 2 hours at a time.

ANS: D The patient being able to sleep for at least 2 hours at a time is an appropriate goal for Disturbed sleep pattern during hospitalization. The patient falling asleep within 15 minutes of going to bed is a goal for Insomnia. The patient reporting an ability to concentrate on tasks is a goal for Anxiety. The patient repeating medication instructions on discharge is an appropriate goal for Disturbed thought processes.

The patient shares with the nurse the vivid, full color dreams experienced by the patient last night. These data would indicate that the patient has reached what stage of sleep? a. Stage 1 NREM b. Stage 2 NREM c. Stage 3 NREM d. REM

ANS: D Vivid, full color dreaming occurs during REM sleep. This stage usually begins about 90 minutes after sleep has begun. The eyes move rapidly, and heart rate, respiratory rate, and blood pressure fluctuate; loss of skeletal muscle tone occurs. The patient has an increase in gastric secretions and is difficult to arouse.

Sleep

Active, multiphase process. Two phases: Rapid eye movement sleep (REM) and Non-REM (NREM) sleep

Question:A nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? Select all that apply. a. A patient who has uncontrolled hypothyroidism b. A patient with coronary artery disease c. A patient who has gastroesophageal reflux (GERD) d. A patient who is HIV positive e. A patient who is taking corticosteroids for arthritis f. A patient with a urinary tract infection

Answer: a, b, c. A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and III. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has gastroesophageal reflux (GERD) may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.

A nurse formulates the following diagnosis for an elderly patient who is having trouble getting to sleep at night: Disturbed Sleep Pattern: Initiation of Sleep. Which of the following nursing interventions would the nurse perform related to this diagnosis? Select all that apply. a. Arrange for assessment for depression and treatment. b. Discourage napping during the day. c. Decrease fluids during the evening. d. Administer diuretics in the morning. e. Encourage patient to engage in some type of physical activity. f. Assess medication for side effects of sleep pattern disturbances.

Answer: a, b, e, f. For patients who are having trouble initiating sleep, the nurse should arrange for assessment for depression and treatment, discourage napping, promote activity, and assess medications for sleep disturbance side effects. Limiting fluids and administering diuretics in the morning are appropriate interventions for Disturbed Sleep Pattern: Maintaining Sleep.

To promote sleep in a patient, a nurse suggests what intervention? a. Follow the usual bedtime routine if possible. b. Drink two or three glasses of water at bedtime. c. Have a large snack at bedtime. d. Take a sedative-hypnotic every night at bedtime.

Answer: a. Keeping the same bedtime schedule helps promote sleep. Drinking two or three glasses of water at bedtime will probably cause the patient to awaken during the night to void. A large snack may be uncomfortable right before bedtime; instead, a small protein and carbohydrate snack is recommended. Taking a sedative-hypnotic every night disturbs REM and NREM sleep, and sedatives also lose their effectiveness quickly.

A nurse is performing a sleep assessment on a patient being treated for a sleep disorder. During the assessment, the patient falls asleep in the middle of a conversation. The nurse would suspect which disorder? a. REM behavior disorder b. Narcolepsy c. Enuresis d. Sleep apnea

Answer: b. Narcolepsy is an uncontrollable desire to sleep; the person may fall asleep in the middle of a conversation. REM Behavior Disorder (RBD) is characterized by "acting out" dreams while asleep. Enuresis is urinating during sleep or bedwetting. Sleep apnea is a condition in which breathing ceases for a period of time between snoring.

A nurse is discussing with an older female patient the factors that affect sleep. What fact does the nurse teach her? a. Drinking a cup of regular tea at night induces sleep. b. Using alcohol moderately promotes a deep sleep. c. Aging decreases the amount of REM sleep a person experiences. d. Exercising decreases REM and NREM sleep.

Answer: c. The nurse would teach the patient that the amount of REM sleep decreases with age. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity increases both REM and NREM sleep.

A nurse caring for patients in a long-term care facility is implementing interventions to help promote sleep in elderly patients. Which action is recommended for these patients? a. Increase physical activities during the day. b. Encourage short periods of napping during the day. c. Increase fluids during the evening. d. Dispense diuretics during the afternoon hours.

Answer:a. In order to promote sleep in the elderly patient, the nurse should encourage daily physical activity such as walking or water aerobics, discourage napping during the day, decrease fluids at night, and dispense diuretics in the morning or early evening.

A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep? Select all that apply. a. A patient who is taking iron supplements for anemia b. A patient with Parkinson disease who is taking dopamine c. An elderly patient taking diuretics for congestive heart failure d. A patient who is taking antibiotics for an ear infection e. A patient who is prescribed antidepressants f. A patient who is taking low-dose aspirin prophylactically

Answer:b, c, e. Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems.

A nurse is caring for a patient who states he has had trouble sleeping ever since his job at a factory changed from the day shift to the night shift. Which diagnosis would be most appropriate for this patient? a. Ineffective Coping: Multiple Stressors of New Job b. Sleep Deprivation: Difficulty Falling Asleep c. Disturbed Sleep Pattern: Altered Sleep-Wake Pattern d. Risk for Injury: Activity Intolerance/Sleep Deprivation

Answer:c. When assessment data point to a sleep problem that is amenable to nursing therapy, it receives the label Disturbed Sleep Pattern if the problem is time limited (such as changing shifts) or Sleep Deprivation if the problem is prolonged. The labels Ineffective Coping and Risk for Injury have not yet been determined.

Question:A nurse working the night shift in a pediatric unit observes a 10-year-old male patient walking the hallway in a sleep state. The child is unaware of his environment and doesn't recall the incident in the morning. Which sleep disorder would the nurse expect?a. Bruxism b. Cataplexy c. Restless leg syndrome d. Somnambulism

Answer:d. Somnambulism (sleepwalking) may range from sitting up in bed to walking around the room or the house to walking outside the house. The sleepwalker is unaware of the environment. Bruxism is grinding of one's teeth and frequently is an indicator of stress. Cataplexy is a sudden loss of motor tone that may cause the person to fall asleep; it is usually experienced during a period of strong emotion. People with restless leg syndrome (RLS) cannot lie still and report unpleasant creeping, crawling, or tingling sensations in the legs.

The nurse is completing a sleep assessment for a newly admitted patient. Which data reported by the patient would cause the nurse to suspect obstructive sleep apnea? (Select all that apply.) a. Morning headaches b. Sudden weight loss c. Loud snoring during sleep d. Daytime sleepiness e. Deep sleep during the night f. Increased blood pressure problems

Answers: a, c, d, f Signs of obstructive sleep apnea include headaches from hypoxemia on first awakening, loud snoring related to airway collapse, daytime sleepiness from nonrestorative sleep at night, and increased hypertension. Sudden weight loss is not associated with obstructive sleep apnea, although it can be related to other medical disorders such as cancer. Deep sleep is not obtained with obstructive sleep apnea, because the affected person experiences many awakenings during the night.

An elderly, tense patient is having trouble relaxing enough to sleep. Which measures should be implemented by the nurse to help promote sleep? (Select all that apply.) a. Give the patient a back rub. b. Take the patient for a brisk walk right before bedtime. c. Provide a warm, quiet environment. d. Encourage the patient to eat a large meal in the evening. e. Give the patient a diet cola. f. Play soft music during the 30 minutes before bedtime.

Answers: a, c, f Giving a back rub, providing a warm and quiet environment, and playing soft music enhance relaxation, which will lead to easier transition into sleep. Brisk exercise, caffeine drinks, and large meals all are contraindicated in the evening because they induce changes that will interfere with sleep.

A patient reports that the prescribed sleeping medication is no longer effective. What information would be appropriate for the nurse to recommend to the patient? (Select all that apply.) a. Take the medication with an alcoholic drink. b. Use relaxation techniques before sleep. c. Do not study in the bedroom before bedtime. d. Adjust sleep temperature for comfort. e. Sleep in a different room of the home.

Answers: b, c, d Tolerance frequently develops to sleeping medications, especially with long-term use, and additional sleep hygiene practices such as mindful relaxation, only sleeping in the bedroom, and creating a comfortable environment can be effective adjunctive measures. Alcohol plus a sleeping medication is a dangerous combination. Sleeping in an alternate room removes the patient from the familiar setting and is more likely to disrupt sleep.

Dyssomnias Sleep Disorders

Insomnia Obstructive Sleep Apnea Primary and Secondary Hypersomnia Disorders of sleep-wake cycle

Children and Sleep

Newborns sleep 12-18 hours per day. 50% of that time is spent in REM 50% NREM and infants immediately enter REM upon falling asleep; lots of time spend in light sleep, irregular sleep sleep pattern

Potential Causes for Sleep Changes in the Elderly

Physical ailments Lack of daily routine Circadian rhythm changes Medications

Parasomnias Sleep Disorders

Somnambulism (Sleep walking) Night terrors Restless legs syndrome Eating Violent Behaviors

Elderly and Sleep

Total sleep time is decreased; older adults take longer to fall asleep, and awaken more frequently during the night. Amount of time in Stage III decreases. might have problem with nocturnal voiding

The nurse is completing an assessment on an older-adult patient who is having difficulty falling asleep. Which condition will the nurse further assess for in this patient?a. Depression b. Mild fatigue c. Hypertension d. Hypothyroidism

a. Depression

Which nursing observation of the patient in intensive care indicates the patient is sleeping comfortably during NREM sleep? a. Eyes closed, lying quietly, respirations 12, heart rate 60 b. Eyes closed, tossing in bed, respirations 18, heart rate 80 c. Eyes closed, mumbling to self, respirations 16, heart rate 68 d. Eyes closed, lying supine in bed, respirations 22, heart rate 66

a. Eyes closed, lying quietly, respirations 12, heart rate 60

A nurse observes some involuntary muscle jerking in a sleeping patient. The nurse determines that the patient is most likely in which stage of sleep? a. Stage I NREM sleep b. Stage II NREM sleep c. Stage III NREM sleep d. REM sleep

a. Involuntary muscle jerking occurs in stage I NREM sleep. In the other stages, the muscles proceed from a relaxed state to large muscle immobility.

The nurse is caring for a patient on the medical-surgical unit who is experiencing an exacerbation of asthma. Which intervention will be most appropriate to help this patient sleep? a. Place bed in semi-Fowler's position. b. Offer iron-rich foods for meals. c. Provide a snack before bedtime. d. Encourage the patient to read.

a. Place bed in semi-Fowler's position.

The nurse is preparing an older-adult patient's evening medications. Which treatment will the nurse recognize as relatively safe for difficulty sleeping in older adults? a. Ramelteon (Rozerem) b. Benzodiazepine c. Antihistamine d. Kava

a. Ramelteon (Rozerem)

The nurse is evaluating outcomes for the patient with insomnia. Which key principle will the nurse consider during this process? a. The patient is the best evaluator of sleep. b. The nurse is the best evaluator of sleep. c. Effective interventions are the best evaluators of sleep. d. Observations of the patient are the best evaluators of sleep.

a. The patient is the best evaluator of sleep.

The nurse is completing a sleep assessment on a patient. Which tool will the nurse use to complete the assessment? a. Visual analog scale b. Cataplexy scale c. Polysomnogram d. RAS scale

a. Visual analog scale

The student nurse learns that during non-rapid eye movement (NREM) sleep, which activities occur? (Select all that apply.) a.Brain waves slow b.Slow rhythmic scanning eye movements c.Dreaming d.Drop in blood pressure e.Conservation of energy

a.Brain waves slow d.Drop in blood pressure e.Conservation of energy Rationale: During non-rapid eye movement (NREM) sleep, in which REM does not occur, physiological activity is reduced, brain waves, breathing and heart rate slow, and blood pressure drops. Slow scanning eye movements do not occur in either REM or NREM. Dreaming occurs in REM.

he nurse conducting a sleep workshop in the community would identify which patients to be at risk for obstructive sleep apnea (OSA)? (Select all that apply.) a.Deviated septum b.Recessed chin c.Alcohol use d.Large neck e.Recent tonsillectomy

a.Deviated septum b.Recessed chin c.Alcohol use d.Large neck Rationale:Risk factors for OSA include obesity, large neck circumference, smoking, alcohol use, and a family history of OSA. Structural abnormalities such as a recessed chin, abnormal upper-airway structures, deviated septum, nasal polyps, or enlarged tonsils can predispose a person to OSA.

The nurse recognizes which sleeping conditions are identified as dyssomnias? (Select all that apply.) a.Difficultly getting to sleep b.Nocturnal enuresis c.Inability staying asleep d.Being excessively sleepy e.Falling asleep during the day f. stages of sleep

a.Difficultly getting to sleep c.Inability staying asleep d.Being excessively sleepy e.Falling asleep during the day Rationale: Dyssomnias are disorders associated with getting to sleep, staying asleep, or being excessively sleepy. Changes in the amount or timing of sleep result in daytime sleepiness, poor concentration, and a feeling of not being rested. The stages of sleep are REM and NREM. Nocturnal enuresis is a parasomnia.

The nurse will include which interventions to help improve sleep quality during hospitalization on all patients' care plans? (Select all that apply.) a.Maintaining sleep routines b.Minimizing disruptions c.Providing light snacks d.Using sleep medications e.Using relaxation measures

a.Maintaining sleep routines b.Minimizing disruptions c.Providing light snacks e.Using relaxation measures Rationale: Medications would be used carefully and do not always improve sleep. Addressing the sleep environment, maintaining sleep routines, providing light snacks if allowed, and instituting relaxation measures will all improve sleep.

The nurse knows that during rapid eye movement (REM) sleep, which activities occur? (Select all that apply.) a.Memories are stored b.Increase in cerebral blood flow c.Slow rhythmic scanning eye movements d.Release of epinephrinee.Repair of brain cells

a.Memories are storedb.Increase in cerebral blood flowd.Release of epinephrine Rationale:Rapid eye movement (REM) sleep occurs during deep sleep and is manifested by quick scanning movements of the eyes that are associated with dreaming. REM sleep is associated with memory storage, learning, increased cerebral blood flow, and epinephrine release. Repair of brain cells occurs during non-REM sleep.

The nurse teaches the patient what information about polysomnograpy? a.This is the recording of brain waves and other variables. b.This is the relay of motor impulse to the hypothalamus. c.This is the patterns of biological functioning. d.This is the recording of seizure activity in the brain.

a.This is the recording of brain waves and other variables. Rationale:Polysomnography is the recording of brain waves and other physiologic variables, such as muscle activity and eye movements, during sleep. The reticular activating system (RAS) receives sensory impulses from the spinal cord and relays motor impulses to the thalamus. The circadian rhythms influence patterns of biological and behavioral functions. An electroencephalogram is used to record seizure activity in the brain.

The nurse is admitting a patient to the general medical-surgical unit. What should the nurse assess as part of a routine sleep assessment? (Select all that apply.) a.Usual sleeping and waking times b.Bedtime routines c.Sleeping environment preferences d.Medications used for sleep e.Any current life events

a.Usual sleeping and waking times b.Bedtime routines c.Sleeping environment preferences d.Medications used for sleep e.Any current life events Rationale: A sleep assessment should be completed when a patient is admitted to a health facility. The nurse assesses the patient's usual sleeping and waking times, medications, illnesses, bedtime routines, and sleeping environment preferences and incorporates the information into the plan of care when possible. The nurse should also assess current life events and emotional status.

The nurse is beginning a sleep assessment on a patient. Which question will be mostappropriate for the nurse to ask initially? a. "What is going on?" b. "How are you sleeping?" c. "Are you taking any medications?" d. "What did you have for dinner last night?"

b. "How are you sleeping?"

A patient has sleep deprivation. Which statement by the patient will indicate to the nurse that outcomes are being met? a. "I wake up only once a night to go to the bathroom." b. "I feel rested when I wake up in the morning." c. "I go to sleep within 30 minutes of lying down." d. "I only take a 20-minute nap during the day."

b. "I feel rested when I wake up in the morning."

n elderly patient complains of difficulty sleeping after the death of his spouse of 56 years. What would be an appropriate nursing assessment for this patient? a. Assess the patient for possible use of sedatives. b. Obtain a health history regarding sleep hygiene. c. Assess the patient's weight over the past year. d. Request a sleep study to rule out sleep apnea.

b. Obtain a health history regarding sleep hygiene

The nurse is educating a patient about taking measures to help avoid disruption to the circadian rhythm. Which statement by the patient indicates a need for further education? a."I know the circadian rhythm influences biological functions." b."I know the circadian rhythm exists only in humans." c."I know the sleep-wake circadian rhythm is impacted by the light-dark cycle." d."The most familiar circadian rhythm is the day-night 24-hour cycle."

b."I know the circadian rhythm exists only in humans." Rationale: Biological rhythms exist in plants, animals, and humans. In humans, these biorhythms, along with internal and external factors, affect sleep. The most familiar rhythm is the day-night, 24-hour circadian rhythm cycle. Circadian rhythms influence patterns of biological and behavioral functions. Some creatures are diurnal, or primarily active during the day, whereas others are nocturnal, with most of their activity during the night.

The nurse recognizes what function of the reticular activating system (RAS)? a.Records brain waves and other variables. b.Relays motor impulse to the hypothalamus. c.Influences patterns of biological functioning. d.Is affected by the light-dark cycle.

b.Relays motor impulse to the hypothalamus. ***NOT SURE IF THIS IS CORRECT I COULDNT FIND IT IN NOTES**** Rationale:The RAS receives sensory impulses from the spinal cord and relays motor impulses to the thalamus and all parts of the cerebral cortex. Polysomnography is the recording of brain waves and other physiologic variables, such as muscle activity and eye movements, during sleep. The circadian rhythms influence patterns of biological and behavioral functions, and the sleep-wake circadian rhythm is affected by the light-dark cycle.

The nurse is providing community education on sudden infant death syndrome (SIDS). What information does the nurse include? (Select all that apply.) a.SIDS is the second most common cause of death among infants (1 to 12 months). b.The etiology remains largely unknown. c.The most modifiable risk factor is sleeping supine. d.Risk factors include being exposed to cigarette smoke. e.It is defined as sudden unexpected death.

b.The etiology remains largely unknown. d.Risk factors include being exposed to cigarette smoke. e.It is defined as sudden unexpected death. Rationale: SIDS is the leading cause of death among infants 1 to 12 months of age. The etiology remains largely unknown. The most important modifiable SIDS risk factor appears to be prone sleeping. Risk factors include the infant's being exposed to cigarette smoke. Sudden infant death syndrome (SIDS) is defined as the sudden unexpected death of an infant younger than 1 year of age that remains unexplained after a thorough postmortem investigation.

A nurse observes a slight increase in a patient's vital signs while he is sleeping during the night. According to the patient's stage of sleep, the nurse expects what conditions to be true? Select all that apply. a. He is aware of his surroundings at this point. b. He is in delta sleep at this time. c. It would be most difficult to awaken him at this time. d. This is most likely an NREM stage. e. This stage constitutes around 20% to 25% of total sleep. f. The muscles are relaxed in this stage.

c, e. This scenario describes REM sleep. During REM sleep, it is difficult to arouse a person, and the vital signs increase. REM sleep constitutes about 20% to 25% of sleep. In stage I NREM sleep, the person is somewhat aware of surroundings. Delta sleep is NREM stages III. In stage III NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.

The nurse identifies which sequence to be the usual progression of sleep? a.NREM 1-3 then REM, then back through NREM 1 and 2 b.REM then NREM 1-4, then back through NREM 2 and 3 c.NREM 1-3 then back through NREM 3 and 2 then REM d.REM then NREM 1-4 then back through NREM 3

c. NREM 1-3 then back through NREM 3 and 2 then REM Rationale:The usual sleep sequence for a person is a fairly rapid progression through NREM 1 through 3, back through NREM 3 and 2, and then into REM sleep. There is no NREM stage 4

An older-adult patient is visiting the clinic after a fall during the night. The nurse obtains information on what medications the patient takes. Which medication most likely contributed to the patient's fall? a. Melatonin b. L-tryptophan c. Benzodiazepine d. Iron supplement

c. Benzodiazepine

The nurse is caring for a patient who is having trouble sleeping. Which action will the nurse take? a. Suggest snug-fitting nightwear. b. Provide a favorite beverage. c. Encourage deep breathing. d. Walk with the patient.

c. Encourage deep breathing.

The patient presents to the clinic with reports of irritability, being sleepy during the day, chronically not being able to fall asleep, and being tired. Which nursing diagnosis will the nurse document in the plan of care? a. Anxiety b. Fatigue c. Insomnia d. Sleep deprivation

c. Insomnia

A patient has obstructive sleep apnea. Which assessment is the priority? a. Gastrointestinal function b. Neurological function c. Respiratory status d. Circulatory status

c. Respiratory status

The nurse is caring for a patient in the sleep lab. Which assessment finding indicates to the nurse that the patient is in stage 4 NREM? a. The patient awakens easily. b. The patient's eyes rapidly move. c. The patient is difficult to awaken. d. The patient's vital signs are elevated.

c. The patient is difficult to awaken.

When the nurse is explaining cataplexy to the patient, which description should be included? a.It is an uncontrolled desire to sleep. b.It is falling asleep for several minutes. c.It is loss of voluntary muscle tone. d.It is a sleep cycle that begins with NREM.

c.It is loss of voluntary muscle tone. Rationale:Cataplexy is characterized by the sudden loss of voluntary muscle tone; vivid hallucinations during sleep onset or on awakening; and brief episodes of total paralysis at the beginning or end of sleep. An uncontrolled desire to sleep and falling asleep for several minutes define narcolepsy. Narcolepsy begins with REM sleep.

The nurse recognizes which changes in sleep patterns occur in the older adult? (Select all that apply.) a.Sleep increases to approximately 8 to 10 hours a night. b.REM sleep is shorter. c.Stage 3 NREM is decreased. d.The use of medication may interfere with sleep. e.Older adults awaken more at night.

c.Stage 3 NREM is decreased. d.The use of medication may interfere with sleep. e.Older adults awaken more at night. Rationale: Older adults sleep approximately 7 to 8 hours a night. The first REM stage is longer. There is no stage 4 REM. Deeper stages of sleep are shortened, resulting in less restorative sleep. A decline in health or the use of medications may interfere with sleep. Older adults awaken more at night and take longer to go back to sleep.

A nurse working the night shift at a hospital observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply. a. REM sleep constitutes much of the sleep cycle of a preschool child. b. By the age of 8 years, most children no longer take naps c. Sleep needs usually decrease when physical growth peaks. d. Many adolescents do not get enough sleep. e. Total sleep decreases in adults with a decrease in stage IV sleep. f. Sleep is less sound in older adults and stage IV sleep may be absent.

d, e, f. Many adolescents do not get enough sleep due to the stresses of school, activities, and part-time employment causing restless sleep. Total sleep time decreases during adult years, with a decrease in stage IV sleep. Sleep is less sound in older adults, and stage IV sleep is absent or considerably decreased. REM sleep constitutes much of the sleep cycle of a young infant, and by the age of 5 years, most children no longer nap. Sleep needs usually increase when physical growth peaks.

A nurse is teaching the staff about the sleep cycle. Which sequence will the nurse include in the teaching session?a. NREM Stage 1, 2, 3, REM b. NREM Stage 1, 2,, 3, 2, 1, REM c. NREM Stage 1, 2, 3, REM, 3, 2 REM d. NREM Stage 1, 2, 3, 2, REM

d. NREM Stage 1, 2, 3, 2, REM

The nurse adds a nursing diagnosis of ineffective breathing pattern to a patient's care plan. Which sleep condition caused the nurse to assign this nursing diagnosis? a. Insomnia b. Narcolepsy c. Sleep deprivation d. Obstructive sleep apnea

d. Obstructive sleep apnea

The nurse is providing discharge instructions to the parents of a toddler about sleeping habits. Which statement indicates further education is needed? a."Sleep needs may change during growth spurts." b."Children sleep 12 hours a day." c."Toddlers will often resist going to bed." d."The bedtime routine can vary."

d."The bedtime routine can vary. "Rationale:The regular bedtime routine should be consistently followed. Children need 11 to 14 hours of sleep a day, and toddlers and preschoolers may exhibit resistance to going to bed. Sleep needs fluctuate with growth spurts.

The nurse identifies what physiological response occurs with the onset of darkness and in preparation for sleep? a.Cortisol levels peak b.Cortisol levels increase c.Core body temperature increases d.Melatonin levels increase

d.Melatonin levels increase Rationale: Melatonin levels increase and core temperature and cortisol levels decrease with the onset of darkness. Cortisol levels peak at 6 a.m.