Varcarolis Chapter 19: Sleep-Wake Disorders

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

"Do you usually feel rested and alert when you get up?" The most accurate way to determine an individual's sleep requirements is to ask if the person feels fully awake and functions effectively on the sleep he or she is getting. REF: 368-369

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

"Have you ever fallen asleep while driving?" Clients with sleep paralysis can often also exhibit symptoms of narcolepsy such as extreme sleepiness resulting in falling asleep at inappropriate times.REF: Page 368-369

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

"How much sleep do you usually get each night?" Short sleep duration has been associated with obesity, cardiovascular disease, hypertension, and diabetes.REF: Page 365

Which statement by Kyla, a patient you are educating in the sleep disorders clinic, indicates that she needs further teaching? "I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can." "Getting less than 6 hours of sleep at night may increase my risk for medical problems." "Getting enough sleep will increase my productivity at work." "Since I have to drive for my job, getting enough sleep will help me avoid accidents."

"I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can." Sleeping more than 8 hours per night is associated with up to a twofold increased risk of obesity, diabetes, hypertension, incident cardiovascular disease, stroke, depression, and substance abuse. The other options are all true.Cognitive Level: Analyze (Analysis)Nursing Process: ImplementationNCLEX: Physiological IntegrityText page: 365

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

"I've actually missed work because I'm too tired to go."

Kyla asks you to explain what basal sleep requirement is. Your best response is: "The basal temperature of your body needed to induce the best sleep." "The sleep time by your body needed to repair cellular damage." "The amount of sleep needed to be fully awake and perform well in the daytime." "The amount of sleep needed to transition to REM sleep."

"The amount of sleep needed to be fully awake and perform well in the daytime." Basal sleep requirement is the amount of sleep required to feel fully awake and able to sustain normal levels of performance during the periods of wakefulness. The other options do not describe basal sleep requirement. Cognitive Level: Apply (Application) Nursing Process: Implementation NCLEX: Physiological Integrity Text page: 368

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

"There is much hope for improvement through treatment. Let's talk about some strategies for your problems at work." This response instills hope regarding the ability of the patient to improve and suggests positive strategies for daily functioning. The other responses are nontherapeutic.Cognitive Level: Apply (Application)Nursing Process: ImplementationNCLEX: Psychosocial IntegrityText page: 375

Medications to treat insomnia are usually prescribed for no longer than 1 to 2 days. 1 to 2 months. 3 weeks. 2 weeks.

2 weeks. Nurses frequently provide education about the benefits of a particular sleep medication, the side effects, untoward effects, and the fact that medications are usually prescribed for no longer than 2 weeks because tolerance and withdrawal may result. REF: 376

Which season would be most associated with increased periods of wakefulness in the general population? a. Summer b. Winter c. Spring d. Fall

ANS: A Circadian drive is associated with physiology. Light is the main exogenous factor that drives wakefulness. Days are longest in summer. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 367 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A patient reports, "The medicine prescribed to help me get to sleep worked well for about a month, but I don't have any more of those pills, and now my insomnia is worse than ever. I had nightmares the last 2 nights." Which type of medication did the health care provider most likely prescribe? a. Hypnotic b. Tricyclic antidepressant c. Conventional antipsychotic d. Central nervous system stimulant

ANS: A Hypnotics can worsen existing sleep disturbances when they induce drug-dependency insomnia. Once the drug is discontinued, the individual may have rebound insomnia and nightmares. CNS stimulants worsen insomnia while they are in use. Tricyclic antidepressants and atypical antipsychotics may help insomnia but would not be used for initial therapy. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 375-376 (Table 19-2) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

Which person would be most likely to experience sleep fragmentation? a. An obese adult b. A toddler who attends day care c. A person diagnosed with mild osteoarthritis d. An adolescent diagnosed with anorexia nervosa

ANS: A Obese adults experience more disruption of sleep stages, resulting in fragmentation. Obesity is the leading factor for obstructive sleep apnea, which causes sleep fragmentation. These changes are also associated with illness and some medications. The changes are evident on a hypnogram. An adolescent with anorexia nervosa would have a low body weight and therefore decreased risk for sleep fragmentation. Persons with arthritis have pain that may sometimes interrupt sleep, but it would not have as high risk as would obesity. Toddlers do not generally experience sleep fragmentation. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 369 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A patient experiencing primary insomnia asks the nurse, "I take a nap during the day. Doesn't that make up for a lost night's sleep?" Select the nurse's best reply. a. "Circadian drives give daytime naps a structure different from nighttime sleep." b. "The body clock operates on a 24-hour cycle, making nap effectiveness unpredictable." c. "It is a matter of habit and expectation. We expect to be more refreshed from a night's sleep." d. "Sleep restores homeostasis but works more efficiently when aided by melatonin secreted at night."

ANS: A Regular sleep cycles occur with nighttime sleep, with progression through two distinct physiological states: four stages of non-rapid eye movement and a period of REM sleep. Naps often contain different amounts of REM sleep, thus changing the physiology of sleep as well as the psychological and behavioral effects of sleep. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 373 (Box 19-1) | Page 375-376 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority? a. "It's important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents." b. "Sleep deprivation is usually self-limiting. See your health care provider if it lasts more than a year." c. "Turn the radio on with a soft volume as you prepare for bed each evening. It will help you relax." d. "Three glasses of wine each evening help many patients who suffer from sleep deprivation."

ANS: A Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. Alcohol compounds problems associated with sleep deprivation. Sleep deprivation should be evaluated and treated; a 1-year delay is too long. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 365-366 | Page 371 | Page 373-374 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

Normally, most people sleep at night. What is the physiological rationale? a. The master biological clock responds to darkness with sleep. b. Darkness stimulates histamine release, which promotes sleep. c. Cooler environmental temperatures stimulate retinal messages. d. Stimulation of the sympathetic nervous system promotes sleep.

ANS: A The master biological clock in the suprachiasmatic nucleus (SCN) of the hypothalamus regulates sleep as well as other physiological processes. Darkness cues the clock for sleep. Light cues it for wakefulness. Light stimulates retinal messages. Histamine release is associated with wakefulness. Stimulation of the sympathetic nervous system promotes alertness. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 367 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A patient says, "I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep." Which medication would the nurse expect a health care provider to prescribe for this patient? a. zolpidem (Ambien) b. flurazepam (Dalmane) c. risperidone (Risperdal) d. methylphenidate (Ritalin)

ANS: A Zolpidem is a short-acting hypnotic that will help the patient initiate sleep and awaken without untoward symptoms of drowsiness. Methylphenidate is a central nervous system stimulant. Flurazepam is a long-acting hypnotic that will produce hangover drowsiness during the next day. Risperidone is an antipsychotic and not likely to be useful in this scenario. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 375-376 (Table 19-2) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

A night shift worker reports, "I'm having trouble getting to sleep after a night's work. I have a hearty breakfast with coffee, read the paper, do my exercises, and then go to bed. However, I just lie awake until it is nearly time to get up to be with my family for dinner." What changes should the nurse suggest? Select all that apply. a. Drink juice with breakfast rather than coffee. b. Exercise after awakening rather than before. c. Turn on the television when going to bed. d. Do not read the paper. e. Eat a light breakfast.

ANS: A, B, E Sleep can be disrupted by caffeine, a central nervous system stimulant, exercise performed just before trying to sleep, and eating a heavy meal before retiring. Reading the newspaper is not likely to be so stimulating that it disrupts the patient's ability to sleep. Television will be disruptive to sleep. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 369 | Page 375 (Box 19-2) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

Which comment is most likely from a patient with chronic sleep deprivation? a. "I turn on the television every night to get to sleep. I set the timer so it goes off in 30 minutes." b. "I have diarrhea frequently and not much energy, so I stay at home most of the time." c. "I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours." d. "When my alarm clock goes off every morning, it seems like I am dreaming."

ANS: B A discrepancy between hours of sleep obtained and hours required leads to sleep deprivation. Adults with less than 6 hours of sleep per night often suffer from chronic sleep deprivation. Common complaints include poor general health, physical and mental distress, limitations in ADLs, depressive or anxious symptoms, and pain. One distracter indicates a problem with sleep hygiene [television]. The remaining distracters do not indicate a problem. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 365-366 | Page 373 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A person says, "I often feel like I have been dreaming just before I awake in the morning." Which rationale correctly explains the comment? a. Sleep architecture changes during the sleep period, resulting in increased slow-wave sleep at the end of the cycle. b. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods. c. Dreams occur more frequently when a person is experiencing unresolved conflicts or depression. d. Dream content relates directly to developmental tasks. The person is likely feeling autonomous.

ANS: B Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods, up to 1 hour. Dreaming occurs during REM sleep. The question relates to sleep architecture rather than dream content. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 366-367 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems? a. Skull x-rays b. Electroencephalogram (EEG) c. Positron emission tomography (PET) d. Single-photon emission computed tomography (SPECT)

ANS: B Electroencephalogram (EEG) measures NREM and REM sleep. The distracters represent ways to diagnose structural and metabolic problems. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 366 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

A person is prescribed lorazepam (Ativan) 2 mg po bid prn for anxiety. When the person takes this medication, which change in sleep is anticipated? The patient will: a. have fewer dreams. b. have less slow-wave sleep. c. experience extended sleep latency. d. enter sleep through rapid eye movement (REM) sleep.

ANS: B Lorazepam is a benzodiazepine, which reduces slow-wave sleep. REM sleep would likely increase. Persons with narcolepsy often enter sleep through REM. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 367 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A patient reports, "Nearly every night I awaken feeling frightened after a bad dream. The dream usually involves being hunted by people trying to hurt me. It usually happens between 4 and 5 AM." The nurse assesses this disorder as most consistent with criteria for which problem? a. Sleep deprivation b. Nightmare disorder c. Night terror disorder d. REM sleep behavior disorder

ANS: B Nightmares are long, frightening dreams from which people awaken in a frightened state. They occur during REM sleep late in the night. Night terror disorder occurs as arousal in the first third of the night during non-REM sleep and is accompanied by feelings of panic. REM sleep behavior disorder involves acting out a violent dream during REM sleep. Nightmare disorder may lead to sleep deprivation. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 369 | Page 373 (Box 19-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

A home care nurse assesses a very demanding patient with chronic obstructive pulmonary disease (COPD). Afterward, the nurse talks with the spouse who has provided this patient's care for 6 years. The spouse says, "I don't need much sleep anymore. I might need to help him during the night." Select the nurse's most therapeutic response. a. "It sounds like you are very devoted to your spouse." b. "I noticed you fell asleep while I was assessing your spouse. I'm concerned about you." c. "Your spouse is lucky to have you to provide care rather than being placed in a nursing home." d. "If you keep going like this, your health will be impaired also. Then who will take care of both of you?"

ANS: B Sleep deprivation can cause accidents. The correct answer makes an observation, gives important information about safety, and communicates care and compassion for the spouse. The distracters do not invite further dialogue with the spouse. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 365-366 | Page 373 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

A nurse counsels a patient on ways to determine the person's total sleep requirement. Which instruction would produce the most accurate results? a. "For 1 full week, record what you remember about your dream content and related feelings as soon as you wake up. Bring the record to your next appointment." b. "While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings." c. "For 2 full weeks, record how much time you sleep each night and rate your daytime alertness on a scale of 1 to 10. Calculate your average alertness score." d. "All adults need 7 or 8 hours of sleep to function properly. Let's design ways to help you reach that goal."

ANS: B Sleep requirements are most accurately determined by going to bed at the usual time and waking up without an alarm for several nights, ideally on vacation. The average of these findings indicates the estimated requirements. Two distracters relate to dream content and daytime alertness. Some adults are long sleepers or short sleepers with different requirements for sleep from the general population. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 368 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

A nurse cares for these four patients. Which patient has the highest risk for problems with sleep physiology? a. Retiree who volunteers twice a week at Habitat for Humanity b. Corporate accountant who travels frequently c. Parent with three teenagers d. Lawn care worker

ANS: B The corporate accountant is likely to work long hours and have significant stress associated with work demands. Compounded by travel, these factors are likely to precipitate unstable sleep patterns and inadequate sleep time. The retiree and lawn care worker engage in physical activity during the day, which will promote natural fatigue and sleep. The parent's sleep is unlikely to be disturbed; teenagers sleep through the night. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 365 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A nurse who works night shift says, "I am exhausted most of the time. I sleep through my alarm. Sometimes my brain does not seem to work right. I am worried that I might make a practice error." Which question should the nursing supervisor ask first? a. "What stress are you experiencing in your life?" b. "How much sleep do you get in a 24-hour period?" c. "Would it help if you do some exercises just before going to bed?" d. "Have you considered using a hypnotic medication to help you sleep?"

ANS: B Total sleep hours should be ascertained before seeking to correct a sleep disorder. In this case, the patient describes sleep deprivation symptoms rather than a sleep disorder. The correct response is the only option that addresses total sleep hours. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 373-374 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

Which neurotransmitters are most responsible for wakefulness? Select all that apply. a. Gamma-aminobutyric acid (GABA) b. Norepinephrine c. Acetylcholine d. Dopamine e. Galanin

ANS: B, C, D Gamma-aminobutyric acid (GABA) and galanin are sleep-promoting neurotransmitters. PTS: 1 DIF: Cognitive Level: Remember (Knowledge) REF: Page 367-368 TOP: Nursing Process: N/A MSC: Client Needs: Health Promotion and Maintenance

A new patient at the sleep disorders clinic tells the nurse, "I have not slept well in a year, so I never feel good. I do not expect things will ever improve or be any different." Interventions the nurse should consider include: (select all that apply) a. suggesting use of alcohol as a sedative. b. providing instruction in relaxation techniques. c. counseling the patient to address cognitive distortions. d. health teaching regarding factors that influence sleep. e. teaching fatigue-producing activities to become overtired. f. encouraging long daytime naps to compensate for sleep deprivation.

ANS: B, C, D Interventions that could be helpful include teaching relaxation techniques, such as meditation or progressive relaxation, to relieve the tension that sometimes prevents initiation of sleep. Reviewing factors that influence sleep can assist the patient to diagnose and remove barriers to sleep. Cognitive therapy could be helpful in combating the hopelessness verbalized by the patient. Alcohol consumption actually disrupts sleep. Becoming overtired may be a barrier to nighttime sleep. Naps may help replace lost sleep, but lengthy daytime sleep will prevent the patient from sleeping well at night. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 375-377 (Box 19-2) TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Psychosocial Integrity

A nurse provides health education for an adult with sleep deprivation. It is most important for the nurse to encourage caution when the patient engages in: a. using a vacuum cleaner. b. cooking a meal. c. driving a car. d. bathing.

ANS: C Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. The distracters are less likely to be associated with serious injury. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 365-366 | Page 371 | Page 373-374 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

A patient says, "It takes me about 15 minutes to go to sleep each night." This comment describes: a. delta sleep. b. parasomnia. c. sleep latency. d. rapid eye movement sleep.

ANS: C Sleep latency refers to the amount of time it takes a person to fall asleep. The distracters represent other phases of the sleep cycle. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 366 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A patient with rheumatoid arthritis reports, "For the past month I've been having a lot of trouble falling asleep. When I finally get to sleep, I wake up several times during the night." Which information should the nurse seek initially? a. "What have you done to try to improve your sleep?" b. "What would be a good sleep pattern for you?" c. "How much exercise are you getting?" d. "Do you have pain at night?"

ANS: D Patients with diseases such as arthritis may have sleep disturbance related to nightly pain. Because the pain is chronic, the patient may fail to realize it is the reason for the inability to sleep. The other options do not follow the patient's lead or begin problem solving without an adequate baseline. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 365 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A young adult says to the nurse, "I go to sleep without any problem, but I often wake up during the night because it feels like there are rubber bands in my legs." Which assessment question should the nurse ask to assess for restless legs syndrome (RLS)? a. "What type of birth control do you use?" b. "How much caffeine do you use every day?" c. "How much exercise do you get in a typical day?" d. "Does anyone else in your family have this problem?"

ANS: D Restless legs syndrome (RLS) is a sensory and movement disorder characterized by an unpleasant, uncomfortable sensation in the legs accompanied by an urge to move. Symptoms begin or worsen during periods of inactivity, such as sleep. Symptoms can have a significant impact on the individual's ability to fall asleep and stay asleep. There is likely to be a strong genetic component, especially when seen in individuals less than 40 years old. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 370 | Page 373 (Box 19-1) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A person is prescribed sertraline (Zoloft) 100 mg PO daily. Which change in sleep is likely secondary to this medication? The patient will have: a. more dreams. b. excessive sleepiness. c. less slow-wave sleep. d. less rapid eye movement (REM) sleep.

ANS: D Sertraline (Zoloft) is an SSRI antidepressant medication, which suppresses REM sleep. Dreams would decrease because they occur during REM. Benzodiazepines reduce slow-wave sleep. SSRIs have a side effect of insomnia. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 369-370 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A patient tells the nurse, "Everyone says we should sleep 8 hours a night. I can only sleep 6 hours, no matter how hard I try. Am I doing harm to my body?" Select the nurse's best response. a. "Tell me about strategies you have tried to increase your total sleep hours." b. "Lack of sleep acts as a stressor on the body and can cause physical changes." c. "If you have really tried to sleep more, maybe you should consult your health care provider." d. "If you function well with 6 hours of sleep, you are a short sleeper. That's normal for some people."

ANS: D Some individuals require less sleep than others do. Those who need less are called "short sleepers," compared with "long sleepers," who require more than 8 hours. The distracters do not provide information the patient is seeking or are untrue. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 368 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

A 76-year-old man tells the nurse at the sleep disorder clinic, "I awaken almost nightly in the midst of violent dreams in which I am defending myself against multiple attackers. Then I realize I have been hitting and kicking my wife. She has bruises." Which health problem is most likely? a. Sleep Paralysis b. Night Terror Disorder c. Sleep-Related Bruxism d. Rapid Eye Movement (REM) Sleep Behavior Disorder

ANS: D The scenario describes REM sleep behavior disorder in which the patient engages in violent and complex behaviors during REM sleep as though acting out his dreams. Older men have a higher incidence of this problem. Sleep paralysis refers to the sudden inability to perform voluntary movement at either sleep onset or awakening from sleep. Bruxism refers to grinding teeth during stage 2 sleep. Night terror disorder occurs as arousal in the first third of the night during non-REM sleep, accompanied by feelings of panic. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 369-370 | Page 373 (Box 19-1) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

Ellie asks what medication may help her condition. Your response is based on the knowledge that: there is no effective medication treatment for hypersomnolence disorder. medication therapy with benzodiazepines may be initiated. Ellie may be prescribed a stimulant. Ellie will be started on an anticholinesterase inhibitor for increased cognition

Ellie may be prescribed a stimulant. Pharmacotherapy with long-acting amphetamine-based stimulants such as methylphenidate and non-amphetamine-based stimulants such as modafinil are helpful in hypersomnolence disorder. The other options are incorrect because there is effective medication treatment; benzodiazepines are sedating and addictive; and anticholinesterase inhibitors are used for the treatment of dementia.Cognitive Level: Apply (Application)Nursing Process: ImplementationNCLEX: Physiological IntegrityText page: 368

An older adult client is reporting symptomatology that suggests REM sleep behavior disorder (RSBD). The nurse is correct in recognizing that this client is at risk for developing lymphoma. hypertension. acute renal failure. Parkinson's disease.

Parkinson's disease. RSBD is seen in elderly males as they begin to develop neurological pathologies such as Parkinson's disease.REF: Page 370

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

Polysomnography Polysomnography consists of an electroencephalogram that records respirations, eye movements, and muscle tone during sleep. Sleep apnea becomes apparent if respirations cease frequently during sleep.REF: Page 368

According to the National Sleep Foundation, which condition is an example of a social problem that may be a result of sleepiness? Narcolepsy Road rage Alcohol abuse Insomnia

Road rage Social problems such as road rage may be caused, in part, by a national epidemic of sleepiness. REF: 365-366

An older adult who reports taking a late afternoon nap every day to make up for his disrupted sleep at night still feels tired. The nurse explains that an afternoon nap includes a great deal of REM sleep. a late afternoon nap does not compensate for a lack of nighttime sleep. a noontime nap includes very little REM sleep. the elderly always need fewer than 6 hours of sleep each night.

a late afternoon nap does not compensate for a lack of nighttime sleep. Daytime naps do not compensate for a lack of nighttime sleep. Daytime naps differ in structure from normal nighttime sleeping as a result of a circadian cycle.REF: Page 377

The most effective nursing intervention regarding the accurate assessment of sleep disorders involves a sleep diary. information regarding sleep cycles. client description of the symptomatology. assessment for substance abuse.

a sleep diary. Self-reported sleep patterns may be biased, and so clinical tools such as a sleep diary are helpful in accurately estimating total sleep time.REF: Page 373

Factors that consistently increase the risk for sleep disturbance include gender and race. diet and exercise. alcohol and tobacco. income and education.

alcohol and tobacco. There is a strong correlation between alcohol and tobacco use with sleep latency and efficiency problems.REF: Page 370

A client who travels often and therefore experiences jet lag regularly reports the use of over-the-counter (OTC) melatonin supplements. The nurse responds by informing the client that melatonin is a naturally secreted hormone and thus is a safe supplement. research has supported the effectiveness of using melatonin supplements for jet lag. currently, no standardized, safe therapeutic dosage range for melatonin supplements has been established. hypertension is a common side effect of melatonin supplement therapy.

currently, no standardized, safe therapeutic dosage range for melatonin supplements has been established. Because melatonin is an OTC product, the FDA has no input on the identification of effective dosage ranges or standardization of nutraceutical ingredients. REF: 376

A depressed client is likely to report a sleep disorder that includes frequent awakenings during the night. nightmares. difficulty falling asleep. sleepwalking.

frequent awakenings during the night. Depressed clients often report normal sleep onset, followed by repeated awakenings during the second half of the night. REF: 368-369

When providing possible interventions to promote the safety of a client reporting symptoms of somnambulism, the nurse includes gating the stairways. sleeping on a mattress placed on the floor. regular bedtime dose of a benzodiazepine. avoiding the use of serotonergic medications.

gating the stairways. Somnambulism or sleep walking can result in falls; gating the stairways may minimize that risk.REF: Page 369

A client tells the nurse that when she was younger, she slept 8 to 10 hours nightly, whereas now she sleeps only 6 or 7 hours and has to take a nap each afternoon. The nurse can assess that the client has a primary sleep disorder. is suffering from sleep apnea. has an age-related sleep pattern change. is displaying signs of sleep deprivation.

has an age-related sleep pattern change. The older a person gets, the more likely he or she is to have decreased total time sleeping, even though time in bed is increased. REM sleep is also reduced, and wakefulness during the night is increased. REF: 367-368

Ellie, a 38-year-old patient referred for sleep studies, reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. Ellie's symptoms describe: circadian rhythm disorder. hypersomnolence. rapid eye movement (REM) sleep behavior disorder. breathing-related sleep disorder.

hypersomnolence. The patient with hypersomnolence reports recurrent periods of sleep or unintended lapses into sleep, frequent napping, nonrefreshing nonrestorative sleep regardless of the amount of time slept, and difficulty with full alertness during the wake period. Circadian rhythm sleep disorders occur when there is a misalignment between the timing of the individual's normal circadian rhythm and external factors that affect the timing or duration of sleep. Patients with REM sleep disorder display elaborate motor activity associated with dream mentation. Breathing-related sleep disorder is characterized by frequent upper airway obstruction. Cognitive Level: Apply (Application)Nursing Process: DiagnosisNCLEX: Physiological IntegrityText page: 368-369

A client reports insomnia and shares that a friend has recommended a nonprescription hormone product that can be purchased at the local health food store. The nurse suspects that the medication is a benzodiazepine. a tranquilizer. melatonin. lithium.

melatonin. The use of melatonin appears to be helpful in treating sleep problems in the elderly. However, this practice is not without risk. Melatonin products are not approved by the U.S. Food and Drug Administration; therefore, variation may exist in the purity, safety, and effectiveness of the products.REF: Page 376

A non-habit-forming melatonin receptor agonist often prescribed for insomnia is zolpidem (Ambien). ramelteon (Rozerem). eszopiclone (Lunesta). zaleplon (Sonata).

ramelteon (Rozerem). Ramelteon (Rozerem) is a short-acting melatonin receptor agonist that has been approved by the FDA for insomnia and is not habit forming. REF: 376; Table 19-2

A recovering alcoholic client is being treated for a sleep disorder. Research has shown that a successful sleep treatment plan is vital to support the client's ability to work and support himself. sustaining his continued sobriety. re-integration into positive interpersonal relationships. general health and wellness.

sustaining his continued sobriety. Targeting sleep disturbances during recovery may support continued abstinence by addressing a distracting and common disorder in recovering alcoholic clients.REF: Page 373

When providing sleep hygiene information to a client reporting difficulty falling asleep, the nurse includes drinking a small amount of alcohol to relax just before bedtime. taking a short nap after lunch whenever possible. keeping the bedroom warm to induce coziness. taking a 20-minute walk after dinner.

taking a 20-minute walk after dinner. Light, daily exercise often promotes sleep; however, the exercise should not be done right before bedtime. REF: 375; Box 19-2

A client reports to the nurse that falling asleep can often take hours. An appropriate intervention would be to teach the client how to do progressive relaxation. advise the client to drink an ounce or two of brandy at bedtime. suggest that the client seek a referral for polysomnography. point out that reducing stress at work would be advisable.

teach the client how to do progressive relaxation. Progressive relaxation relaxes muscle groups sequentially and generates a state of pleasant comfort and ease, a natural prelude to sleep. REF: 375