Ch. 33: Rest and Sleep PrepU

The nurse is promoting bedtime rituals with a family. Which statement indicates the nurse may need to provide further instructions to the mother? a) "Our rituals include a short bedtime story each night." b) "My boys love to rough-house in their room right before bedtime." c) "I let the kids have a snack of peanut butter crackers or fruit shortly before bed." d) "My daughter sleeps soundly when she has her bear in bed with her and the nightlight is on."

"My boys love to rough-house in their room right before bedtime." Explanation: Bedtime rituals such as reading stories, having a healthy carbohydrate snack, holding a favorite stuffed toy, and use of a nightlight promote a healthy sleep routine for children. Most studies show that exercise right before going to bed impedes the person's ability to fall asleep quickly.

The nurse knows that a client understands the purpose of a sleep diary when the client states: a) "I will write down all my morning activities." b) "I will record the time I go to bed and how long it takes me to fall asleep." c) "I will keep track of my sleep information for 2 months." d) "I will only keep track of my sleep habits at home, not when I am traveling out of town."

"I will record the time I go to bed and how long it takes me to fall asleep." Explanation: Keeping notes of times of sleep and waking are important details to record in a sleep diary. The notes are usually maintained for 14 days and include specifics such as all wakeful activities and sleep patterns in strange environments.

A nurse is instructing her students on the role of hormones in sleep patterns. Which statement would indicate to the nursing instructor that the student needs additional education? a) "Estrogen has been shown to decrease sleep latency." b) Hypothyroidism may contribute to a lack of slow-wave sleep." c) "A hyperactive thyroid can make the client sleepy all the time." d) "Women often experience fatigue due to loss of estrogen."

"A hyperactive thyroid can make the client sleepy all the time." Explanation: Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow-wave sleep.

A nurse is visiting the home of a first-time mother and her newborn. The nurse is teaching the mother about the newborn's sleep needs. The nurse would inform the mother that newborns sleep approximately how many hours per day? a) 14 to 20 hours b) 18 to 22 hours c) 8 to 10 hours d) 10 to 12 hours

14 to 20 hours Explanation: On average, infants require 14 to 20 hours of sleep each day.

A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep? a) 9 to 12 hours each day b) 8 to 9 hours each day c) 14 to 20 hours each day d) 12 to 14 hours each day

14 to 20 hours each day Explanation: The pediatric nurse informs the new parent that on average, infants require 14 to 20 hours of sleep each day.

The parents of a newborn ask when they can expect the baby to sleep through the night. The nurse responds that the baby will most likely sleep through the night by: a) 6 weeks of age b) 6 months of age c) 1 year of age d) 3 months of age

3 months of age Explanation: Most infants sleep through the night by 3 months of age, but nocturnal awakenings continue to be frequent during the latter half of the first year.

Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern? a) What do you usually do to help yourself fall asleep? b) Do you usually go to bed and wake up about the same time each day? c) How much sleep do you think you need to feel rested? d) In what way does the sleep you get each day affect your everyday living?

Do you usually go to bed and wake up about the same time each day? Explanation: The best interview question for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern would be to ask if the client usually goes to bed and wakes up about the same time each day. The other questions are possible to ask the client, but are not related to recent changes in the client's sleep-wakefulness pattern.

Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening? a) Eat a bar of a favorite chocolate before bedtime. b) Eat some crackers with peanut butter at bedtime. c) Exercise vigorously for 30 minutes before bedtime. d) Smoke a cigarette to relax and calm down at bedtime.

Eat some crackers with peanut butter at bedtime. Explanation: Carbohydrates make tryptophan more available to the brain, thereby promoting sleep. Therefore, a small protein- and carbohydrate-containing snack such as peanut butter on toast or cheese and crackers are effective.

A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest? a) involves all the body systems b) decrease in cognitive response to stimuli c) decrease in awareness of environment d) decrease in motor response to stimuli

decrease in awareness of environment Explanation: There is a decrease in the awareness of the environment in sleep; this does not happen during rest. Motor and cognitive response to stimuli may be decreased in both sleep and rest. Sleep is a whole body phenomenon; whereas, rest may involve the whole body system or only a part.

Which activity for rest break should not be incorporated into care planning for clients to aid in healing and recovery? a) drinking an 8 oz cup of a caffeinated beverage b) stretching exercises c) going for a short walk d) taking a short 15- to 30-minute nap e) focusing thoughts on a pleasant scene away from work

drinking an 8 oz cup of a caffeinated beverage Explanation: Drinking a caffeinated beverage is not as energizing as a short 15- to 30-minute nap, stretching exercises, or taking a short walk.

When an older adult client walks with her knees slightly flexed and body leaning, the nurse determines that the client: a) requires a better walking shoe. b) requires crutches for mobility. c) should have an orthopedic consultation. d) is demonstrating a common gait for the older adult.

is demonstrating a common gait for the older adult. Explanation: Many older people have more difficulty overcoming inertia and using gravity efficiently. One contributing factor is the shift in the center of gravity. To compensate for this shift, the knees flex slightly for support.

The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is: a) measure the client's weight and assess visual acuity. b) auscultate the lung fields and perform neuro checks. c) measure neck circumference and auscultate the abdomen. d) observe client's hours of sleep and review client's sleep diary.

observe client's hours of sleep and review client's sleep diary. Explanation: Observing the sleeping patterns and checking the client's sleep diary can lead the nurse to clues about the quality of the client's sleep.

In Stage 4 sleep, the: a) respirations are irregular b) blood pressure is elevated c) temperature increases d) pulse rate is slow

pulse rate is slow Explanation: During slow-wave sleep, the muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle all decrease.

When a nurse notes that a sleeping client is demonstrating irregular respirations and is showing eye movement, the nurse identifies the stage of sleep the client is experiencing as: a) rapid eye movement (REM) b) light sleep c) transitional d) slow wave

rapid eye movement (REM) Explanation: In REM sleep, respirations are irregular and oxygen consumption increases.

Which factor necessitates the need for more sleep in the adolescent population? a) increased life stresses b) rapid growth c) part-time employment d) increased nutritional needs

rapid growth Explanation: The growth spurt that occurs during adolescence may necessitate the need for more sleep. However, the stresses of school, activities, and part-time employment may cause adolescents to have restless sleep, and many adolescents do not get enough sleep.

A client tells the nurse that the client often has a difficult time falling asleep at night. What suggestion offered by the nurse may assist the client in achieving sleep? a) it is best to avoid a snack prior to bedtime b) a snack containing protein and fat c) a snack containing carbohydrates and protein d) a snack containing carbohydrates and fat

a snack containing carbohydrates and protein Explanation: A small snack containing protein and carbohydrates may be effective in promoting calmness and relaxation prior to bedtime

The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to: a) apply facial mask that will deliver positive air pressure. b) insert an oral appliance prior to attempting sleep. c) take prescribed sedative before trying to sleep. d) anticipate sleeping overnight at a health care center.

anticipate sleeping overnight at a health care center. Explanation: Polysomnography is a sleep study. The client will be scheduled for the study at a health care center and sleep overnight as part of the study. The client should avoid sedatives as this will aggravate OSA. Interventions for OSA include inserting an oral appliance or applying a facial mask for continuous positive airway pressure.

An older adult client with mild hypothermia has been admitted to the health care facility. What should the nurse do to provide an appropriate environment to an older adult client? a) Keep an attendant with the client. b) Ensure that the environment is warmer. c) Use a bright light at night for safety. d) Raise the side rails of the bed.

Ensure that the environment is warmer. Explanation: Ensuring that the environment is warmer than normal is the most appropriate activity to deal with hypothermia because older adult clients tend to prefer warmer room temperature because of decreased subcutaneous fat deposits.

A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage? a) Midbrain b) Hypothalamus c) Medulla d) Cerebral cortex

Hypothalamus Explanation: The hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleeping and waking. Injury to the hypothalamus may cause a person to sleep for abnormally long periods. The medulla and midbrain are part of the reticular activating system (RAS), which plays a part in the cyclic nature of sleep. The cerebral cortex does not have any role in the sleep process.

A client calls a sleep clinic "helpline" and describes her 46-year-old husband's sleep patterns: snoring loudly, then becoming startled and waking up 5 or 6 times a night. The wife is asking how to improve his sleep patterns. The nurse concludes: a) the husband may be exhibiting signs of sleep apnea. b) the wife should consider wearing ear plugs to bed. c) the husband should only eat a small carbohydrate snack before bed. d) the wife needs interventions to promote Stage II sleep for herself.

the husband may be exhibiting signs of sleep apnea. Explanation: Obstructive sleep apnea is characterized by snoring, waking, and apneic episodes throughout the night. Sleep apnea can be dangerous if it causes hypoxemia or cardiac dysrhythmia.

A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because: a) they may be disoriented on awakening. b) they are typically prone to sleep walking. c) they are the age group least likely to use prescribed sleep medications. d) they nap in the afternoon, which lessens their hours of sleep at night.

they may be disoriented on awakening. Explanation: The elderly sleep less soundly for less time, and have little or no Stage IV deep sleep. It is common for them to be confused upon awakening, which could lead to injury.

The nurse is planning care for a client with a nursing diagnosis of Activity Intolerance. What assessment finding would cause the nurse the most concern? a) joint stiffness after sitting for an hour b) a change in pulse from 80 to 84 after walking up 20 stairs c) walking with a slow and uncoordinated movement d) shortness of breath after walking up five stairs

shortness of breath after walking up five stairs Explanation: Activity Intolerance may result from any condition that interferes with the transport of oxygenated blood to tissue. The altered response to activity includes exertional dyspnea, shortness of breath. Shortness of breath after walking up five stairs would be included in this nursing diagnosis.

The nurse is teaching the practice of stimulus control to a patient who has insomnia. The nurse would include which teaching points in the teaching plan? (Select all that apply.) a) Instruct the patient to get up the same time every day, no matter what time he or she fell asleep. b) Instruct the patient to exercise moderately 1 hour before going to bed. c) Allow the patient to nap during the day if he or she could not sleep during the night. d) Instruct the patient to leave the bedroom if he or she cannot get to sleep within 15 to 20 minutes; he or she should return to the bedroom when sleepy. e) Encourage the patient to consume one or two alcoholic drinks to help him or her relax before bedtime. f) Recommend that the patient use the bedroom for sex and sleep only.

• Recommend that the patient use the bedroom for sex and sleep only. • Instruct the patient to leave the bedroom if he or she cannot get to sleep within 15 to 20 minutes; he or she should return to the bedroom when sleepy. • Instruct the patient to get up the same time every day, no matter what time he or she fell asleep. Explanation: The nurse would include having the client get up at the same time every day, leave the bedroom if not able to sleep within 15 to 20 minutes, and use the bedroom for sex and sleep only. Napping can further disrupt a client's sleep-wakefulness cycle. Moderate exercise 1 hour before bed would not be recommended. The consumption of alcohol before bed would not be encouraged with a client who has a history of insomnia.

The nurse recognizes that sleep deprivation related to environmental concerns will apply to which clients? Select all that apply. a) a 16-year-old female who works part time on Saturdays b) an 84-year-old male hospitalized for prostate surgery c) a 58-year-old female who takes cholesterol-lowering medication and aspirin daily d) a 67-year-old male who has two beers during the late night newscast e) a 32-year-old male machinist, two pack a day smoker

• a 67-year-old male who has two beers during the late night newscast • a 32-year-old male machinist, two pack a day smoker • an 84-year-old male hospitalized for prostate surgery Explanation: Alcohol consumption, smoking, pain, and/or a new environment all predispose clients to sleep disruption.

Parents tell the nurse that their 5-year-old is only sleeping 10 hours now and is refusing to take an afternoon nap. The nurse should teach the parents: a) "This is normal development for children in this age group." b) "Don't let your child eat any candy or chocolate after dinner." c) "Five-year-olds sleep only 10 to 12 hours at night, but napping is very important at this stage." d) "It might be a problem. You should discuss this with your pediatrician."

"This is normal development for children in this age group." Explanation: Preschoolers typically sleep 10-16 hours, but become less dependent on napping as they approach school age. By 5 years, they usually do not need routine naps. Telling them to call their pediatrician is passing off responsibility. Sweets are not recommended before bedtime, and this child has normal sleep habits.

The client has been in the intensive care unit for several days. The client appears to be sleeping throughout the night. The nurse records the data listed above. The nurse evaluates that rapid eye movement (REM) sleep is occurring at: a) 0300. b) 0100. c) 0200. d) 0400.

0100. Explanation: During REM sleep, the client's temperature, pulse, blood pressure, and respirations increase. The client may experience small muscle twitching, such as facial muscles twitching, and irregular pulse rate and respirations. During non-eye movement sleep, the client will exhibit a decrease in body temperature, pulse, blood pressure, and respirations.

Which client could be diagnosed with insomnia? a) A 20-year-old man who is reporting excessive drowsiness at work to the point that he falls asleep while at his computer. He goes to bed at 11 p.m. and wakes up at 7 a.m. without difficulty. Twice in the last year he passed out after getting extremely angry. b) A 45-year-old woman who has been reporting fatigue for the last year. When asked about her sleep schedule she states that she usually goes to bed around 1 a.m. and gets up at 7 a.m. when her 5-year-old daughter gets up. She describes herself as a night owl. c) A 40-year-old obese man who is reporting fatigue. He states that he goes to bed around 9 p.m. every night and wakes up between 5 and 6 in the morning. He feels like he gets a good night's sleep but his wife says that she constantly has to poke him throughout the night because he "stops breathing." d) A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m.

A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m. Explanation: The 50-year-old woman appears to be suffering from early-awakening insomnia. Because it has been longer than 1 month it is considered a chronic insomnia.

A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning the client reports overwhelming fatigue and has told the nurse, "I just can't manage to get any sleep around here." How should the nurse first respond to this client's statement? a) Obtain a p.r.n. order for a sedative-hypnotic from the client's physician. b) Assess the factors that the client believes contribute to the problem. c) Facilitate a change in the client's diet to ensure more carbohydrates at dinner. d) Educate the client on relaxation techniques and reduce noise levels on the unit.

Assess the factors that the client believes contribute to the problem. Explanation: Assessment is the first step in the nursing process. Consequently, the nurse should determine the factors contributing to the client's problem before performing interventions.

What factor has been hypothesized by researchers regarding current thoughts on sleep? a) Population is healthier due to sleep. b) Chronic sleep deprivation is present. c) More sleep is obtained through napping. d) The current population requires less sleep.

Chronic sleep deprivation is present. Explanation: Most recently, researchers have hypothesized that much of the population in industrialized nations may be chronically sleep deprived.

During the morning assessment, the client reports to the nurse that the client is experiencing a hangover from a sleeping pill. The nurse reviews the Medication Administration Record. Which medication is most likely to cause the client's complaint? a) Zolpidem (Ambien) b) Flurazepam (Dalmane) c) Ramelteon (Rozerem) d) Eszopiclone (Lunesta)

Flurazepam (Dalmane) Explanation: All of the listed medications are ones that promote sleep. Flurazepam is the drug most likely to cause the client's complaint of a morning hangover.

Which statement about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents? a) Nightmares are rare in toddlers. b) Slow-wave sleep occurs less in toddlers than in adults. c) Getting the child to sleep can be difficult. d) Most toddlers fall asleep easily.

Getting the child to sleep can be difficult. Explanation: Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.

The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include? a) Advise parents that waking from nightmares or night terrors is common during the adolescent stage. b) Teach parents of infants to report any eye movements, groaning, or grimacing by their infant during sleep periods. c) Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. d) Inform parents about the preschool child's awareness of the concept of death possibly occurring and encourage parents to help alleviate the child's fears.

Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. Explanation: The nurse would include the education point that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. It is normal for infants to have eye movements, groaning, or grimacing during sleep periods. School-age children become aware of the concept of death, not preschool children. Waking from nightmares or night terrors is common during the preschooler stage.

A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which condition is a manifestation of depression in an older client? a) Nightmares b) Insomnia c) Somnambulism d) Nocturnal enuresis

Insomnia Explanation: Insomnia and hypersomnia are often manifestations of depression in older clients. Nightmares, somnambulism (sleepwalking), and nocturnal enuresis are examples of parasomnias. These are conditions associated with activities that cause arousal, or partial arousal, usually during transitions in NREM periods of sleep. However, these are not manifestations of depression in an older adult client.

For the last 3 weeks, a nurse in a long-term care facility has administered a sedative-hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation? a) The client's daily activity is interfering with the drug. b) The client is eating carbohydrates prior to bedtime. c) Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration. d) The nurse needs to administer another drug such as diphenhydramine for effectiveness.

Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration. Explanation: Although most sedative-hypnotic drugs provide several nights of excellent sleep, the medication often loses its effects after 1 or 2 weeks. Alcohol and diphenhydramine should not be administered with a sedative-hypnotic drug. Increased activity assists the client in sleeping. Foods such as protein and carbohydrates have been shown to help a client sleep.

The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborn's sleep patterns. Which statement is accurate about a newborn's sleep patters? a) Newborns are inactive when awake. b) Newborns sleep 16 to 17 hours per day. c) Newborns have shorter periods of REM sleep. d) Newborns will nap two times per day.

Newborns sleep 16 to 17 hours per day. Explanation: Newborns sleep an average of 16 to 17 hours per 24 hours a day, divided into about seven sleep periods distributed fairly evenly throughout the day and night.

A new client in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis? a) Bring the client a warm glass of milk at bedtime. b) Use tactile relaxation techniques, such as a back massage. c) Provide an opportunity for the client to talk about concerns. d) Help the client maintain normal bedtime routine and time for sleep.

Provide an opportunity for the client to talk about concerns. Explanation: Stress and anxiety interfere with a person's ability to relax, rest, and sleep. The client is scheduled for a surgical procedure in the morning. The nursing diagnosis addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other options are incorrect because the options do not address the situation at hand, or the nursing diagnosis that is noted.

A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client? a) Impaired Bed Mobility b) Relocation Stress Syndrome c) Risk for Injury d) Sleep Deprivation

Sleep Deprivation Explanation: Sleep deprivation is the most appropriate nursing diagnosis for this client because the symptoms of restless legs syndrome keep the person awake and prevent continuous sleep. Eventually, sleep deprivation affects the person's life, damaging work productivity and personal relationships.

The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects a nursing diagnosis of: a) Role Performance, Ineffective related to inability to work at occupation. b) Anxiety related to hospitalization. c) Sleep Pattern Disturbance related to acute pain. d) Mobility, Impaired Physical related to Restless Leg Syndrome (RLS).

Sleep Pattern Disturbance related to acute pain. Explanation: The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain he is experiencing. Anxiety may be present but that is a symptom of his problem rather than the nursing diagnosis. He may have impaired mobility, but it is not due to RLS. Also, his role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data. (

Which problem is associated with obesity, heavy snoring, and shallow breathing? a) Hypersomnia b) Hyperpnea c) Narcolepsy d) Sleep apnea

Sleep apnea Explanation: Sleep apnea refers to recurrent periods of absence of breathing for 10 seconds or longer, occurring at least 5 times per hour.

The nurse makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep are unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to: a) use caution when driving an automobile. b) change bedtime to later in the evening. c) ingest a small amount of alcohol prior to bedtime. d) drink at least 1 cup of coffee with the evening meal.

use caution when driving an automobile. Explanation: The client is describing hypersomnia and is at increased risk for a motor vehicle accident when drowsy while driving an automobile. The client is to avoid alcohol, caffeine, and late night activities.

A nurse caring for a client with hypersomnia investigates the cause of the sleep disorder. What are possible causes to consider? Select all that apply. a) Malnourishment b) Eating disorders c) Alcohol abuse d) Depression e) Another sleep disorder, such as sleep apnea f) Some medications

• Another sleep disorder, such as sleep apnea • Depression • Alcohol abuse • Some medications Explanation: The possible causes to hypersomnia could include another sleep disorder (such as sleep apnea), depression, alcohol abuse, or the effect of some medications. Malnourishment and eating disorders would not be a cause of hypersomnia.

During an orientation class for new RN graduates, the nurse educator identifies which conditions as potential risks for clients to experience sleep pattern disturbance? Select all that apply. a) Glaucoma b) Type 1 diabetes mellitus (DM) c) Substance abuse d) Stroke e) Depression f) Constipation

• Depression • Substance abuse • Constipation • Stroke Explanation: People engaged in changing shift work, particularly overnights, can be prone to higher risk of depression, loneliness, substance abuse, type 2 DM, and gastrointestinal and cardiovascular symptoms.

How should an injured muscle associated with exercise be treated? (Select all that apply.) a) Apply heat to the injured area. b) Consult a health care provider within 1 week. c) Keep the injured elevated. d) Apply an elastic bandage to the injured area. e) Continue exercising unless there is pain.

• Keep the injured elevated. • Apply an elastic bandage to the injured area. Explanation: Elevation of an injured area will help to reduce edema. An elastic bandage for compression will help to reduce edema. Ice should be applied to minimize pain and edema. Ice, not heat, should be applied to minimize pain and edema. A physician (or health care provider) should be contacted immediately to diagnose the extent of the injury. Exercising should be discontinued until the injury is healed.