Ch 34: Sleep NCLEX Q's

Sleep-wake cycles across the life span

-Children and infants have up to 14 hours of sleep a day, 6 hours of REM, 8 hours of NON-REM sleep -Adults sleep around 8 hours, 1-2 hours REM, 6-7 hours NON-REM -Older adults require even less sleep about 6 hours, 1 hours of REM and 5 hours of NON-REM sleep

Sleep Diary

-Client may be asked to keep track of: -Time factors associated with sleep -Activities performed 2-3 hours prior to sleep -Consumption of caffeine, alcohol -Medications -Bedtime rituals -Difficulty remaining awake during day -Any worries or fears that may be contributing

Drugs & Their effects on Sleep: Anticonvulsants

-Decrease REM sleep time -Cause daytime drowsiness

Stage 4: NREM

-Deepest stage of sleep -Very difficult to arouse sleeper -If sleep loss has occurred, sleeper will spend considerable portion of night in this stage -VS are significantly lower than during waking hours -Stage lasts approx. 15-30 minutes -Sleepwalking and enuresis sometimes occur

Primary hyperparathyroidism

problem with the parathyroid gland itself Noncancerous growth: Adenoma (most common) Hyperplasia of the glands (enlargement) Cancerous growth

Stage 3: NREM Sleep

-Important for children and adolescents -Initial stages of deep sleep -Sleeper difficult to arouse and rarely moves -Muscles completely relaxed -Vital signs decline but remain regular -Lasts 15 to 30 minutes -Hormonal response includes secretion of growth hormone (stages 3 & 4)

Tetany

(severe) due to low calcium and high phosphate level which is involuntary muscle cramping and contraction: bronchospasm and laryngospasms, hand/feet spasms, seizures, EKG changes

Which of the following substances is a natural hormone produced by the pineal gland that induces sleep? 1)Amphetamine 2)Melatonin 3)Methylphenidate 4)Pemoline

2)Melatonin

The nurse recognizes that a client is experiencing insomnia when the client reports

1.Difficulty staying asleep 2.Extended time to fall asleep 3.Feeling tired after a night's sleep These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia. Falling asleep at inappropriate times is indicative of narcolepsy.

Which of the following sleep disorders is the most prevalent? 1)Hypersomnia 2)Insomnia 3)Parasomnia 4)Sleep-awake schedule disturbance.

2) Insomnia

Select all that apply to the use of barbiturates in treating insomnia: 1)Barbiturates deprive people of NREM sleep 2)Barbiturates deprive people of REM sleep 3)When the barbiturates are discontinued, the NREM sleep increases. 4)When the barbiturates are discontinued, the REM sleep increases. 5)Nightmares are often an adverse effect when discontinuing barbiturates.

2, 4, 5

22. A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart? 1. naloxone HCl (Narcan 2. activated charcoal 3. flumazenil (Romazicon) 4. ipecac syrup

22. Answer: 2. There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the GI tract, preventing absorption.

A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply. 1)Eat a heavy snack before bedtime 2)Read in bed before shutting out the light 3)Leave the bedroom if you are unable to sleep 4)Drink a cup of warm tea with milk at bedtime 5)Exercise in the afternoon rather than the evening 6)Count backwards from 100 to 0 when your mind is racing.

3, 5, 6

3. The nurse finds a client sleep walking down the unit hallway. An appropriate intervention the nurse implements is: 1. Asking the client what he or she is doing and call for help 2. Quietly approaching the client and then loudly calling his or her name 3. Lightly tapping the client on the shoulder and leading him or her back to bed 4. Blocking the hallway with chairs and seating the client

3. Answer: 3. The nurse should not startle the client but should gently awaken the client and lead him or her back to bed.

30. Which of the following substances is a natural hormone produced by the pineal gland that induces sleep? 1. Amphetamine 2. Melatonin 3. Methylphenidate 4. Pemoline

30. Answer: 2. Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.

Narcolepsy can be best explained as: 1)A sudden muscle weakness during exercise 2)Stopping breathing for short intervals during sleep 3)Frequent awakenings during the night 4)An overwhelming wave of sleepiness and falling asleep

4) An overwhelming wave of sleepiness and falling asleep

Which of the following conditions characterizes rapid eye movement (REM) sleep? 1)Disorientation and disorganized thinking 2)Jerky limb movements and position changes 3)Pulse rate slowed by 5 to 10 beats/minute 4)Highly active brain and physiological activity levels.

4) Highly active brain and physiological activity levels.

Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants? 1)Prevent any activity within the hospital setting while on oral muscle relaxants 2)Make sure that the patient knows that sedation should be minimal with these agents. 3)Cardiovascular stimulation, a common side effect, would lead to hypertension 4)Make sure the patient's call light is close by in case of the need for assistance with activities.

4) Make sure the patient's call light is close by in case of the need for assistance with activities.

Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent? 1) Alteration in tissue 2) perfusion 3) Fluid volume excess 4) Risk for injury 5) Risk for infection

4) Risk for injury

4. The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises. 1. 1st 2. 2nd 3. 3rd 4. 4th

4. Answer: 1. The client is most sensitive to noise in the hospital setting the first night because everything is new. This represents sensory overload, which interferes with sleep and decreases rapid eye movement (REM) as well as total sleep time.

5. Which of the following medications are the safest to administer to adults needing assistance in falling asleep? 1. Sedatives 2. Hypnotics 3. Benzodiazepines 4. Anti-anxiety agents

5. Answer: 3. The group of drugs that are the safest are the benzodiazepines. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.

6. To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.) 1. Drinking a glass of wine just before retiring to bed 2. Eating a large meal 1 hour before bedtime 3. Consuming a small glass of warm milk at bedtime 4. Performing mild exercises 30 minutes before going to bed

6. Answer: 3. A small glass of milk relaxes the body and promotes sleep.

4.Which patient is at highest risk for obstructive sleep apnea? 82-year-old male with Parkinson's disease who has dysphagia 68-year-old obese male who smokes one pack of cigarettes per day 18-year-old female with cystic fibrosis who has recurrent pneumonia 35-year-old female with a BMI of 22 kg/m2 who has seasonal allergies to pollen

68-year-old obese male who smokes one pack of cigarettes per day Risk of obstructive sleep apnea increases with obesity (BMI > 28 kg/m2), age more than 65 years, neck circumference > 17 inches, craniofacial abnormalities, and acromegaly. Smokers are more at risk for OSA, and OSA is more common in men than women (until menopause).

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 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.

A. A patient who has uncontrolled hypothyroidism. B. A patient with coronary artery disease. C. A patient who has GERD. A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has 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 is caring for an older adult who is having trouble getting to sleep at night and formulates the nursing diagnosis Disturbed sleep pattern: Initiation of sleep. Which 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.

A. Arrange for assessment for depression and treatment. B. Discourage napping during the day. E. Encourage patient to engage in some type of physical activity. F. Assess medication for side effects of sleep pattern disturbances. 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.

A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? Select all that apply. A. Daily mental activities B. Daily physical activities C. Morning and evening body temperature D. Daily measurement of fluid intake and output E. Presence of anxiety or worries affecting sleep F. Morning and evening blood pressure readings

A. Daily mental activities B. Daily physical activities E. Presence of anxiety or worries affecting sleep A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is not usually kept in a sleep diary.

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.

A. Follow the usual bedtime routine if possible. 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 caring for patients in a long-term care facility is implementing interventions to help promote sleep in older adults. 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

A. Increase physical activities during the day. In order to promote sleep in the older adult, 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 observes involuntary muscle jerking in a sleeping patient. What would be the nurse's next action? A. No action is necessary as this is a normal finding during sleep. B. Call the primary care provider to report possible neurologic deficit. C. Lower the temperature in the patient's room. D. Awaken the patient as this is an indication of night terrors.

A. No action is necessary as this is a normal finding during sleep. Involuntary muscle jerking occurs in stage I NREM sleep and is a normal finding. There are no further actions needed for this patient.

A patient has obstructive sleep apnea (OSA). What should the nurse include in the teaching related to ways the patient can minimize the negative effects of OSA? Select all that apply. A Raise the head end of the bed slightly. B Use an oral appliance that prevents the airway from collapsing. C Sleep in a side-lying position. D Avoid consuming alcoholic beverages several hours before going to sleep. E Take sleeping pills before going to bed.

A.B.C.D Raising the head end of the bed keeps the airway open and prevents blockage to the airway. An oral appliance serves as special mouth guard to prevent the airway from collapsing. Sleeping on the side may help the patient to breathe easily. Alcoholic beverages may worsen OSA by decreasing the muscle tone and causing airway collapse. Use of sedatives will exacerbate OSA due to respiratory depression.

A patient with obstructive sleep apnea tells the nurse, "I just hate using this continuous positive airway pressure (CPAP) thing, but I know I need it. Is there anything I can do so that I don't need to use it?" Which of these would be an appropriate suggestion from the nurse? A Taking a nap during the day. B Referral to a weight loss program. C Trying a mild sedative at bedtime. D Drinking a glass of wine just before bedtime.

B. Because excessive weight worsens obstructive sleep apnea (OSA), referral to a weight loss program may be indicated. Weight loss and bariatric surgery reduce OSA. Daytime napping does not help this condition. Instruct the patient to avoid taking sedatives or consuming alcoholic beverages for three to four hours before sleep. Sleep medications often make OSA worse.

A nurse on a maternity ward is teaching new mothers about the sleep patterns of infants and how to keep them safe during this stage. What comment from a parent alerts the nurse that further teaching is required? A. "I can expect my newborn to sleep an average of 16 to 24 hours a day." B. "If I see eye movements or groaning during my baby's sleep I will call the pediatrician." C. "I will place my infant on his back to sleep." D. "I will not place pillows or blankets in the crib to prevent suffocation."

B. "If I see eye movements or groaning during my baby's sleep I will call the pediatrician." Eye movements, groaning, grimacing, and moving are normal activities at this age and would not require a call to the pediatrician. Newborns sleep an average of 16 to 24 hours a day. Infants should be placed on their backs for the first year to prevent SIDS. Parents should be cautioned about placing pillows, crib bumpers, quilts, stuffed animals, and so on in the crib as it may pose a suffocation risk.

A nurse caring for patients in a busy hospital environment should implement which recommendation to promote sleep? A. Keep the room light dimmed during the day. B. Keep the room cool. C. Keep the door of the room open. D. Offer a sleep aid medication to patients on a regular basis.

B. Keep the room cool. The nurse should keep the room cool and provide earplugs and eye masks. The nurse should also maintain a brighter room environment during daylight hours and dim lights in the evening, and keep the door of the room closed. Sleep aid medications should only be offered as prescribed.

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. Circadian rhythm sleep-wake disorder B. Narcolepsy C. Enuresis D. Sleep apnea

B. Narcolepsy Narcolepsy is an uncontrollable desire to sleep; the person may fall asleep in the middle of a conversation. Circadian rhythm sleep-wake disorders are characterized by a chronic or recurrent pattern of sleep-wake rhythm disruption primarily caused by an alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep-wake schedule desired or required; a sleep-wake disturbance (e.g., insomnia or excessive sleepiness); and associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder) (Sateia, 2014). Enuresis is urinating during sleep or bedwetting. Sleep apnea is a condition in which breathing ceases for a period of time between snoring.

Enuresis

Bed wetting

Function of T3 and T4

Burns calories How fast new cells how fast digest food stimulates sympathetic nervous system (alertness, quick responses,) body temp Regulates brain development

A patient with sleep apnea asks the nurse, "What can I do to get better sleep?" What is an appropriate nursing response? A "Taking one to two sleeping pills at night will prevent sleep apneic episodes." B "Keeping your hypertension under control is beneficial for general health." C "Being overweight is a contributing factor; losing weight can often resolve apnea." D "High blood glucose levels contribute to the apnea; monitor your sugar carefully."

C. Being overweight is an important risk factor for sleep apnea. Reducing weight often helps in resolving this condition. Taking sleeping pills may habituate a person, and taking it on a regular basis should be avoided. Keeping hypertension and blood glucose in control is beneficial for general health, but is not related to sleep apnea specifically.

The patient is scheduled for a sleep study test to see if the patient has mild sleep apnea. What should the nurse teach the patient to do until the test can be completed? IncorrectA Take sleep medications B Use the spouse's continuous positive airway pressure (CPAP) mask C Sleep in a side-lying position D Do not use pillows when sleeping

C. Conservative treatment for mild obstructive sleep apnea (OSA) begins with sleeping on one's side. Sleep medication often makes OSA worse. CPAP is adjusted for the patient and used with more severe symptoms after diagnosis. Elevating the head of the bed may eliminate OSA.

A patient with severe sleep apnea has been prescribed continuous positive airway pressure (CPAP). A nurse adjusts the blower to maintain adequate positive pressure during inspiration and expiration. The nurse should maintain the pressure in what range? A.1-5 cm of H2O B.5-10 cm of H2O C.5-25 cm of H2O D.1-25 cm of H2O

C. The pressure required to maintain an adequate positive pressure is 5-25 cm of H2O. This range of pressure is essential to avoid collapse of the airway.

PTH Negative feedback loop

Low levels of calcium detected in the blood causes the parathyroid gland to release PTH which stimulated the bones and kidneys to increase calcium levels.

A nurse is discussing with an older adult patient measures to take to induce sleep. What teaching point might the nurse include? A. Drinking a cup of regular tea at night induces sleep. B. Using alcohol moderately promotes a deep sleep. C. Having a small bedtime snack high in tryptophan and carbohydrates improves sleep. D. Exercising right before bedtime can hinder sleep.

C. Having a small bedtime snack high in tryptophan and carbohydrates improves sleep. The nurse would teach the patient that having a small bedtime snack high in tryptophan and carbohydrates improves sleep. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity within a 3-hour interval before normal bedtime can hinder sleep.

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. It would be most difficult to awaken him at this time. E. This stage constitutes around 20% to 25% of total sleep. 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 and IV sleep. In stage IV NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.

To assist an adult client to sleep better, the nurse recommends which of the following?

Consuming a small glass of warm milk at bedtime A small glass of milk relaxes the body and promotes sleep. Alcohol, large meals, and exercising all within 1 to 2 hours of bedtime have insomnia-producing effects and may, in fact, stimulate wakefulness. Large meals could also produce indigestion.

Oral calcium with Vitamin D for hypoparathyroidism

Calcium Carbonate "Os-cal with vitamin D" (patient education: GI upset, constipation...renal calculi...flank pain) ***Calcium supplements interfere with the absorption of iron and thyroid hormone so give at separate times

IV calcium

Calcium glutinate very low calcium levels give slowly as ordered (be on cardiac monitor and watch for cardiac dysrhythmias). Assess for infiltration or phlebitis because it can cause tissue sloughing (best to give via a central line). Also, watch if patient is on Digoxin because this can cause Digoxin toxicity.

The nurse observes a patient's respirations during sleep and notes the absence of respirations that lasts from 15 to 45 seconds. What should the nurse consider this patient is experiencing? 1. laryngeal spasm 2. sleep apnea 3. respiratory acidosis 4. renal failure

Correct Answer: 2 Manifestations of obstructive sleep apnea include periods of apnea that last 15 to 120 seconds. No symptoms of laryngeal spasm or renal failure are noted. Respiratory acidosis would be diagnosed from arterial blood gases.

A nurse working in a sleep lab 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. 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. 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.

Complementary/alternative therapy for Alzheimer's Disease Patient

Ginko Biloba Fish high in omega-3 fatty acids 1000 international units vitamin E twice daily

Thyroid storm

Hyperthyroidism Abrupt onset of CHF Delirium Altered clotting Temperature, pulse, b/p and respirations will increase.

How does the thyroid gland release T3 and T4 Feedback loop

Hypothalumus = TRH =Anterior Pituitary gland = TSH(thyroid stimulating hormone) = Thyroid = T3 and T4

Parathyroid Gland

In the neck behind the thyroid gland 4 parathyroid glands and they secrete parathyroid hormone

3.What type of drug regimen would the nurse anticipate being prescribed for a 52-year-old man diagnosed with narcolepsy and cataplexy? Valerian and diazepam (Valium) Melatonin and ropinirole (Requip) Modafinil (Provigil) and desipramine (Norpramin) Diphenhydramine (Benadryl) and low dose fluoxetine (Prozac)

Modafinil (Provigil) and desipramine (Norpramin) Narcolepsy drug management includes amphetamine-like stimulants or non-amphetamine wake-promotion drugs (e.g., modafinil) to relieve excessive daytime sleepiness and antidepressant drug therapy (e.g, desipramine) to control cataplexy. Drugs that often cause drowsiness such as diazepam, melatonin, and diphenhydramine are not indicated for use in patients wtih narcolepsy.

Parathyroid Hormone Replacement: Natpara

Monitor calcium levels: can increase calcium levels too high, GI issues nausea vomiting, paresthesia

Paresthesia

Tingling sensation of the mouth, face, and finger/toes

Foods that promote the growth of a goiter are

Turnips spinach cabbage Seafood

Nocturia

Urination during the night

2ndary causes of hyperparathyroidism

a disease that is causing the hyperparathyroid gland to mess up hypocalcemia - overworked to try to keep calcium levels up. Vitamin D deficiency: low absorption of calcium Chronic renal failure: kidneys aren't able to activate the vitamin d = intestines cannot absorb calcium, and kidneys do not absorb calcium.

1.The nurse providing care to a group of patients during the night sets a goal of promoting restful sleep. The nurse defines sleep as an unconscious state in which arousal is not easily accomplished. a basic but unorganized behavior that is not necessary to survival. a state of chemical balance among acetylcholine, norepinephrine, and serotonin. a state during which a person lacks conscious awareness but can easily be aroused.

a state during which a person lacks conscious awareness but can easily be aroused.

Which statement made by the parent of a school aged child requires follow up by the nurse? a. I encourage evening exercise about an hour before bedtime b. I make sure that the room is dark and quiet at bedtime c. We use quiet activities such as reading a book before bedtime

a. I encourage evening exercise about an hour before bedtime Best evidence related to sleep hygiene recommends avoiding exercise within 2 hours of bedtime. Exercise should be in the morning or afternoon. Encourage the parent to use quiet activities before bedtime to promote sleep

Signs and symptoms of sleep apnea include which of the following? a. Loud snoring b. Difficulty falling asleep c. Headache in the evening d. Nighttime sleepiness

a. Loud snoring

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

b. Antihistamines should not be used because they can cause confusion and increase your risk of falls. Older adults should avoid the use of over the counter antihistamines. These medications have a long duration of action in older adults and can cause confusion, constipation, urinary retention, and increased risk of falls.

The most effective treatments for sleep apnea include all of the following EXCEPT a. weight loss. b. the use of stimulant drugs. c. the use of a continuous positive airway pressure (CPAP) mask. d. surgery for breathing obstructions.

b. the use of stimulant drugs.

loop diuretics "Lasix":

decreases calcium levels by inhibiting calcium resorption in the renal tubules (watch potassium levels)

Hypoparathyroidism diet

high calcium dairy, green leafy vegetables low in phosphate organ meats, soft drinks, eggs

7. Which studies are used to diagnose insomnia? EEG Self-report Actigraphy Polysomnography

Self-report

3. Which assessment question is most appropriate when the nurse is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)? "Do you smoke?" "Do you tend to awaken early in the morning?" "Are you under a lot of stress at work or at home right now?" "Do you have a history of chronic obstructive pulmonary disease?"

"Do you smoke?" Smoking is a major etiologic factor in OSA. Early wakening and stress are associated with insomnia, not OSA in particular. COPD exacerbates the hypoxemia associated with OSA but does not precipitate the onset of OSA itself.

10. A patient was just diagnosed with narcolepsy and wants to know what he can do to get rid of it. What is the best response the nurse can give this patient? "If you take your medicine and naps, you will be cured." "Patient support groups may be able to help you feel better." "Drug therapy and behavioral strategies will be used to help treat it." "Safety precautions must only be when you are driving an automobile."

"Drug therapy and behavioral strategies will be used to help treat it."

2.The nurse teaches a 44-year-old woman with a sleep disorder about sleep hygiene. Which statement, if made by the patient, indicates understanding of the instructions? "I will go to bed at the same time whether I am sleepy or not." "I should set the temperature in my bedroom under 70° F at night." "I must stop drinking alcoholic beverages 2 hours before I go to bed." "I can use the prescribed sleeping pills every night to help me stay asleep."

"I should set the temperature in my bedroom under 70° F at night." Good sleep hygiene should include the following: a cool, dark, and quiet bedroom, going to bed only when sleepy, avoiding sleeping pills or using them cautiously, and avoiding alcohol for at least 4 to 6 hours before bedtime.

Bisphosphonates:

"Pamidronate (Aredia) or Alendronate (Fosamax)" helps protect bones from losing calcium by slowing down osteoclasts (which break down bones) and allow osteoblasts to work (to help build bones) Patient education for Fosmax: take on empty stomach, by itself, with a full glass of water, and sit-up right for 30 minutes after taking (very hard on the esophagus and stomach and can cause ulcers)...wait 30 minutes before taking antacids, vitamins.

Chvostek's Sign

(nerve hyperexcitability of the facial nerves). To elicit this response, you would tap at the angle of the jaw via the masseter muscle and the facial muscles on the same side of the face will contract momentarily (the lips or nose will twitch) if positive.

Drugs & Their effects on Sleep: Benzodiazepines

-Alter REM sleep -Increase sleep time -Increase daytime sleepiness

Drugs & Their effects on Sleep: Beta-Adrenergic Blockers

-Cause nightmares -Cause insomnia -Cause awakening from sleep

Sleep Deprivation: Physiologic Signs & Symptoms

-Hand tremors -Decreased reflexes -Slowed response time -Reduction in word memory -Decrease in reasoning and judgment -Cardiac dysrhythmias

Drugs & Their effects on Sleep: Nicotine

-Decreases total sleep time -Decreases REM sleep time -Causes awakening from sleep -Causes difficulty staying asleep

Client Education

-Importance of sleep -Conditions that interfere with sleep -Safe use of sleep medications -Effects of prescribed medications on sleep -Effects of disease states on sleep

Insomnia

-Difficulty falling asleep -Waking up frequently -Difficulty staying asleep -Daytime sleepiness -Difficulty concentrating -Irritability -Risk factors: older age & females

Sleep Apnea

-Frequent short breathing pauses during night -More than 5 apneic episodes >10 sec/hr considered abnormal -Symptoms include snoring, frequent awakenings, difficulty falling asleep, morning headaches, memory and cognitive problems, irritability -Types: obstructive (obese patients, swollen tonsils), central (CNS disturbance; basically forget to breath), or mixed -Wear a CPAP at night

Stage 1: NREM

-Lightest level of sleep -Lasts a few minutes -Decreased physiological activity beginning with a gradual fall in vital signs and metabolism -Person easily aroused by sensory stimuli such as noise -If person awakes, feels as though daydreaming has occurred -Reduction in autonomic activities

Outcomes for Clients with Sleep disturbances

-Maintain (or develop) a sleeping pattern than provides sufficient energy for daily activities -Enhance feeling of well being -Improve the quality and quantity of the client's sleep

Sleep Deprivation: Psychological signs and symptoms

-Mood swings -Disorientation -Irritability -Decreased motivation -Fatigue -Sleepiness -Hyperexcitability

Drugs & Their effects on Sleep: Diuretics

-Nighttime awakenings caused by nocturia

Stage 2: NREM Sleep

-Period of sound sleep -Relaxation progresses -Arousal still easy -Lasts 10 to 20 minutes -Body functions still slowing

Drugs & Their effects on Sleep: Caffeine

-Prevents person from falling asleep -Causes person to awaken during night -Interferes with REM sleep

Functions of Sleep

-Purpose of sleep is physiological and psychological restoration and maintenance of biological functions -Restores normal levels of activity -Restores normal balance among parts of the nervous system -Necessary for protein synthesis -Psychological well-being -Dreams: occur in NREM & REM sleep; important for learning, memory and adaptation to stress

NANDA; Sleep pattern disturbances as etiology of other diagnoses

-Risk for injury -Ineffective coping -Fatigue -Risk for impaired gas exchange -Deficient knowledge -Anxiety -Activity intolerance

General Nursing Interventions for Sleep Disturbances

-Scheduling nursing care to promote uninterrupted sleep -Teaching stress reduction, relaxation techniques or good sleep hygiene -Limited interruptions during the night, provide a quiet environment with a comfortable room temperature, limit the number of visitors and duration of visits, carry out all the procedures within a given time frame

Sleep Pattern Assessment

-Sleep history -Health history -Physical exam -If warranted, a sleep diary and diagnostic studies

Drugs & Their effects on Sleep: Alcohol

-Speeds onset of sleep -Reduces REM sleep -Awakens person during night and causes difficulty returning to sleep

Drugs & Their effects on Sleep: Opiates

-Suppress REM sleep -Cause increased daytime drowsiness

Drugs & Their effects on Sleep: Antidepressants & Stimulants

-Suppress REM sleep -Decrease total sleep time

NANDA: Disturbed Sleep Pattern

-with specific descriptions such as difficulty falling asleep or difficulty staying asleep -Various etiologies may be involved and specified

When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is: 1)Headache 2)Early awakening 3)Impaired reasoning 4)Excessive daytime sleepiness

4) Excessive daytime sleepiness

The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply): 1)Extended time to fall asleep 2)Falling asleep at inappropriate times 3)Difficulty staying asleep 4)Feeling tired after a night's sleep

1, 3, 4

A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply: 1) Chronic stress 2) Severe anxiety 3) Generalized pain 4) Excessive caffeine 5) Chronic depression 6) Environmental noise

1, 4, 6

The nurse is providing health teaching for a client using herbal compounds such as valerian for sleep. What points need to be included?

1. Should not be used indefinitely 2. May interfere with prescribed medications 3. Over time they can lead to further sleep problems 4. Are not regulated by the Food and Drug Administration (FDA)

The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS), the best position in which to place the baby after nursing is

1. Supine 2. Side lying Research demonstrates that the occurrence of SIDS is reduced with these two positions. Placing the infant prone has been implicated as a cause of SIDS. Fowler's position is a semi-sitting position and has not been discussed in the prevention of SIDS.

10. The nurse understands that the most vivid dreaming occurs during: 1. REM sleep 2. Stage 1 NREM 3. Stage 4 NREM 4. Transition period from NREM to REM sleep

10. Answer: 1. Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate and are believed to be functionally important to learning, memory processing, and adaptation to stress.

11. A client taking a beta adrenergic blockers for HTN can experience interference with sleep patterns such as: 1. Nocturia 2. Increased daytime sleepiness 3. Increased awakening from sleep 4. Increased difficulty falling asleep

11. Answer: 2. Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.

12. Narcolepsy can be best explained as: 1. A sudden muscle weakness during exercise 2. Stopping breathing for short intervals during sleep 3. Frequent awakenings during the night 4. An overwhelming wave of sleepiness and falling asleep

12. Answer: 4. Narcolepsy is a dysfunction of mechanisms that regulate the sleep and wake states. Excessive daytime sleepiness is the most common complaint associated with this disorder. During the day a person may suddenly feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur within 15 minutes of falling asleep.

13. A nursing measure to promote sleep in school-age children is to: 1. Make sure the room is dark and quiet 2. Encourage evening exercise 3. Encourage television watching 4. Encourage quiet activities prior to bed time.

13. Answer: 4. The amount of sleep needed during the school years is individualized because of varying states of activities and levels of health. A 6-year old averages 11-12 hours of sleep nightly, whereas an 11-year old sleeps about 9-10 hours. The 6- or 7-year old can usually be persuaded to go to bed by encouraging quiet activities.

14. A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply. 1. Eat a heavy snack before bedtime 2. Read in bed before shutting out the light 3. Leave the bedroom if you are unable to sleep 4. Drink a cup of warm tea with milk at bedtime 5. Exercise in the afternoon rather than the evening 6. Count backwards from 100 to 0 when your mind is racing.

14. Answer: 3, 5, and 6. Lying in bed when one is unable to sleep increases frustration and anxiety which further impede sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backwards requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.

15. A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply: 1. Chronic stress 2. Severe anxiety 3. Generalized pain 4. Excessive caffeine 5. Chronic depression 6. Environmental noise

15. Answer: 1, 4, and 6. Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.

16. A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care? 1. Monitor apical heart rate every 2 hours 2. Monitor blood pressure every 4 hours 3. Instruct the client to call for ambulation assistance 4. Clear a path to the bathroom at bedtime.

16. Answer: 3. Chloral hydrate is a sedative. This medication does not affect cardiac function. Blood pressure changes are not significant with the use of this medication. A client should call for assistance to the bathroom at night. Additionally, the client may experience residual daytime sedation; therefore, the nurse should instruct the client to call for ambulation assistance during the daytime hours.

17. Select all that apply to the use of barbiturates in treating insomnia: 1. Barbiturates deprive people of NREM sleep 2. Barbiturates deprive people of REM sleep 3. When the barbiturates are discontinued, the NREM sleep increases. 4. When the barbiturates are discontinued, the REM sleep increases. 5. Nightmares are often an adverse effect when discontinuing barbiturates.

17. Answer: 2, 4, and 5. Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares.

18. Select all that apply that is appropriate when there is a benzodiazepine overdose: 1. Administration of syrup of ipecac 2. Gastric lavage 3. Activated charcoal and a saline cathartic 4. Hemodialysis 5. Administration of Flumazenil

18. Answer: 2, 3, and 5. If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation.

19. A patient is admitted to the emergency department with an overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart? 1. naloxone (Narcan) 2. naltrexone (ReVia) 3. nalmefene (Revex) 4. flumazenil (Romazicon)

19. Answer: 4. Flumazenil is the antidote for benzodiazepine overdoses.

A client taking a beta adrenergic blockers for hypertension can experience interference with sleep patterns such as: 1)Nocturia 2)Increased daytime sleepiness 3)Increased awakening from sleep 4)Increased difficulty falling asleep

2) Increased daytime sleepiness Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.

When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about: 1) Nonsteroidal antiinflammatory drugs (NSAIDs) 2) Opioids 3) Anticonvulsants 4) Antidepressants 5) Adjuvants

2) Opioids

To validate the suspicion that a married male client has sleep apnea the nurse first: 1) asks the client if he experiences apnea in the middle of the night 2) Questions the spouse if she is awakened by her husband's snoring 3) Places the client on a continuous positive airway pressure (CPAP) device 4) Schedules the client for a sleep test

2) Questions the spouse if she is awakened by her husband's snoring

Older adults who take long-acting sedatives or hypnotics are likely to experience: 1)Hallucinations 2)Ataxia 3)Alertness 4)Dyspnea

2)Ataxia

Select all that apply that is appropriate when there is a benzodiazepine overdose: 1)Administration of syrup of ipecac 2)Gastric lavage 3)Activated charcoal and a saline cathartic 4)Hemodialysis 5)Administration of Flumazenil

2, 3, 5

2. When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:. 1. Nonsteroidal antiinflammatory drugs (NSAIDs) 2. Opioids 3. Anticonvulsants 4. Antidepressants 5. Adjuvants

2. Answer: 2. Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.

20. Older adults who take long-acting sedatives or hypnotics are likely to experience: 1. Hallucinations 2. Ataxia 3. Alertness 4. Dyspnea

20. Answer: 2. If longer-acting barbiturates are used in older adults, these clients may experience daytime sedation, ataxia, and memory deficits.

21. Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent? 1. Alteration in tissue perfusion 2. Fluid volume excess 3. Risk for injury 4. Risk for infection

21. Answer: 3. Sedative-hypnotics cause CNS depression, putting the patient at risk for injury.

23. During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating: 1. "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time." 2. "Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis." 3. "Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses." 4. "There really is no difference; the terms are used interchangeably."

23. Answer: 3. Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.

24. The patient's chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced: 1. Delirium tremens 2. Malignant hyperthermia 3. A tonic-clonic seizure 4. Respiratory arrest

24. Answer: 2. Dantrolene is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia.

25. Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent? 1. Use IM dosage forms for longer duration 2. Administer safely with other CNS depressants for insomnia 3. Monitor geriatric patients for the common occurrence of paradoxical reactions. 4. Evaluate for physical dependence that occurs within 48 hours of beginning the drug.

25. Answer: 3

26. Pediatric and geriatric patients often react with more sensitivity to CNS depressants. This type of sensitivity manifests itself in the development of which type of reaction? 1. Idiopathic 2. Teratogenic 3. Paradoxical 4. Psychogenic

26. Answer: 3

27. Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants? 1. Prevent any activity within the hospital setting while on oral muscle relaxants 2. Make sure that the patient knows that sedation should be minimal with these agents. 3. Cardiovascular stimulation, a common side effect, would lead to hypertension 4. Make sure the patient's call light is close by in case of the need for assistance with activities.

27. Answer: 4

28. Which of the following conditions characterizes rapid eye movement (REM) sleep? 1. Disorientation and disorganized thinking 2. Jerky limb movements and position changes 3. Pulse rate slowed by 5 to 10 beats/minute 4. Highly active brain and physiological activity levels.

28. Answer: 4. Highly active brain and physiological activity levels characterize REM stage. Stages 3 and 4 of NREM sleep are characterized by disorientation and disorganization, During REM sleep, the body movement ceases except for the eyes. The pulse rate slows by 5-10 beats/minute during NREM sleep, not REM sleep.

29. Which of the following sleep disorders is the most prevalent? 1. Hypersomnia 2. Insomnia 3. Parasomnia 4. Sleep-awake schedule disturbance.

29. Answer: 2. Approximately 1/3 of American adults have some type of sleep disorder, and insomnia is the most common.

During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating: 1)"Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time." 2)"Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis." 3)"Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses." 4)"There really is no difference; the terms are used interchangeably."

3) "Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses."

The nurse finds a client sleepwalking down the unit hallway. An appropriate intervention the nurse implements is: 1) Asking the client what he or she is doing and call for help 2) Quietly approaching the client and then loudly calling his or her name 3) Lightly tapping the client on the shoulder and leading him or her back to bed 4) Blocking the hallway with chairs and seating the client

3) Lightly tapping the client on the shoulder and leading him or her back to bed

Which of the following medications are the safest to administer to adults needing assistance in falling asleep? 1) Sedatives 2) Hypnotics 3) Benzodiazepines 4) Anti-anxiety agents

3)Benzodiazepines

To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.) 1)Drinking a glass of wine just before retiring to bed 2)Eating a large meal 1 hour before bedtime 3)Consuming a small glass of warm milk at bedtime 4)Performing mild exercises 30 minutes before going to bed

3)Consuming a small glass of warm milk at bedtime

Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent? 1)Use IM dosage forms for longer duration 2)Administer safely with other CNS depressants for insomnia 3)Monitor geriatric patients for the common occurrence of paradoxical reactions. 4)Evaluate for physical dependence that occurs within 48 hours of beginning the drug.

3)Monitor geriatric patients for the common occurrence of paradoxical reactions.

A nursing measure to promote sleep in school-age children is to: 1)Make sure the room is dark and quiet 2)Encourage evening exercise 3)Encourage television watching 4)Encourage quiet activities prior to bed time.

4) Encourage quiet activities prior to bed time.

7. The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply): 1. Extended time to fall asleep 2. Falling asleep at inappropriate times 3. Difficulty staying asleep 4. Feeling tired after a night's sleep

7. Answer: 1, 3, and 4. These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia.

8. The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply): 1. Prone 2. Side-lying 3. Supine 4. Fowler's

8. Answer: 2 and 3. Research demonstrate that the occurrence of SIDS is reduced with these two positions.

9. When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is: 1. Headache 2. Early awakening 3. Impaired reasoning 4. Excessive daytime sleepiness

9. Answer: 4. Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.

The client with sleep apnea asks her nurse how her new prescription for Xyrem (sodium oxybate) can help this problem. What is the nurse's best response? A. "The drug depresses your nervous system and allows you to have a deeper night's sleep." B. "Xyrem stimulates daytime wakefulness so that you are less likely to have narco-lepsy with your sleep apnea." C. "The drug reduces the water content of your oral mucous membranes, increasing the diameter of your throat so that your tongue does not obstruct your airway." D. "Xyrem constantly elevates the carbon dioxide content of your blood, which then triggers the respiratory centers of the brain so that you breathe more rapidly and more deeply."

A One problem with sleep apnea is that clients get so little restful sleep at night that they develop excessive daytime sleepiness (narcolepsy), often falling asleep while at work, driving, or per-forming other tasks. Xyrem does not help the apnea but does promote a deeper sleep, so that the client is less likely to fall asleep at inappropriate places or times during the day.

1. Which individual most clearly exhibits the signs and symptoms of primary insomnia? A man whose increased sleep latency is not clearly attributable to any particular cause A woman who is in the habit of having a cappuccino in the late evening while she watches TV A man whose corticosteroid therapy causes him to feel "edgy" and unable to fall asleep at night A woman who has experienced frequent nighttime awakenings since the recent death of her husband

A man whose increased sleep latency is not clearly attributable to any particular cause

What is the rationale for using CPAP to treat sleep apnea? A) positive air pressure holds the airway open B) negative air pressure holds the airway closed C) delivery of oxygen facilitates respiratory effort D) alternating waves of air stimulate breathing

A) positive air pressure holds the airway open

A patient with sleep apnea is given a noninvasive method of monitoring rest and activity cycles. The patient is required to wear a small watch device on the wrist. What is the name of this method? A Actigraphy IncorrectB Electromyogram C Polysomnography D Electrooculogram

A. Actigraphy is a noninvasive method of monitoring rest and activity cycles. In this method, a small actigraph watch is worn on the wrist to measure gross motor activity. An electromyogram records muscle tone. Polysomnography is also used to measure sleep apnea but through electrodes that record the main stages of sleep and wakefulness. Eye movements are recorded with an electrooculogram.

The spouse of a patient tells the nurse that, during sleep, the patient's respiration ceases for 10 seconds. This happens repeatedly during the night. As a result, the patient feels sleepy throughout the day. What is this condition known as? A Apnea B Insomnia C Hypopnea D Hypercapnia

A. Apnea is a medical condition in which there is a cessation of spontaneous respirations for 10 seconds or more. It can prevent the patient from sleeping soundly and cause daytime sleepiness. Insomnia is a lack of sleep. Hypopnea is a condition characterized by shallow respirations. Hypercapnia is a condition characterized by an increased concentration of carbon dioxide in the body.

Which assessment question is most appropriate when the nurse is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)? A. "Do you smoke?" B "Do you tend to awaken early in the morning?" C "Are you under a lot of stress at work or at home right now?" D "Do you have a history of chronic obstructive pulmonary disease (COPD)?"

A. Smoking is a major etiologic factor in OSA. Early wakening and stress are associated with insomnia, not OSA in particular. COPD exacerbates the hypoxemia associated with OSA, but does not precipitate the onset of OSA itself.

A patient has undergone an uvulopalatopharyngoplasty. Which instructions should the nurse give this patient at the time of discharge? Select all that apply. A "The throat may feel sore. It is normal." B "Snoring may persist until inflammation subsides." C "If you feel soreness in the throat, it is a sign of complication." D "If snoring doesn't stop immediately, you may need another surgery." E "There may be foul breath. You can reduce it by using a diluted mouthwash."

A.B.E The nurse has to inform the patient that a sore throat after surgery is normal. Snoring may also be present until the inflammation after surgery has subsided. The patient may have a foul breath odor that may be reduced by rinsing with diluted mouthwash and then salt water. Snoring and sore throat are commonly seen after surgery.

A patient's partner informs the nurse that the patient wakes up with a startle and gasps for breath several times at night. The nurse understands the patient is experiencing sleep apnea. What are the common risk factors in this patient for sleep apnea? Select all that apply. A Body mass index (BMI) 30 kg/m2 B Age 44 years C Habit of smoking D.Neck circumference 18 inches E .Occasional consumption of alcohol

A.C.D. The common risk factors for sleep apnea include BMI greater than 28 kg/m2, smoking habit, and neck circumference greater than 17 inches. Sleep apnea is often observed in patients older than 65 years. Occasional consumption of alcohol is not a risk factor by itself.

Which problem is associated with obesity, heavy snoring, and shallow breathing? A) Sleep apnea B) Narcolepsy C) Hypersomnia D) Hyperpnea

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

6. Which nursing observation of the patient in intensive care indicates that the patient is sleeping comfortably? 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 straight in bed, respirations 22, heart rate 66

ANS: A During NREM sleep, biological functions slow. During sleep, the heart rate decreases to 60 beats per minute or less. The patient experiences decreased respirations, blood pressure, and muscle tone.

8. The nurse is discussing lack of sleep with a middle-aged adult. The nurse recognizes that insomnia in this age group is commonly due to a. Anxiety. b. Teenagers keeping them awake. c. Caring for pets. d. Late night television.

ANS: A During middle adulthood, the total time spent sleeping at night begins to decline. Anxiety, depression, and illness can affect sleep, and women can experience menopausal symptoms. Insomnia is common because of the changes and stresses associated with middle age. Teenagers, caring for pets, and late night television can influence the amount of sleep; however, these are not the most common causes of insomnia in this age group.

22. The nurse is caring for a patient on the medical-surgical unit who is experiencing an exacerbation of asthma. Which of the following interventions would be most appropriate to help the patient sleep? a. Bed placed in semi-Fowler's position b. Increased BNC oxygen to 5 L a minute c. A snack provided before bedtime d. Encouraging the patient to read

ANS: A For patients with a physical illness, the nurse helps control symptoms that disrupt sleep. Placing the patient in an upright position eases the work of breathing. Increasing the oxygen provided would require a reason to do so, and a physician's order is required. Providing a snack and encouraging the patient to read may be good interventions for patients, but the most appropriate would be raising the head of the bed.

11. 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 is providing an educational session on sleep regulation for new nurses in the Sleep Disorder Treatment Center. Which of these statements by the nurses would best indicate that learning has occurred? a. "If the patient has a disease process in the central nervous system, it can influence the functions of sleep." b. "If the patient has a disease process in the cranial nerves, it can influence the functions of sleep." c. "If the patient has an interruption in the motor pathways, it can influence the functions of sleep." d. "If the patient has an interruption in the spinal reflexes, it can influence the functions of sleep."

ANS: A Sleep involves a sequence of physiological states maintained by the central nervous system. Current theory indicates that it is an active multiphase process that involves many parts of the brain and hormone and chemical secretion. A disease process associated with the cranial nerves, motor pathway, or spinal reflexes may influence a person's ability to sleep, but the best answer is the central nervous system.

16. The nurse is completing a sleep assessment on a patient. The nurse utilizes which of the following tools to complete the assessment? a. Visual Analogue Scale b. OUCHER scale c. FACES scale d. Glasgow Coma Scale

ANS: A The Visual Analogue Scale is utilized for assessing sleep quality. The OUCHER and FACES scales are used to measure pain, and the Glasgow Coma Scale is used to measure level of consciousness.

15. The nurse is caring for a patient who has been in holding in the emergency department for 24 hours. The nurse is concerned about the patient experiencing sleep deprivation. What would be the best action for the nurse to take? a. Expedite the process of obtaining a medical-surgical room for the patient. b. Pull the curtains shut, dim the lights, and decrease the number of visitors. c. Obtain an order for a medication to help the patient sleep. d. Ask everyone in the unit to try to be quiet so the patient can sleep.

ANS: A The most effective treatment for sleep deprivation is elimination or correction of factors that disrupt the sleep pattern. Nurses play an important role in identifying treatable sleep deprivation problems. Obtaining a private room in the designated unit for the patient will help with decreasing stimuli and promoting more rest than an individual can obtain in an emergency department even with the interventions mentioned.

24. The nurse is evaluating outcomes for the patient with the nursing diagnosis of Insomnia. During this process, the nurse recognizes that a. The patient is the best evaluator of sleep. b. Interventions will need to be adjusted. c. Medical conditions will not influence outcomes. d. Observations of the patient provide needed data.

ANS: A The patient is the source for evaluating outcomes. The patient is the only one who knows whether sleep problems have improved and what has been successful. Interventions may or may not need to be adjusted. Observations do provide needed data, but in the case of insomnia, the patient is the source for evaluating the restfulness of sleep. Sometimes, the nurse has to work with the patient to redefine sleep expectations associated with medical conditions.

A 32-year-old morbidly obese male complains of excessive fatigue, snoring, and awakening in the middle of the night, which prevents restorative sleep. He is sluggish during the day due to the lack of sleep and feels like he is going "fall asleep at the wheel" when driving to work. Occupation: dishwasher. Medical history includes hypertension and type 2 diabetes. Current medications include ACE inhibitor and metformin. Denies use of alcohol, tobacco, or drugs. On physical examination, the patient is afebrile, pulse 88, resps 20/min, BP 178/95. BMI is 45. These are signs and symptoms of: A. Obstructive sleep apnea B. Primary insomnia C. Heart failure D. All of the above

ANS: A With the obesity epidemic, the incidence of obstructive sleep apnea (OSA) is also increasing. Besides obesity, other predisposing and risk factors include narrowed upper airways, macroglossia, tonsillar hypertrophy, sleep medicines, alcohol, smoking, nasal obstruction, and hypothyroidism. It occurs more in middle-aged men. A thorough medication history, respiratory history, neurologic history, and mental health assessment should be performed. One of the more common symptoms of OSA is snoring, usually reported by the spouse. The patient may complain of frequent nighttime awakening, morning drowsiness, headache (caused by carbon dioxide buildup in the brain), cognitive impairment, as well as impotence and weight gain, which can be both a cause and an effect. Systemic hypertension is a complication of OSA but often resolves when the cause of the apnea is corrected.

1. 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.

3. 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, C, 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

2. 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 caring for a patient who is having trouble sleeping. To encourage decreased stimulus to the reticular activating system and activation of the bulbar synchronizing region, which actions would the nurse implement? a. Encourage television for distraction. b. Encourage relaxed positions. c. Walk with the patient. d. Provide a favorite beverage.

ANS: B Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness. Researchers also hypothesize that the release of serotonin from specialized cells in the bulbar synchronizing region (BSR) produces sleep. As the patient closes his eyes and assumes relaxed positions, stimuli to the RAS decrease, and at some point the BSR takes over. Television, walking, and drinking a favorite beverage would not necessarily encourage sleep.

17. The nurse is beginning a sleep assessment on a patient. Which of the following would be the most appropriate question to ask? 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?"

ANS: B Asking patients how they are sleeping is an introductory question. After this beginning question is asked, problems with sleep such as the nature of the problem, signs and symptoms, onset and duration of the issue, severity, predisposing factors, and the effect on the patient can be assessed. What is going on is too broad and open ended for information about sleep to be obtained specifically. Medications and food intake can be part of the detailed assessment of sleep issues.

25. A patient has received a nursing diagnosis of sleep deprivation. Which of the following statements by the patient would indicate that outcomes are being met? a. "I wake up only once a night to go 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."

ANS: B Being able to sleep and feeling rested would indicate that outcomes are being met for sleep deprivation. Limiting a nap to 20 minutes is an intervention to promote sleep. Going to sleep within 30 minutes indicates that the patient may not be experiencing insomnia. Waking up during the night may indicate insomnia, and decreasing fluids in the evening is an intervention to help prevent this situation.

10. 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 71/2 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.

7. The nurse is discussing with a new mother the sleep requirements of a neonate. Which of these comments would indicate that the patient has an understanding of the neonate's sleeping pattern? a. "I can't wait to get the baby home to play with the brothers and sisters." b. "I will ask my mom to come after the first week, when the baby is more alert." c. "I will get the baby on a sleeping schedule the first week while my mom is here." d. "I won't be able to nap during the day because the baby will be awake."

ANS: B The neonate averages about 16 hours of sleep. During the first week of life, the child sleeps almost constantly.

4. 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. Decrease fluids 2 to 4 hours before sleep. e. Watch television right before sleep. f. Get up if unable to fall asleep in 15 to 30 minutes.

ANS: B, C, D, F The nurse should instruct the patient to sleep where she sleeps best, to use sedatives as a last resort, to decrease fluid intake to cut down on bathroom trips, and, if unable to sleep in 15 to 30 minutes, to get up out of bed. Naps should be eliminated if not part of the individual's routine schedule, and if naps are taken, they should be limited to 20 minutes or less a day. Television can stimulate and disrupt sleep patterns

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.

13. 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.

A nurse is caring for a client who has sleep apnea and is prescribed modafinil (Provigil). The client asks, "How will this medication help me?" How should the nurse respond? a. "This medication will treat your sleep apnea." b. "This sedative will help you to sleep at night." c. "This medication will promote daytime wakefulness." d. "This analgesic will increase comfort while you sleep."

ANS: C Modafinil is helpful for clients who have narcolepsy (uncontrollable daytime sleep) related to sleep apnea. This medication promotes daytime wakefulness.

18. 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.

14. The patient has just been diagnosed with narcolepsy. The nurse provides an educational session and teaches the patient to avoid a. Antidepressant medications. b. Naps shorter than 20 minutes. c. Sitting in hot, stuffy rooms. d. Chewing gum

ANS: C Patients with narcolepsy need to avoid factors that increase drowsiness such as alcohol, heavy meals, exhausting activities, long-distance driving, and long periods of sitting in hot, stuffy rooms. Patients are treated with antidepressants, and management techniques involve scheduling naps no longer than 20 minutes and chewing gum. Additional management techniques include exercise, light high-protein meals, deep breathing, and taking vitamins.

4. The nurse is caring for a patient in the sleep lab. The nurse recognizes that the patient is in stage 4 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 4 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.

26. The older patient is visiting the clinic after a fall during the night. Which of the following data points obtained most likely would contribute to this fall? a. The patient has been taking glucosamine. b. The patient has been taking a fish oil. c. The patient has been taking Benadryl (diphenhydramine). d. The patient has been taking vitamin C.

ANS: C When older adults are using Benadryl (diphenhydramine), an over-the-counter medication for sleep, caution them that they may experience dizziness, drowsiness, confusion, constipation, and urinary retention because of the long duration of action of the medication. This can contribute to a fall in an older adult. Fish oil given for the treatment of cholesterol, although an issue after a fall with potential bleeding, is not a cause for the fall, nor is glucosamine, which is used in the treatment of joint issues. Neither of these substances are utilized for sleep. Vitamin C is used to support the immune system; it is not used for sleep and does not cause falls.

The nurse is caring for a young adult patient on the medical-surgical unit. When doing midnight checks, she sees that the patient is awake and is doing a puzzle. What is the best explanation for the patient being awake? A. The patient was waiting to talk with the nurse B. The patient misses his family and is lonely C. The patients sleep-wake cycle preference is late evening D. The patient has been kept up by the noise on the unit

ANS: C All persons have biological clocks that synchronize their sleep-wake cycle. This explains why some individuals fall asleep in the early evening and some late evening or early morning. This patient is awake and alert enough to do a puzzle. The individual's sleep-wake preference is probably late evening. Waiting to talk with the nurse, being lonely, and noise on the unit may contribute to lack of sleep, but the best explanation for the patient being awake is the biological clock.

23. A young mother has been hospitalized for an irregular heartbeat (arrhythmia). The night nurse comes in to see the patient awake. What would be the most appropriate nursing intervention? a. Inform the patient that it is late and time to go to sleep. b. Ask the patient if she would like medication to help her sleep. c. Recommend the great movie that is on television tonight. d. Take time to sit and talk with the patient about her inability to sleep.

ANS: D Assessment is the first step of the nursing process; therefore assessment needs to be done first and involves ascertaining the cause of the patient's inability to sleep. Patients who are admitted to the hospital for uncertain diagnoses can be stressed and worried about the testing and outcomes. In addition, a young mother can be worried about the care of the children and those caring for the children. This uncertainty and change in routine can cause difficulty in resting or falling asleep. Take the time to talk with the patient to determine the cause of the inability to sleep. A distraction such as a television may or may not work for the patient. After assessment is completed, a sedative may or may not be in order. Telling the patient that it is late and time to go to sleep is not a therapeutic response for an adult who is under stress.

A nurse assesses a client who reports waking up feeling very tired, even after 8 hours of good sleep. Which action should the nurse take first? a. Contact the provider for a prescription for sleep medication. b. Tell the client not to drink beverages with caffeine before bed. c. Educate the client to sleep upright in a reclining chair. d. Ask the client if he or she has ever been evaluated for sleep apnea.

ANS: D Clients are usually unaware that they have sleep apnea, but it should be suspected in people who have persistent daytime sleepiness and report waking up tired. Causes of the problem should be assessed before the client is offered suggestions for treatment.

20. 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.

21. 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.

9. A single dad is discussing with the nurse the sleep needs of a preschooler. Which of the following directions would be most helpful to the parent? a. "It is important that the 5-year-old get a nap every day." b. "Preschoolers sleep soundly all night long." c. "On average, the preschooler needs to sleep 10 hours a night." d. "The preschooler may have trouble settling down after a busy day."

ANS: D The preschooler usually has difficulty relaxing or settling down after long, active days. By the age of 5, naps are rare for children, except those for whom a siesta is a custom. Preschoolers frequently partially awaken during the night. On average, a preschooler needs 12 hours of sleep.

19. The nurse is caring for a postpartum patient. The patient's labor has lasted over 28 hours within the hospital; the patient has not slept and is disoriented to date and time. What is the most appropriate nursing diagnosis? a. Impaired parenting b. Insomnia c. Ineffective coping d. Sleep deprivation

ANS: D This patient has been deprived of sleep by staying awake during a 28-hour labor. Disorientation is one potential sign of sleep deprivation. In this scenario, we have a clear cause for the patient's lack of sleep, and it is a one-time episode. Insomnia, on the other hand, is a chronic disorder whereby patients have difficulty falling asleep, awaken frequently, or sleep only for a short time. This scenario does not indicate that this has been a chronic problem for this patient. Although ineffective coping can manifest as a sleep disturbance, we have clear evidence that it was labor that deprived this patient of sleep, not an inability to cope. It could be difficult to care for an infant when sleep deprived; however, this scenario gives no evidence that this mother displays impaired parenting and is not caring adequately for her child or lacks the skills to do so.

5. 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.

A 64-year-old obese man is admitted to the hospital for treatment of heart failure secondary to alcoholism. For which of the following negative consequences should the nurse assess? A) Chronic pain B) Obstructive sleep apnea C) Parkinson disease D) RLS

Ans: B Factors associated with increased risk for obstructive sleep apnea include obesity, diabetes, stroke, Parkinson disease, congestive heart failure, genetic predisposition, craniofacial anatomic features, and the use of alcohol or medications that depress the respiratory center

A 45-year-old obese man arrives in a clinic with complaints of daytime sleepiness, difficulty going to sleep at night, and snoring. What is the patient exhibiting manifestation of? A) Angina B) Diabetes C) Obstructive sleep apnea D) Depression

Ans: C Feedback: Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of angina or diabetes. Snoring is not an indication of depression.

A 45-year-old obese man arrives in a clinic with complaints of daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem? A) Adenoiditis B) Chronic tonsillitis C) Obstructive sleep apnea D) Laryngeal cancer

Ans: C Feedback: Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This patient's symptoms are not suggestive of laryngeal cancer.

5.What are prevailing characteristics of narcolepsy? Select all that apply. 1) Involuntary 2) Cataplexy 3) Hallucinations 4) Temporary paralysis

Answer: 1) Involuntary 2) Cataplexy 3) Hallucinations 4) Temporary paralysis Rationale: The person with narcolepsy experiences a sudden, uncontrollable urge to sleep lasting from seconds to minutes, even though the person sleeps well at night. The person cannot avoid the "sleep attacks" but awakens easily. Narcolepsy is characterized by involuntary episodes of sleepiness, slurred speech, slackening of the facial muscles, a feeling of impending weakness of the knees, paralysis, and hallucinations. Some have other symptoms, such as cataplexy, a sudden loss of muscle tone usually triggered by an emotional event (e.g., laughter, surprise, or anger), but most only have hypersomnia.

4.What is the hormone that promotes sleep? 1) Melatonin 2) L-tryptophan 3) Progesterone 4) Oxytocin

Answer: 1) Melatonin Rationale: The levels of melatonin, which is the natural hormone that promotes sleep, decline in the latter decades of life. It is produced at night by the pineal gland in the brain.

What is the hormone that promotes sleep? 1) Melatonin 2) L-tryptophan 3) Progesterone 4) Oxytocin

Answer: 1) Melatonin Rationale: The levels of melatonin, which is the natural hormone that promotes sleep, decline in the latter decades of life. It is produced at night by the pineal gland in the brain.

8.Which of the following is a common, normal emotional response to a stressor? 1) Depression 2) Fear 3) Anxiety 4) Panic

Answer: 3) Anxiety Rationale: Anxiety is a common emotional response to a stressor. Depression is a prolonged feeling of sadness. Fear is a specific, cognitive response to a known threat. Panic is an unreasonable and irrational response to a stressor.

1.Which of the following would be an abnormal assessment finding for an older adult that the nurse would document and report to the primary care provider? Decreased: 1) Reaction time 2) Short-term memory 3) Intellectual ability 4) Cognitive processing speed

Answer: 3) Intellectual ability Rationale: There should be no loss of intellectual ability. An elderly person can learn, although learning takes longer. Reaction time slows as we age, and it is also normal to have a decline of short-term memory, although long-term memory loss is not as common. Cognitive processing speed declines with age. This includes slower computational skills and reduced speed for problem-solving, but this does not imply that intellect is impaired.

2.The nurse in the hospital has a prescription to administer medication at 0400 to Mrs. Giovanni. Mrs. Giovanni is asleep when the nurse enters the room. She is difficult to arouse and confused. Identify the stage of sleep Mrs. Giovanni was likely in when the nurse awakened her. 1) Stage II 2) Stage III 3) Stage IV 4) REM

Answer: 3) Stage IV Rationale: Stage IV is the deepest sleep and the most restorative. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage IV sleep, and if awakened, the person may appear confused and react slowly.

The nurse in the hospital has a prescription to administer medication at 0400 to Mrs. Giovanni. Mrs. Giovanni is asleep when the nurse enters the room. She is difficult to arouse and confused. Identify the stage of sleep Mrs. Giovanni was likely in when the nurse awakened her. 1) Stage II 2) Stage III 3) Stage IV 4) REM

Answer: 3) Stage IV Rationale: Stage IV is the deepest sleep and the most restorative. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage IV sleep, and if awakened, the person may appear confused and react slowly.

6.How would the nurse be able to identify the person with narcolepsy from one with seizures? 1) Episodes are short in duration. 2) Episodes come on suddenly. 3) The patient can be aroused from the episode. 4) The patient loses voluntary control of his muscles.

Answer: 3) The patient can be aroused from the episode. Rationale: The patient with narcolepsy can be aroused from the sleep episode. A person with seizure activity is unresponsive to stimulus and does not resolve in relationship to arousing. Narcolepsy and seizures are triggered suddenly. Both involve involuntary control of motor function with paralysis and cataplexy. Typical seizures last less than 8 minutes. Most narcoleptic episodes are also brief with microactivity lasting only a few minutes. Infrequently, the uncontrollable urge to sleep goes on for up to an hour.

How would the nurse be able to identify the person with narcolepsy from one with seizures? 1) Episodes are short in duration. 2) Episodes come on suddenly. 3) The patient can be aroused from the episode. 4) The patient loses voluntary control of his muscles.

Answer: 3) The patient can be aroused from the episode. Rationale: The patient with narcolepsy can be aroused from the sleep episode. A person with seizure activity is unresponsive to stimulus and does not resolve in relationship to arousing. Narcolepsy and seizures are triggered suddenly. Both involve involuntary control of motor function with paralysis and cataplexy. Typical seizures last less than 8 minutes. Most narcoleptic episodes are also brief with microactivity lasting only a few minutes. Infrequently, the uncontrollable urge to sleep goes on for up to an hour.

3.Depression, hyperthyroidism, hypothyroidism, pain, and sleep apnea are examples of: 1) disorders that are provoked by sleep. 2) conditions known as parasomnias. 3) conditions that cause secondary sleep disorders. 4) disorders associated with narcolepsy.

Answer: 3) conditions that cause secondary sleep disorders. Rationale: Secondary sleep disorders occur when a disease causes alterations in sleep stages or in quantity of sleep. Depressed people may spend more time in bed; however, in general, they have difficulty falling asleep, experience less slow-wave (deep) sleep, spend less time in REM sleep, awaken early, and have less total sleep time. An increase in thyroid secretion causes an increase in stage III and IV sleep. Hypothyroidism causes a decrease in those stages. Hyperthyroidism creates increased metabolic rate, making it difficult to fall asleep. Acute pain and chronic pain interfere with sleep. They inhibit sleep, increase arousals during sleep, and cause longer awake intervals during the night. During periods of sleep apnea, O2 level in the blood drops, and the CO2 level rises, causing the person to wake up frequently.

Depression, hyperthyroidism, hypothyroidism, pain, and sleep apnea are examples of: 1) disorders that are provoked by sleep. 2) conditions known as parasomnias. 3) conditions that cause secondary sleep disorders. 4) disorders associated with narcolepsy.

Answer: 3) conditions that cause secondary sleep disorders. Rationale: Secondary sleep disorders occur when a disease causes alterations in sleep stages or in quantity of sleep. Depressed people may spend more time in bed; however, in general, they have difficulty falling asleep, experience less slow-wave (deep) sleep, spend less time in REM sleep, awaken early, and have less total sleep time. An increase in thyroid secretion causes an increase in stage III and IV sleep. Hypothyroidism causes a decrease in those stages. Hyperthyroidism creates increased metabolic rate, making it difficult to fall asleep. Acute pain and chronic pain interfere with sleep. They inhibit sleep, increase arousals during sleep, and cause longer awake intervals during the night. During periods of sleep apnea, O2 level in the blood drops, and the CO2 level rises, causing the person to wake up frequently.

5.A nurse is admitting a 75-year-old patient to the nursing unit, accompanied by his son. Using a life span approach to care, which of the following is essential for the nurse to do? 1) Increase the room temperature. 2) Speak slowly and use short sentences. 3) Direct admission questions to the patient's son. 4) Ask the patient if he has had any falls in the past year.

Answer: 4) Ask the patient if he has had any falls in the past year. Rationale: Falls are a major source of morbidity in hospitalized patients. On admission, nurse should ask all older adults (age 65 and older) if they have had any falls in the past year. Although it is true that some older adults may like a warm temperature, this is not universally true; it would need to be assessed for each individual. Speaking slowly and using short sentences is recommended for patients with learning or hearing disabilities; however, the nurse cannot assume that all older adults have either of these. The best assessment data usually are obtained from the patient. The nurse should interview other family members only if the patient is not communicating clearly; the nurse has not yet assessed that in this scenario.

1.The duration of sleep is regulated by the: 1) electrical impulses transmitted to the cerebellum. 2) person's innate biorhythms. 3) amount of sleep a person usually requires. 4) reticular activating system.

Answer: 4) reticular activating system. Rationale: In the morning, with an increase in environmental light, the hypothalamus is signaled to induce gradual arousal from sleep. The reticular formation is then activated by the stimuli from the cerebral cortex. The reticular formation is responsible for maintaining wakefulness. Together, the reticular formation and cortical neurons are called the reticular activating system (RAS). The RAS regulates the duration of sleep.

The duration of sleep is regulated by the: 1) electrical impulses transmitted to the cerebellum. 2) person's innate biorhythms. 3) amount of sleep a person usually requires. 4) reticular activating system.

Answer: 4) reticular activating system. Rationale: In the morning, with an increase in environmental light, the hypothalamus is signaled to induce gradual arousal from sleep. The reticular formation is then activated by the stimuli from the cerebral cortex. The reticular formation is responsible for maintaining wakefulness. Together, the reticular formation and cortical neurons are called the reticular activating system (RAS). The RAS regulates the duration of sleep.

Question: A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? Select all that apply. a. Daily mental activities b. Daily physical activities c. Morning and evening body temperature d. Daily measurement of fluid intake and output e. Presence of anxiety or worries affecting sleep f. Morning and evening blood pressure readings

Answer: a, b, e. A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is not usually kept in a sleep diary.

Question: 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.

Causes of hypoparathyroidism

Destruction or manipulation of the parathyroid glands Hypomagnesemia: Low levels of magnesium can cause the parathyroid gland not to work Autoimminue Body is resistant to PTH - parathyroid works great but the bones and kidneys do not respond to its being released.

Question: 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 IV NREM sleep d. REM sleep

Answer: 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.

Question: 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.

Question: A nurse caring for patients in a busy hospital environment should implement which recommendation to promote sleep? a. Keep the room light dimmed during the day. b. Keep the room cool. c .Keep the door of the room open. d. Offer a sleep aid medication to patients on a regular basis.

Answer: b. The nurse should keep the room cool and provide earplugs and eye masks. The nurse should also maintain a brighter room environment during daylight hours and dim lights in the evening, and keep the door of the room closed. Sleep aid medications should only be offered as prescribed.

Question: 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.

Answer: 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 and IV sleep. In stage IV NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.

Question: 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.

Answer: 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 and IV sleep. In stage IV NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.

Question: 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.

Answer: 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.

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 IV. 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.

Question: 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.

Question: A nurse assesses a patient's body temperature in the late afternoon as 37.2°C (99°F). What would be the nurse's best action related to this slight elevation in temperature? a. Assess the patient for infection. b. Record the temperature as a normal finding. c. Call the physician for an order for antipyretics. d. Decrease the room temperature.

Answer: b. A slight increase in body temperature in the late afternoon is the result of a normal circadian rhythm and does not need to be reported unless it becomes higher. This slight variation from normal does not necessarily mean an infection is present. A warm environment might cause an elevation in body temperature, but the most likely cause is normal circadian rhythm.

Question: 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.

Question: 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.

Question: 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.

Question: 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.

1. To validate the suspicion that a married male client has sleep apnea the nurse first: 1. Asks the client if he experiences apnea in the middle of the night 2. Questions the spouse if she is awakened by her husband's snoring 3. Places the client on a continuous positive airway pressure (CPAP) device 4. Schedules the client for a sleep test

Answers and Rationale 1. Answer: 4. (2- Although this is a diagnostic tool, the first thing the nurse would do is question the spouse. This may lead to determining whether more tests are needed).

The nurse incorporates what priority nursing intervention into a plan of care to promote sleep for a hospitalized client?

Avoid awakening client for nonessential tasks Hospitals and extended care facilities usually do not adapt care to an individual's sleep-wake cycle preferences. The nurse should attempt to avoid awakening sleeping clients for nonessential tasks to try and preserve their sleep cycles.

The nurse is caring for a middle-aged man who complains of excessive daytime sleepiness. The nurse's examination reveals that the patient has large tonsils. He jokingly tells the nurse that his wife complains that he snores. The nurse hypothesizes that the patient has which of the following disorders? a. deviated septum b. obstructive sleep apnea c. occlusion of the nostrils d. upper respiratory infection

B Obstructive sleep apnea occurs when muscles in the nasopharynx and pharynx relax during sleep, resulting in pauses in breathing. Typically patients are overweight, middle-aged men who complain of excessive daytime sleepiness. Logged

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's disease who is taking dopamine. C. An older adult 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.

B. A patient with Parkinson's disease who is taking dopamine. C. An older adult taking diuretics for congestive heart failure. E. A patient who is prescribed antidepressants. Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are see

Which of the following medications are the safest to administer to adults needing assistance in falling asleep?

Benzodiazepines The safest group of drugs is the benzodiazepenes. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.

A patient with sleep apnea is scheduled for surgery that involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove the obstructing tissue. What is this surgery called? A Mastectomy B Tonsillectomy C Uvulopalatopharyngoplasty D Genioglossal advancement and hyoid myotomy

C. Uvulopalatopharyngoplasty is a surgery for resolving sleep apnea. This surgery involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove the obstructing tissue. Mastectomy is surgery for the excision of breast cancer. Tonsillectomy is surgery for the excision of the tonsils. Genioglossal advancement and hyoid myotomy is another surgery for sleep apnea. It involves advancing the attachment of the muscular part of the tongue on the mandible.

A nurse working the night shift in a pediatric unit observes a 10-year-old patient who is snoring and appears to have labored breathing during sleep. Upon reporting the findings to the primary care provider, what nursing action might the nurse expect to perform? A. Preparing the family for a diagnosis of insomnia and related treatments. B. Preparing the family for a diagnosis of narcolepsy and related treatments. C. Anticipating the scheduling of polysomnography to confirm OSA. D. No action would be taken, as this is a normal finding for hospitalized children.

C. Anticipating the scheduling of polysomnography to confirm OSA. OSA (pediatric) is defined by the presence of one of these findings: snoring, labored/obstructed breathing, enuresis, or daytime consequences (hyperactivity or other neurobehavioral problems, sleepiness, fatigue). According to the American Academy of Pediatrics children and adolescents with symptoms of OSA, including snoring, should have polysomnography to confirm the diagnosis. Although OSA may cause insomnia, this is not the primary diagnosis in this case. Narcolepsy is a condition characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. This scenario is not usually a normal finding in hospitalized children during sleep.

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. For what recommended treatment might the nurse prepare this patient? A. The use of a central nervous system stimulant B. Continuous positive airway pressure machine (CPAP) C. Chronotherapy D. The application of heat or cold therapy to promote sleep

C. Chronotherapy Chronotherapy requires a commitment on the part of the patient to act over a period of weeks to progressively advance or delay the time of sleep for 1 to 2 hours per day. Over time, this results in a shift of the sleep-wake cycle. The use of a central nervous system stimulant is recommended for narcolepsy. Continuous positive airway pressure machine (CPAP) is used for OSA, and the application of heat or cold therapy to the legs is used to treat RLS.

Medications for the Alzheimer's Patient

Cholinesterase inhibitors NMDA-receptor antagonist antidepressants

Sleep apnea would be diagnosed in a patient who has which of these findings? 1. More than 15 apnea episodes per hour of sleep 2. More than 5 apnea episodes per hour over an 8-hour period 3. More than 75% of the apneas are obstructive. 4. More than 75% of the apneas and hypopneas are obstructive. a. 1, 4 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4

D During a sleep study, obstructive sleep apnea (OSA) is confirmed when either of the following two conditions exists: 15 or more apneas, hypopneas, or RERAs per hour of sleep (i.e., the AHI or RDI >15 events/hour) in an asymptomatic patient. More than 75% of the apneas and hypopneas must be obstructive. Or, 5 or more apneas, hypopneas, or RERAs per hour of sleep (i.e., the AHI or RDI >5/hour events/hour) in patients with symptoms (e.g., sleepiness, fatigue, and inattention) or signs of disturbed sleep (e.g., snoring, restless sleep, and respiratory pauses). More than 75% of the apneas and hypopneas must be obstructive.

Which intervention is appropriate to include on a care plan for improving sleep in the older adult?

Decrease fluids 2 to 4 hours before sleep By decreasing fluids 2 to 4 hours before sleep, it is less likely that the client will awaken because of a need to urinate. Limiting naps during the day will help improve nighttime sleep. The client should sleep until the same time each morning. Exercising in the evening can make falling asleep more difficult.

8. The patient is in the ICU and becoming more irritable as the days go by. The nurse determines the patient is not getting enough sleep. What actions will best help facilitate the patient's sleeping? Give the patient a back rub. Keep the lights on during the day. Talk to the patient when he wakes up at night. Do the vital signs and treatments at the same time.

Do the vital signs and treatments at the same time.

5. What principle should guide nursing practice when providing care for older patients? Drug therapy should be used conservatively. Older adults require less sleep than younger adults. Cognitive-behavioral interventions are less effective than among younger adults. Patient teaching should focus on older adults accepting age-related changes in their sleep cycles.

Drug therapy should be used conservatively.

The nurse is developing a plan of care for a client experiencing narcolepsy. Which intervention is appropriate to include on the plan?

Encourage client to take one or two 20-minute naps during the day Brief daytime naps of no longer than 20 minutes help reduce subjective feelings of sleepiness. Carbohydrates can increase sleepiness. Limiting fluids will not help the client with narcolepsy, nor will energy preservation.

What nursing measure promotes sleep in school-aged children?

Encourage quiet activities prior to bedtime. Encouraging quiet activities before bedtime helps prepare children for sleep. Evening exercise and watching television can make falling asleep more difficult. Children may sleep better with a night light in the room

5.A 58-year-old male patient on the surgical unit after coronary artery bypass grafting complains of vivid nightmares. What assessment should the nurse complete to determine the most likely cause of the nightmares? Ask the patient about a history of post-traumatic stress disorder. Determine if the patient has a history of sleep apnea or narcolepsy. Evaluate the medications the patient is receiving for possible side effects. Review the documentation record to determine if the patient had a fever last night.

Evaluate the medications the patient is receiving for possible side effects. Medication side effects are the most common cause of nightmares in intensive care patients. Drug classes most likely to cause nightmares are sedative-hypnotics, β-adrenergic antagonists, dopamine agonists, and amphetamines.

The nurse is gathering a sleep history from a client who is being evaluated for obstructive sleep apnea. What common symptom will the client most likely report?

Excessive daytime sleepiness The client will awake with a headache. The other options may exist, but headache is the most common complaint

The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises.

First The client is most sensitive to noise in the hospital setting on the first night because everything is new. This represents sensory overload, which interferes with sleep and decreases rapid eye movement (REM) as well as total sleep time

Thyroid storm intervention

Hypothermia blanket Oxygen Potassium Iodine - block release of thyroid hormone PTU - anti thyroid hormone will counteract the excessive amount of the hormone Propranolol - help decrease hr and bp hydrocorstisone - thyroid storm depletes the clients supply of cortisol

The nurse teaches a client taking phenytoin (Dilantin), an anticonvulsant, that this group of medications causes which symptom of a sleep problem?

Increased daytime sleepiness The anticonvulsants can cause increased daytime sleepiness because they decrease REM sleep time. They do not cause nocturia, increased awakenings, or increased difficulty falling asleep.

Thyroid gland cannot make T3 and T4 hormones without

Iodine (must come from food)

Older adults are cautioned about the use of nonprescription sleeping medications because these medications can:

Lead to further sleep disruption even when they initially seemed to be effective. Over-the-counter medications for sleep often cause more problems than benefits. The other answers are incorrect.

The nurse finds a client sleepwalking down the unit hallway. An appropriate intervention the nurse implements is:

Lightly tapping the client on the shoulder and leading him or her back to bed. The nurse should not startle the client but should gently awaken the client and lead him or her back to bed. Sleepwalkers are unaware of their surroundings. Asking them what they are doing is not helpful. The nurse may or may not need assistance. Startling the client may result in injury. Blocking the walkway with chairs may result in injury.

Thyroid plays a major role in

Metabolism Growth and development Temperature regulation

Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching?

My grandmother told me that babies sleep better on their stomachs." Babies should sleep on their backs, not their stomachs, as a SIDS preventative. Babies should not be put to bed with a bottle. Due to nighttime feedings, new moms should be encouraged to temporarily place a cradle near where they sleep and know that they will have to get up during the night to feed the baby.

Hypothyroidism

Not enough PTH being released by parathyroid gland to cause kidneys and bones to release or absorb calcium = calcium levels fall. = hypocalcemia and hyperphospatemia (kidneys start to conserve phosphate)

Sleep Cycle

Once asleep a person passes through 4 to 5 sleep cycles

When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:

Opioids Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.

4. An obese male patient is scheduled to begin treatment with continuous positive airway pressure (CPAP). How will this treatment method alleviate obstructive sleep apnea (OSA)? Calming the patient Preventing airway collapse Increasing the efficiency of gas exchange across alveolar walls Requiring the patient to breathe through his nose rather than his mouth

Preventing airway collapse

To validate the suspicion that a married male client has sleep apnea, the nurse first:

Questions the spouse if she is awakened by her husband's snoring. Asking the spouse would be a starting place to determine if a client has sleep apnea. This may lead to determining whether more tests are needed. The client would not know if he experiences sleep apnea. CPAP is a treatment for sleep apnea. Although this is a diagnostic tool, the first thing the nurse would do is question the spouse.

The client reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs in which sleep phase?

REM sleep The dreams of REM sleep are vivid and elaborate. The other answers are incorrect.

Sleep Regulation

Regulated by a sequence of physiological states integrated by CNS activity

Parathyroid Hormone (PTH)

Regulates calcium and phosphate levels Regulates calcium by acting on bones(stimulates osteoclasts which break down the bones and this causes bone resorption = releases calcium into the blood. Kidneys reabsorb calcium and activates vitamin D Therefore in the GI system vitamin d helps the small intestine to reabsorb calcium from food intake and regulated phosphate by inhibiting the kidneys from reabsorbing phosphate, and is excreted into the urine.

Signs and symptoms of Parathyroid

Remember PTH Paresthesia Tetany Posititve Trousseau's Sign Positive Chvostek's Sign

11. Insufficient sleep is associated with changes in bodily function and health problems. Which disease/disorder description is related to disturbed sleep? Insufficient sleep is linked to a decreased risk for type 2 diabetes mellitus. Inadequate sleep in people with hypertension leads to future decreases in BP. Short sleep duration may result in metabolic changes that are linked to obesity. Radiation for cancer treatment is associated with fragmented sleep and fatigue.

Short sleep duration may result in metabolic changes that are linked to obesity.

2.A college student has sought care prompted by his complaints of insomnia over the past several months. What should his health care provider initially recommend? Melatonin Benzodiazepines Sleep hygiene practices Over-the-counter sleep aids

Sleep hygiene practices

9. The patient will schedule a test to see if he has mild sleep apnea. What should the nurse teach the patient to do until the test can be completed? Take sleep medications. Use his wife's CPAP mask. Sleep in a side-lying position. Do not use pillows when sleeping.

Sleep in a side-lying position.

Physiology of Sleep

Sleep is an altered state of consciousness where perception of and reaction to environment is decreased

Sleep apnea

Snores loudly Stops breathing for 10 sec or more Nightime awakenings excessive daytime sleepiness and fatigue Morning headache Sore Throat Personality and behavioral changes Dysrhytmias hypertension Risk of stroke Risk of Myocardial infarction Risk of Heart failure

Signs and symptoms of hyperparathyroidism

Too much calcium causes bones to become fragile (because calcium has left the bones) muscles and nerve function will slow down as well. Bones fractures (osteoporosis) - PTH causing excessive stimulation of bone osteoclasts= calcium leaks into blood. Calculi formation Constipation GI Problems nausea, vomiting, epigastric pain Frequent urination: high amounts of calcium cause the kidneys to work harder. EKG changes Short QT interval

6. The nurse usually works day shift but will be working night shift to help a friend. What can the nurse do to help herself sleep during the day? Make the bedroom warmer. Use room-darkening window shades. Drink warm Earl Grey tea at the end of her shift. Go to the gym to work out before going home to sleep.

Use room-darkening window shades.

Signs and Symptoms of hypothyroidism

WT gain unable to tolerate cold Goiter (bulge in the neck from constant stimulation of the hypothalamus. tired and fatigue Slow HR Thinning hair/brittle Depression Constipitation memory loss Dry skin menstrual problems Myoexedimia sensitive to opioids

Which sleep hygiene actions at bedtime can the nurse delegate to the nursing assistant? (select all that apply) a. giving the patient a backrub b. turning on quiet music c. dimming the lights in the patient's room d. giving a patient a cup of coffee e. monitoring for the effect of sleeping medication that was given

a. giving the patient a backrub b. turning on quiet music c. dimming the lights in the patient's room

The school nurse is teaching health promoting behaviors that improve sleep to a group of high school students. Which points should be included in the education a. go to bed at the same time each night b. study in your bedroom to have quiet space c. turn on the television to help you fall asleep d. avoid drinking coffee or soda before bedtime e. turn off your cell phone at bedtime

a. go to bed at the same time each night d. avoid drinking coffee or soda before bedtime e. turn off your cell phone at bedtime

Grave's disease

autoimmune antibody releases SI (thyroid stimulating immunoglobulin) and likes TSH starts producing lots of t3 and t4 same symptoms as hyperthyroidism Unique symptoms: Protruding eyeballs(surprise look) Goiter of the neck swelling of the feet, spread to chest, face and arms orange peel look

The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? (Select all that apply) a. can cause urinary retention b. Should not be used indefinitely c. May have toxic effects on the liver d. May cause diarrhea and anxiety e. Are not regulated by the FDA

b. Should not be used indefinitely c. May have toxic effects on the liver e. Are not regulated by the FDA Herbal products help promote sleep. These products need to be used cautiously because they are not regulated by the FDA. They should not be used longer term and can interact with prescribed medications. Kava needs to be used cautiously because it can be toxic to the liver

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

b. We'll place the baby on her back to sleep This is based on the current evidence that shows that parents need to place an infant on his or her back to prevent suffocation. Bottles, stuffed animals and pillows should not be placed in the bed with an infant.

The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? a. have patient follow hospital routines b. avoid waking patient for nonessential tasks c. give prescribed sleeping medications at dinner d. turn tv on low to late-night programming

b. avoid waking patient for nonessential tasks avoiding awakening patient for nonessential tasks promotes sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as lab draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits.

The nurse is developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? a. Instruct the patient to sleep in a supine position b. Have patient limit fluid intake 2 hours before bedtime c. Elevate the head of the bed to sleep d. Encourage patient to take an over the counter sleep aid

c. Elevate the head of the bed to sleep Lifestyle changes and modifications of sleep habits should be included on a plan of care for a patient with OSA. Individuals should sleep with the head of the bed elevated and use a side or prone position. Other modifications include a good sleep-hygiene practices, alcohol modification, smoking cessation and weight reduction

Which statement made by an older adult best demonstrates understanding of taking sleep medication? a. I'' take the sleep medicine for 4 or 5 weeks until my sleep problems disappear b. Sleep medicines won't cause any sleep problems once I stop taking them c. I'll talk to my health care provider before I use an over the counter sleep medication d. I'll contact my health care provider if I feel extremely sleepy in the mornings

c. I'll talk to my health care provider before I use an over the counter sleep medication The use of non prescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption even when they initially seemed effective.

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

c. It takes me 45-60 minutes to fall asleep This indicates a potential sleep problem, individuals should fall asleep within 30 minutes of going to bed. Encourage him or her to get out of bed and do a quiet activity until he or she feels sleepy

The patient reports episodes of sleepwalking to the nurse. Through understanding of the sleep cycle, the nurse recognizes that sleepwalking occurs during which sleep phase? a. Rapid Eye Movement (REM) Sleep b. Stage 1 non-rapid eye movement (NREM) sleep c. Stage 4 NREM sleep d. Transition period from NREM to REM sleep

c. Stage 4 NREM Sleep Stage 4 NREM sleep is the deepest stage of sleep. It is difficult to rouse the sleeper in this stage. During this stage sleepwalking and enuresis (bed-wetting) sometimes occur

Which statement made by the patient indicates a need for further teaching on sleep hygiene? a. I'm going to do my exercises before I eat dinner b. I'm going to go to bed every night at about the same time c. I set my alarm to get up at the same time every morning d. I moved my computer to the bedroom so I could work before I go to sleep

d. I moved my computer to the bedroom so I could work before I go to sleep This statement requires further teaching. Good sleep hygiene practices state that the bedroom should only be used for sleeping. Work and study should not be done in the bedroom

The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? a. Incontinence b. Nausea and vomiting c. Bradycardia d. Respiratory Depression

d. Respiratory depression Benzodiazepines in older adults should be used on a short-term, limited basis. Respiratory depression is an adverse effect of benzodiazepines in older adults. Other adverse effects for which to assess include next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination

Calcimimetics for hyperparathyroid

decreases PTH, calcium, and phosphate levels (usually prescribed for patients with secondary hyperparathyroidism with CKD...patients with renal failure struggle with high phosphate levels so this medication helps with this as well) It mimics the role of calcium in the blood and deceives the parathyroid gland into thinking there is enough calcium in the blood so it will quit secreting PTH. Note: Take with food or right after meal....side effects: GI issues and hypocalcemia

Positive Trousseau's

do this by using a blood pressure cuff and place it around the upper arm and inflate it to a pressure greater than the systolic blood pressure and hold it in place for 3 minutes. If it is positive the hand of the arm where the blood pressure is being taken will start to contract involuntarily.

Hyperthyroidism

everything in the body is working on a high rate burning calories heat intolerence increase HR increase b/p Diarrhea Cardiac dysrhythmias Afib Nervous/jittery mood swings

Myxedema coma

life threatening condition in conditions with hypothyroidism everything slowing down more severe than hypothyroidism symptoms. no sedatives

Causes of myxedema coma

lithium inhibits thyroid hormone released older women with hypothyroidism to much thyroid hormone

Phosphate binders for hypoparathyroidism

may be ordered to increase excretion of phosphate by GI system into the stool: Aluminum carbonate (Gelusil Amphojel) ADMINISTER after meals

Calcitonin (injection or nasal sprays):

naturally produced by the thyroid gland and helps lower calcium levels (suppresses osteoclast activity of the bones (helps protect bones) and increases the kidneys excretion of calcium)

Phosphate

plays a role in bone health, muscle and nerve function, the kidneys regulate the amount of phosphate in the body

Calcium

plays a role in muscle and nerve conduction, bone and health and needs vitamin D to help the body absorb calcium.

Complication of thyroidectomy

tetany - low calcium production due to parathyroid