Chapter 07: Sleep and Sleep Disorders

3. Which patient statement indicates a need for further teaching about extended-release zolpidem (Ambien CR)? a. I will take the medication an hour before bedtime. b. I should take the medication on an empty stomach. c. I should not take this medication unless I can sleep for at least 6 hours. d. I will schedule activities that require mental alertness for later in the day.

ANS: A Benzodiazepine receptor agonists such as zolpidem work quickly and should be taken immediately before bedtime. The other patient statements are correct. DIF: Cognitive Level: Apply (application) REF: 94 TOP: Nursing Process: Evaluation

5. What teaching should be included in the plan of care for a patient with narcolepsy? a. Driving an automobile may be possible with appropriate treatment of narcolepsy. b. Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy. c. Antidepressant drugs are prescribed to treat the depression caused by the disorder. d. Stimulant drugs should be used for only a short time because of the risk for abuse.

ANS: A The accident rate for patients with narcolepsy who are receiving appropriate treatment is similar to the general population. Stimulant medications are used on an ongoing basis for patients with narcolepsy. The purpose of antidepressant drugs in the treatment of narcolepsy is the management of cataplexy, not to treat depression. Changes in sleep hygiene are recommended for patients with narcolepsy to improve sleep quality. DIF: Cognitive Level: Apply (application) REF: 97 TOP: Nursing Process: Planning

8. A patient complains of insomnia and daytime fatigue. What is the first action the nurse should take in addressing the patients concerns? a. Question the patient about the use of over-the-counter (OTC) sleep aids. b. Suggest that the patient decrease intake of caffeine-containing beverages. c. Advise the patient to get out of bed if unable to fall asleep in 10 to 20 minutes. d. Recommend that the patient use any prescribed sleep aids for only 2 to 3 weeks.

ANS: A The nurses first action should be assessment of the patient for factors that may contribute to poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions may be appropriate, but assessment is needed first to choose appropriate interventions to improve the patients sleep. DIF: Cognitive Level: Apply (application) REF: 95 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

9. A patient with sleep apnea who uses a continuous positive airway pressure (CPAP) device is preparing to have inpatient surgery. Which instructions should the nurse provide to the patient? a. Remind the patient to take the CPAP device to the hospital. b. Plan to schedule a nighttime polysomnography (PSG) study before surgery. c. Discourage the patient from requesting pain medication while hospitalized. d. Call the hospital to ensure that mechanical ventilation will be available for the patient.

ANS: A The patient should be told to take the CPAP device to the hospital if an overnight stay is expected. Many patients will be able to use their own CPAP equipment, but hospital policy should be checked to make sure it can be used. Patients should be treated for pain and monitored for respiratory depression. Another PSG is not required before surgery. There is no need to call the hospital if the patient takes the CPAP device to the hospital. DIF: Cognitive Level: Apply (application) REF: 99 TOP: Nursing Process: Implementation

4. The nurse cares for a critically ill patient in the intensive care unit (ICU). Which intervention should the nurse include in the plan of care to improve this patients sleep quality? a. Ask all visitors to leave the ICU for the night. b. Lower the level of lights from 8:00 PM until 7:00 AM. c. Avoid the use of opioids for pain relief during the evening hours. d. Schedule assessments to allow at least 4 hours of uninterrupted sleep.

ANS: B Lowering the level of light will help mimic normal day/night patterns and maximize the opportunity for sleep. Although frequent assessments and opioid use can disturb sleep patterns, these actions are necessary for the care of critically ill patients. For some patients, having a family member or friend at the bedside may decrease anxiety and improve sleep. DIF: Cognitive Level: Apply (application) REF: 96 TOP: Nursing Process: Planning

6. The nurse manager of a medical/surgical unit wants to improve the alertness of nurses who work the night shift. Which action will be the most helpful? a. Arrange for older staff members to work most night shifts. b. Provide a sleeping area for staff to use for napping at night. c. Post reminders about the relationship of sleep and alertness. d. Schedule nursing staff to rotate day and night shifts monthly.

ANS: B Short on-site naps will improve alertness. Rotating shifts causes the most disruption in sleep habits. Reminding staff members about the impact of lack of sleep on alertness will not improve sleep or alertness. It is not feasible to schedule nurses based on their ages. DIF: Cognitive Level: Apply (application) REF: 100 TOP: Nursing Process: Implementation

1. A patient complains of difficulty falling asleep and daytime fatigue for the past 6 weeks. What is thebest initial action for the nurse to take in determining whether this patient has chronic insomnia? a. Schedule a polysomnography (PSG) study. b. Arrange for the patient to have a sleep study. c. Ask the patient to keep a 2-week sleep diary. d. Teach the patient about the use of an actigraph.

ANS: C The diagnosis of insomnia is made on the basis of subjective complaints and an evaluation of a 1- to 2-week sleep diary completed by the patient. Actigraphy and PSG studies/sleep studies may be used for determining specific sleep disorders but are not necessary to make an initial insomnia diagnosis. DIF: Cognitive Level: Apply (application) REF: 95 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

7. Which information regarding a patients sleep is most important for the nurse to communicate to the health care provider? a. 64-year-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning b. 21-year-old student who takes melatonin to assist in sleeping when traveling from the United States to Europe c. 41-year-old librarian who has a body mass index (BMI) of 42 kg/m2 says that the spouse complains about snoring d. 32-year-old accountant who is experiencing a stressful week uses diphenhydramine (Benadryl) for several nights

ANS: C The patients BMI and snoring suggest possible sleep apnea, which can cause complications such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to affect this patients sleep quality. DIF: Cognitive Level: Analyze (analysis) REF: 97 TOP: Nursing Process: Assessment

1. Which information obtained by the nurse about an older adult who complains of occasional insomnia indicates a need for patient teaching (select all that apply)? a. Drinks a cup of coffee every morning with breakfast b. Has a snack every evening 1 hour before going to bed c. Likes to read or watch television in bed on most evenings d. Usually takes a warm bath just before bedtime every night e. Occasionally uses diphenhydramine (Benadryl) as a sleep aid

ANS: C, E Reading and watching television in bed may contribute to insomnia. Older adults should avoid the use of medications that have anticholinergic effects, such as diphenhydramine. Having a snack 1 hour before bedtime and/or coffee early in the day should not affect sleep quality. Rituals such as a warm bath before bedtime can enhance sleep quality. DIF: Cognitive Level: Apply (application) REF: 94 TOP: Nursing Process: Assessment

2. A patient with chronic insomnia asks the nurse about ways to improve sleep quality. What is the nursesbest response? a. Avoid aerobic exercise during the day. b. Read in bed for a few minutes each night. c. Keep the bedroom temperature slightly warm. d. Try to go to bed at the same time every evening.

ANS: D A regular evening schedule is recommended to improve sleep time and quality. Aerobic exercise may improve sleep quality but should occur at least 6 hours before bedtime. Reading in bed is discouraged for patients with insomnia. The bedroom temperature should be slightly cool. DIF: Cognitive Level: Apply (application) REF: 93 TOP: Nursing Process: Implementation

10. When caring for patients with sleep disorders, which activity can the nurse appropriately delegate to unlicensed assistive personnel (UAP)? a. Interview a new patient about risk factors for obstructive sleep disorders. b. Discuss the benefits of oral appliances in decreasing obstructive sleep apnea. c. Help a patient choose an appropriate continuous positive airway pressure (CPAP) mask. d. Assist a patient to place the CPAP device correctly over the nose and mouth at bedtime.

ANS: D Because CPAP mask placement is consistently done in the same way, this is appropriate to delegate to UAP. The other actions require critical thinking and nursing judgment, and should be done by the RN. DIF: Cognitive Level: Apply (application) REF: 101 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning