Foundations Chapter 43 Sleep

90 A sleeper usually reaches rapid eye movement (REM) sleep 90 minutes into the sleep cycle.

After how many minutes into the sleep cycle does a sleeper usually reach rapid eye movement (REM) sleep? _________ minutes

1, 3, 4 Sleep deprivation occurs due to rotating shifts because the human biological clock becomes maladjusted. This can cause neurological slowness, blurred vision, decreased judgment, and slowed response time. Sleep deprivation causes decreased reflexes and decreased visual alertness.

The nurse has a sleep disorder due to working rotating shifts. Which physiological symptoms are observed in the nurse? Select all that apply. 1 Blurred vision 2 Increased reflexes 3 Decreased judgment 4 Slowed response time 5 Increased visual alertness

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

The patient reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs during which sleep phase? 1 REM sleep 2 Stage 1 NREM sleep 3 Stage 4 NREM sleep 4 Transition period from NREM to REM sleep

1, 2, 5 The patient may be irritable and agitated due to sleep deprivation. He may also experience decreased auditory and visual alertness. His reflexes would be decreased, and he would experience increased sensitivity to pain.

A 40-year-old patient is hospitalized for insomnia. The nurse reviews his medical records. The nurse finds that the patient has had insomnia for six months, and it started when he began working night shifts. After thoroughly questioning the patient, the nurse learns that he is stressed due to his workload. Which sleep deprivation symptoms will the nurse most likely find in the patient? Select all that apply. 1 Irritability 2 Agitation 3 Increased reflexes 4 Decreased sensitivity to pain 5 Decreased auditory and visual alertness

1, 3, 4 A person's response to sleep deprivation is variable. Sleep deprivation may cause ptosis, decreased reflexes, and fine-motor clumsiness. These manifestations are due to the loss of rapid eye movement (REM) sleep. Nystagmus and gross-motor clumsiness do not occur with sleep deprivation.

A 47-year-old man complains of sleep deprivation. What findings should the nurse expect on assessment? Select all that apply. 1 Ptosis 2 Nystagmus 3 Decreased reflexes 4 Fine-motor clumsiness 5 Gross-motor clumsiness

B 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.

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 effective 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."

1, 3, 4 Normal sleep has two phases: nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep has four stages. Children experience more stage 4 NREM sleep because they need it more. Dreaming is a phenomenon that occurs both in the NREM and REM phases of sleep. However, the dreams of REM sleep are more vivid and colorful compared to those of NREM sleep. Dreams are influenced by personality. Dreams of a creative person are well structured and have positive content, but those of a depressed person are of helplessness. REM sleep is associated with increased cortical activity and epinephrine release.

A head nurse is teaching nursing students about the different phases of sleep. What information should the nurse include? Select all that apply. 1 Children experience more stage 4 nonrapid eye movement (NREM) sleep. 2 Dreams occur during rapid eye movement (REM) sleep only. 3 Personality has an influence on dreams. 4 Dreams occur during both NREM and REM sleep. 5 There is a decreased epinephrine release during REM sleep.

1 Obesity and hypertension are major risk factors for obstructive sleep apnea (OSA). Smoking, heart failure, alcohol, type II diabetes, and a family history of OSA are not major risk factors.

A nurse is teaching a patient about the major risk factors related to obstructive sleep apnea. What statement about risk factors if made by the nurse would be correct? 1 "Obesity and hypertension are major risk factors of obstructive sleep apnea (OSA)." 2 "Smoking and heart failure are major risk factors of obstructive sleep apnea." 3 "Alcohol and type II diabetes are major risk factors of obstructive sleep apnea." 4 "Smoking and a family history of obstructive sleep apnea are major risk factors of obstructive sleep apnea."

1, 4, 5 The patient's symptoms indicate narcolepsy. Alcohol, heavy meals, and long-distance driving tend to induce drowsiness and should be avoided. Smoking is not related to narcolepsy. The patient should not avoid relaxing activities; engaging in exhausting activities may cause drowsiness and should be avoided.

A patient complains that he falls asleep uncontrollably at inappropriate times and has vivid dreams during such times. Which advice should the nurse give to the patient to avoid factors that increase drowsiness? Select all that apply. 1 Avoid alcohol 2 Avoid smoking 3 Avoid relaxing activities 4 Avoid heavy meals 5 Avoid long-distance driving

1, 2, 4 Patients with narcolepsy are often associated with cataplexy and sleep paralysis. The symptoms of narcolepsy first appear in adolescents. Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states. Patients with narcolepsy are treated with stimulants or wakefulness-promoting agents. Patients with narcolepsy often have excessive daytime, not nighttime, sleepiness.

A patient has been diagnosed with narcolepsy. What would the nurse teach the family caregivers about narcolepsy? Select all that apply. 1 "Sleep paralysis is usually present in patients who have narcolepsy." 2 "Symptoms of narcolepsy first appear in the adolescent stage." 3 "Patients who have narcolepsy are prescribed sleep-promoting medications." 4 "Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states." 5 "Excessive nighttime sleepiness is a common complaint associated with narcolepsy."

1, 2, 3 Narcolepsy is a condition in which the sleep-wake cycle mechanism is disturbed and drowsiness increases. Heavy meals can worsen drowsiness and should be avoided. Long-distance driving can be risky because the patient tends to fall asleep while driving. Alcohol also causes drowsiness and should be avoided. Consumption of a protein-rich diet and chewing gum are helpful in decreasing drowsiness.

A patient has narcolepsy. The nurse finds that the patient's drowsiness has increased. What advice does the nurse offer the patient to decrease drowsiness? Select all that apply. 1 "Avoid eating heavy meals." 2 "Avoid long-distance driving." 3 "Avoid the consumption of alcohol." 4 "Avoid eating a protein-rich diet." 5 "Avoid chewing gum."

4 A patient experiencing behaviorally induced circadian rhythm sleep disorder when jet lag affects the circadian rhythm. Inadequate sleep hygiene and an adjustment sleep disorder are classified as insomnias. Rapid eye movement (REM) sleep-behavior disorder is a parasomnia associated with REM sleep.

A patient informs a nurse about sleep disturbances caused by jet lag. What sleep disorder does the nurse suspect? 1 Inadequate sleep hygiene 2 Adjustment sleep disorder 3 Rapid eye movement (REM) sleep-behavior disorder 4 Behaviorally induced circadian rhythm sleep disorder

1, 4, 5 Alcohol promotes sleep, but it also awakens the patient early and makes it hard to return to sleep. It also reduces REM sleep. Alcohol is not a stimulant and does not prevent the patient from falling asleep.

A patient reports difficulty falling asleep. Further assessment shows that the patient consumes alcohol. What are the effects of alcohol on sleep? Select all that apply. 1 Alcohol promotes sleep. 2 Alcohol prevents the patient from falling asleep. 3 Alcohol causes the patient to remain awake. 4 Alcohol awakens the patient early and causes difficulty in returning to sleep. 5 Alcohol reduces rapid eye movement (REM) sleep.

2, 3, 4 Insomnia is a condition in which the patient has difficulty falling asleep. Information about the patient's problem falling asleep and his or her reasons for waking up early helps determine the sleep pattern. If the patient is thinking about a specific issue when trying to sleep, it may be a source of stress. The questions about eating out and living with parents do not contribute to determining the sleep pattern.

A patient reports difficulty falling asleep. Which questions should the nurse ask to assess the patient's insomnia? Select all that apply. 1 "How frequently do you eat out?" 2 "How easily do you fall asleep?" 3 "What causes you to awaken early?" 4 "What do you think of when you try to fall asleep?" 5 "Do you stay with your parents?"

3, 4, 5 The nurse should explain that alcohol causes awakening from sleep and difficulty returning back to sleep. Alcohol also reduces rapid eye movement (REM) sleep. Beta-adrenergic blockers are found to cause nightmares in patients. Alcohol does not prevent the onset of sleep; rather, it enhances the onset of sleep.

A patient who has alcoholism complains of disturbed sleep and fatigue. Which statements should the nurse include when teaching the patient? Select all that apply. 1 "Alcohol causes nightmares." 2 "Alcohol prevents the onset of sleep." 3 "Alcohol causes awakening from sleep." 4 "Alcohol causes difficulty returning to sleep." 5 "Alcohol reduces rapid eye movement (REM) sleep."

4 Rhythmical movements of the feet and legs and an itching sensation in the muscles before sleep are symptoms of restless legs syndrome, which is caused by iron deficiency anemia. In cataplexy, sudden muscle weakness occurs during intense emotions such as sadness, anger, or laughter. Insomnia refers to difficulty falling asleep. Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states.

A patient with iron deficiency anemia reports rhythmical movements of the feet and legs and an itching sensation in the muscles before sleep. Which condition is likely to be found in the patient? 1 Insomnia 2 Cataplexy 3 Narcolepsy 4 Restless legs syndrome

1, 2, 5 In obstructive sleep apnea, the upper airways become partially or completely blocked, diminishing nasal airflow or stopping it for as long as 30 seconds. Consumption of alcohol interferes with the quality of sleep. Weight reduction is helpful in decreasing sleep apnea, because it helps to reduce airway obstruction and promotes lung expansion. Consumption of stimulants causes sleeplessness, so they should be avoided. Sedatives should only be prescribed by the health care provider. Herbal medicines may produce side effects or interact with other medications the patient is already taking.

An obese patient is diagnosed with obstructive sleep apnea. Which conservative approaches are included in the patient's treatment plan? Select all that apply. 1 Limit alcohol consumption. 2 Motivate the patient to lose weight. 3 Recommend that the patient take sedatives. 4 Recommend that the patient take herbal medicines. 5 Avoid the consumption of stimulants before going to bed

1 Various instruments are used to measure a patient's sleep pattern. An EMG measures muscle tone. An electrooculogram (EOG) measures eye movements. An electrocardiogram (ECG) measures the electrical activity of the heart. An electroencephalogram (EEG) measures electrical activity in the cerebral cortex.

For what does an electromyogram (EMG) monitor in a patient diagnosed with a sleep disorder? 1 Muscle tone 2 Eye movements 3 Electrical activity of the heart 4 Electrical activity in the cerebral cortex

4 In stages 1 and 2 of nonrapid eye movement (NREM) sleep, the sleeper can be awakened easily. Stage 1 lasts for a few minutes; stage 2 lasts 10 to 20 minutes. Muscles are completely relaxed in stage 3 of NREM sleep. Stage 1 is the lightest level of sleep; stage 2 is a period of sound sleep.

How is stage 1 of nonrapid eye movement (NREM) sleep similar to stage 2 of NREM sleep? 1 Both stages last for 10 to 20 minutes. 2 Both stages include a light level of sleep. 3 The muscles are completely relaxed in both stages 4 The sleeper can be easily awakened in both stages.

2 Stage 3 involves the initial stages of deep sleep, whereas stage 4 is the deepest stage of sleep. Both stages last 15 to 30 minutes. In both stages, the sleeper cannot be easily awakened and the sleeper's vital signs are lower than they are during waking hours.

How is stage 3 of nonrapid eye movement sleep different from stage 4 of nonrapid eye movement? 1 Stage 3 lasts 15 to 30 minutes. 2 Stage 3 involves initial stages of deep sleep. 3 In stage 3, the sleeper can be easily awakened. 4 In stage 3, vital signs are lower during the waking hours.

15 In a patient who has narcolepsy, rapid eye movement (REM) sleep occurs within 15 minutes of falling asleep.

In a patient with narcolepsy, rapid eye movement (REM) sleep occurs within how many minutes of falling asleep? Record your answer using a whole number. _________ minutes

4 Nonrapid eye movement sleep has four stages. Enuresis occurs in stage 4 of nonrapid eye movement of the sleep cycle. Stage 4 lasts for approximately 15 to 30 minutes. It is the deepest stage of sleep. Enuresis does not occur in stage 1, stage 2, or stage 3.

In which stage of the sleep cycle does enuresis occur? 1 Stage 1 of nonrapid eye movement 2 Stage 2 of nonrapid eye movement 3 Stage 3 of nonrapid eye movement 4 Stage 4 of nonrapid eye movement

1, 2, 5 In the health care setting the noise created by the staff, monitor alarms, and equipment may have adverse effects on the patients. Noise may cause anxiety and lead to delayed healing, increased agitation, and impaired immune function. Noise increases heart rate and raises blood pressure.

Many kinds of noise are generated during the delivery of health care in a variety of settings. What may be the effects of these noises on the patient? Select all that apply. 1 Delayed healing 2 Increased agitation 3 Decreased heart rate 4 Lowered blood pressure 5 Impaired immune function

4

Nonrapid eye movement (NREM) sleep is divided into how many stages? Record your answer using a whole number. _________

B Avoiding awakening patient for nonessential tasks promoted sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as laboratory draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits. The other tasks do not promote sleep.

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 television on low to late-night programming.

D 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.

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

2, 3, 4, 5 Sleep deprivation may slow down all the body systems. This slowing may result in ptosis or blurred vision, cardiac arrhythmias, diminished reflexes, and decreased hearing. Sleep deprivation would not increase the response time to questions asked or to any activity, because responses have slowed.

The nurse is assessing a patient who complains of sleep deprivation. Which physiological symptoms should the nurse expect to find in the patient? Select all that apply. 1 Increased response time 2 Ptosis or blurred vision 3 Cardiac arrhythmias 4 Diminished reflexes 5 Decreased hearing

1, 3, 4 Sleep apnea occurs due to a lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep. Loud snoring, decreased sex drive, and difficulty concentrating are symptoms of sleep apnea. Muscle weakness and excessive urination during the night are not symptoms of sleep apnea.

The nurse is assessing a patient who has sleep apnea. Which symptoms are likely to be found in the patient? Select all that apply. 1 Loud snoring 2 Muscle weakness 3 Decreased sex drive 4 Difficulty concentrating 5 Excessive urination during the night

C SBAR is Situation, Background, Assessment, and Recommendation. This is the correct sequence of steps in SBAR for the patient and sleep problem.

The nurse is contacting the health care provider about a patient's sleep problem. What is the correct order for the steps for SBAR? 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 2. "Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 3. "I'm calling to ask if you would order a hypnotic such as zolpidem (Ambien) to use on a prn basis." 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1° C (98.8° F). A. 2, 1, 3, 4 B. 1, 2, 3, 4 C. 2, 1, 4, 3 D. 1, 2, 4, 3

1, 4, 5 Taking short naps, no longer than 20 minutes, during the day and regular exercise are management strategies that help reduce the feeling of sleepiness. Modafinil is a stimulant used to treat narcolepsy; therefore it is important for patients to understand its side effects.

The nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? (Select all that apply.) A. Take brief, 20-minute naps during the day. B. Drink a glass of wine with dinner. C. Eat the large meal at lunch rather than dinner. D. Establish a regular exercise program. E. Teach the patient about the side effects of modafinil (Provigil).

C 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 good sleep-hygiene practices, alcohol modification, smoking cessation, and weight reduction.

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.

1, 3, 4 Sleep involves a sequence of physiological states maintained by central nervous system activity. Sleep is controlled by prostaglandin D2, L-tryptophan, and growth factors. The major sleep center in the body is located in the hypothalamus, which produces hypocretins. The ascending reticular activating system maintains alertness and wakefulness in response to the visual, auditory, pain, and tactile stimuli. The bulbar synchronizing region releases serotonin and helps the body go to sleep. The medulla does not play a role in sleep. The hypocretins promote wakefulness and rapid eye movement sleep.

The nurse is explaining the physiology of sleep to the student nurses. What information should the nurse include? Select all that apply. 1 Prostaglandin D2 controls sleep. 2 The release of serotonin from the bulbar synchronizing region prevents sleep. 3 Major sleep center is located in the hypothalamus. 4 The ascending reticular activating system (RAS) maintains wakefulness. 5 Hypocretins promote nonrapid eye movement sleep.

2, 3, 5 Herbal products help promote sleep. These products need to be used cautiously because they are not regulated by the U.S. Food and Drug Administration. They should not be used long term and can interact with prescribed medications. Kava needs to be used cautiously because it can be toxic to the liver.

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 U.S. Food and Drug Administration (FDA)

C Good sleep-hygiene practices indicate that individuals should fall asleep within 30 minutes of going to bed. Taking 45 to 60 minutes to fall asleep indicates a potential sleep problem and requires follow-up on sleep-hygiene practices. If an individual does not fall asleep within 30 minutes, encourage him or her to get out of bed and do a quiet activity until he or she feels sleepy.

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 about 45 to 60 minutes to fall asleep." D. "I take the pain medication for my leg pain about 30 minutes before I go to bed."

4 REM sleep is a stage that usually begins about 90 minutes after sleep has begun. Events that occur during this stage of sleep include the loss of skeletal muscle tone or skeletal muscle paralysis. Bedwetting, or enuresis, may occur during stage 4 of nonrapid eye movement (NREM) sleep. In stage 1 of NREM sleep, upon awakening the patient may feel as though daydreaming has occurred. Sleepwalking occurs during stage 4 of NREM sleep.

The nurse is teaching a group of student nurses about the stages of sleep. Which event does the nurse discuss while explaining rapid eye movement (REM) sleep? 1 Bedwetting 2 Daydreaming 3 Sleepwalking 4 Skeletal muscle paralysis

C 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.

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

1, 4, 5 Going to bed at the same time each night, avoiding drinking coffee and soda before bedtime, and turning off electronic devices are effective sleep-hygiene practices for adolescents. Use of electronic devices is a main cause of sleep disruption in adolescents.

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? (Select all that apply.) A. Go to bed at the same time each night. B. Study in your bedroom to have a quiet place. 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.

3 L-tryptophan is a natural protein present in foods such as milk, cheese, and meat; this chemical promotes sleep. Orexins and hypocretins promote wakefulness. Catecholamines, which are secreted by neurons in a reticular activating system, promote wakefulness.

Which chemicals promote sleep? 1 Orexins 2 Hypocretins 3 L-tryptophan 4 Catecholamines

1, 2, 3 Giving the patient a backrub, turning on quiet music, and dimming the lights are all appropriate sleep-hygiene measures. These activities are within the scope of practice for the nursing assistant. Coffee, tea, cola, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night and should not be ingested before bedtime. Monitoring medication effect is a registered nurse activity.

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 the sleeping medication that was given

4 Both antidepressants and anticonvulsants suppress rapid eye movement (REM) sleep. Nocturia is associated with the use of diuretics. The use of anticonvulsants is associated with daytime drowsiness. The use of antidepressants is associated with decreased total sleep time.

Which sleep-related side effect is seen with the use of antidepressants and anticonvulsants? 1 Nocturia 2 Daytime drowsiness 3 Decreased total sleep time 4 Suppressed rapid eye movement (REM) sleep

B 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.

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."

C The statement, "I'll talk to my health care provider before I use an over-the-counter sleep medication" shows an understanding of the risks of over-the-counter sleep medications. The use of nonprescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption even when they initially seemed effective. Caution older adults about using over-the-counter antihistamines because of their long duration of action that can cause confusion, constipation, urinary retention, and increased risk of falls.

Which statement made by an older adult best demonstrates understanding of taking a sleep medication? A. "I'll 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."

A 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.

Which statement made by the parent of a school-age child requires follow-up by the nurse? A. "I encourage evening exercise about an hour before bedtime." B. "I offer my daughter a glass of warm milk before bedtime." C. "I make sure that the room is dark and quiet at bedtime." D. "We use quiet activities such as reading a book before bedtime."

D 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.

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."

4 During stage 4 of NREM sleep, a patient's vital signs are significantly lower than during waking hours. This is a deep, slow-wave sleep stage during which the body releases human growth hormone. Stage 1 NREM sleep is the lightest level of sleep and lasts for just a few minutes. Stage 2 NREM sleep is a period of sound sleep that lasts for 10 to 20 minutes. Stage 3 NREM sleep involves the initial stages of deep sleep lasting for 15 to 20 minutes.

While monitoring a patient's vital signs, the nurse finds that the patient's pulse and respiration during sleep are significantly lower than during waking hours. The nurse also recalls that during this stage of sleep the body releases human growth hormone. The patient is in which nonrapid eye movement (NREM) stage of sleep? 1 Stage 1 2 Stage 2 3 Stage 3 4 Stage 4