Mental Health Course point 34

After teaching a group of nursing students about sleep-wake disorders, the instructor determines that the education was successful when the students identify which of the following as the most prevalent disorder?

insomnia

A nurse provides teaching to a client with sleep problems who presents to the clinic for an annual check-up. Which does the nurse recognize as the most important teaching point?

"Be sure to keep a regular sleep and wake routine."

A client reports to the nurse that he has been experiencing increased sleep latency during a time of interpersonal stress and has been taking over the counter sleep aids several times a week. When assessing for the potential adverse effects of this medication, the nurse should include what question?

"Do you ever find that you feel especially groggy in the morning after taking them?"

The nurse is caring for a client with insomnia. Which statement(s) does the nurse include when teaching the client behavior modification for insomnia? Select all that apply.

"Focus on relaxing all your muscles when you are feeling tense at bedtime." "Spending less time in bed might be helpful." "Avoid watching television in your bedroom."

The nurse is assisting a client in understanding the drawback of using benzodiazepine receptor agonists (BzRAs) to promote sleep. Which drawback is the most important to inform the client about?

It is possible to develop a dependence on the medication.

A nurse is reading a journal article about sleep. When reviewing the statistics about the average person in the Unites States, which of the following would the nurse most likely find as the average duration of sleep?

6 to 6.5 hours

A nurse is preparing a discussion about sleep for a senior adult community group. When talking about the usual number of hours of sleep individuals get per night, which amount would the nurse most likely include?

6—6.5 hours/night

The nurse is admitting an older adult client to the medical-surgical unit for observation following a fall in her home. Which of the following findings would require additional assessment?

"I don't sleep well anymore, but then I'm getting old."

A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following recent falls and a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education?

"I make sure that I take a long nap each afternoon to compensate for my frequent waking at night."

The nurse has been teaching a client ways to improve sleep patterns at home. The nurse evaluates teaching to have been effective when the client states which of the following?

"I need to take any caffeine-containing cold medicine no later than mid-afternoon."

The nurse cares for a client with insomnia who is prescribed zaleplon. Which client statement indicates the need for more teaching?

"I should not take this if I wake early in the night and have trouble falling back to sleep."

The nurse provides safety education to family of a client who sleepwalks. Which statement indicates to the nurse a need for additional teaching?

"I will keep the window open so that I can hear if my partner sleepwalks outside."

The client asks the nurse, "I don't understand what sleep latency is for my journal." Which response by the nurse is accurate?

"It is the amount of time it takes to fall asleep."

A client who is receiving counseling at a community health center has reported during the last three weekly sessions about being unable to sleep. A nurse interviews the family members to determine the effect of the client's problem on them. Which response would the nurse mostlikely expect to hear?

"It's been exhausting living with them these past few weeks." "The moving about all night keeps the rest of us awake."

A young adult comes to the sleep clinic and reports not getting enough sleep and rest. The client reports needing a drink of alcohol to fall asleep. What should the nurse tell this client about alcohol's effect on sleep?

"Long-term effects of alcohol are arousal and wakefulness."

A client asks the nurse, "What causes insomnia?" Which response by the nurse would be most appropriate?

"No one factor is associated with causing insomnia."

An older adult client with a sleep disorder asks the nurse, "Why have my sleep patterns changed over the years?" How should the nurse reply?

"Sleep hormones change as you age."

When discussing options for medications to aid sleep, the client asks the nurse why it would be beneficial to take a benzodiazipine receptor agonist. Select the nurse's best response.

"The body absorbs the medication quickly. You will be able to fall asleep faster."

A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns?

"There may be something else going on with your husband such as delirium or a problem with his medications."

A nurse is assessing a client reporting the symptoms associated with insomnia. What assessment question demonstrates the nurse's understanding of mental health issues often related to the development of insomnia?

"Would you consider yourself as being depressed?"

The nurse encourages a client who is diagnosed with insomnia to keep a sleep journal. Which information should the nurse ask the client to record in the journal? Select all that apply.

"Your sleep diary should include the time of exercise." "You should record any instances of sleep latency in your diary." "You should record caffeine intake for the day in your sleep diary." "Your sleep diary should include the time that you go to bed each day."

A 12-year-old client presents to a pediatric clinic for a well-child visit. The child's parent asks the nurse, "How much sleep should my child get every night?" How should the nurse respond?

"about 9 to 11 hours"

The nurse is assessing a client who is complaining of trouble sleeping. During the history, the client reports that he frequently has to travel for work across time zones. The nurse would suspect which type of circadian rhythm disorder?

Jet lag type

The nurse is assessing a client who was involved in a car accident two weeks prior. The client describes sleep quality as "poor" but is unable to elaborate further. Which intervention should the nurse recommend?

Keep a sleep diary

A nurse is conducting a teaching session for a group of pregnant couples about infants and their sleep habits. Which amount of sleep would the nurse identify as being required by 6-month-old infants?

12 hours

After reviewing information about sleep patterns and changes occurring over the lifespan, a group of nursing students demonstrates understanding when they identify that newborns require how much sleep per day?

17 to 18 hours

The nurse provides care for a client who is diagnosed with insomnia. Which intervention should the nurse include in the client's teaching plan to address this issue? Select all that apply.

Avoid nicotine before bedtime. Abstain from alcoholic beverages. Maintain a regular bedtime and rising time.

A nurse is teaching a client about sleep hygiene and ways to promote sleep. Which of the following would the nurse include in the education plan? Select all that apply

Avoiding caffeine after mid-afternoon Establishing a regular time for bed Using the bedroom for sleep and sex

The nurse caring for a client with a sleep disorder understands that wakefulness is maintained by which of the following areas of the brain?

Reticular activating system (RAS)

A physician is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for "sleeping pills" to help him through this time. Which of the following statements forms a valid basis for the physician's plan for treatment?

Behavioral therapies, counseling and education may be of some use for the client

Which type of therapy resets the biologic clock by using short-acting hypnotics to induce sleep?

Chronopharmacotherapy

The nurse is seeing a client who reports having insomnia. After taking the client's history, the nurse notes the client has been experiencing low mood and anxiety over the past two weeks. Which intervention would be most appropriate for the nurse to include in this client's plan of care?

Cognitive behavioral therapy

The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour each night, as well as the extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. Which circadian rhythm disorder would the nurse suspect?

Delayed sleep phase type

A client is telling a nurse about repeated frightening dreams that the client has been having and that have awakened the client from sleep. When assessing this complaint further, which would the client most likely report?

Continued sense of fear after awakening

When performing a nursing history with a client reporting a sleep disturbance, it is important to assess for which potential contributing factor to sleep difficulties?

Daily use of caffeine

A nurse is assessing a client who is suspected of having hypersomnolence. Which of the following would the nurse expect to find? Select all that apply.

Difficulty awakening in the morning Functional impairment Sleep inertia

A client has been prescribed zolpidem for insomnia disorder. What common side effect should be included in the medication teaching for this client?

Drowsiness

When assessing a client, the nurse is aware the client is more likely to have a circadian rhythm disorder if the client is employed in which occupation?

Emergency room physician

A client reports recent sleep patterns that are suggestive of insomnia. What is the nurse's best initial action?

Encourage the client to keep a sleep diary to accurately monitor sleep patterns

A client admitted to the inpatient unit has a history of sleepwalking. Which action does the nurse implement to ensure the client's safety?

Ensure a consistent bedtime routine.

A 50-year-old client with insomnia is being treated in the sleep clinic. The nurse is conducting a teaching session with the client about tips for sleep. Which information would the nurse most likely include? Select all that apply.

Establish a regular bedtime and rising time. Abstain from alcohol. Exercise regularly. Use the bedroom only for sleep and sex.

A client is experiencing dysfunctional slow-wave sleep. The client asks a nurse to explain what that means. What characteristic will the nurse inform the client regarding dysfunctional slow-wave sleep?

Generally feeling 'unrested'

A nurse is preparing a presentation about lifestyle factors and their effect on sleep for a group of adults at the community center. When effect would the nurse most likely describe as being associated with working the night shift?

increased risk of errors.

Which of the following is the primary symptom to occur in narcolepsy?

Excessive sleepiness

Which of the following should be included in the client education plan to promote good sleep habits? Select all that apply.

Exercise regularly. Provide a comfortable environment. Refrain from caffeine after mid-afternoon. Abstain from alcohol.

The nurse is seeing a client who has been given a diagnosis of hypersolemnence. Which treatment intervention should be discussed first with the client?

Habits associated with normal sleep

The nurse is caring for a client who is post-operative from a total hysterectomy. The nurse should anticipate which change is going to impact the client's recovery from surgery?

Hormone fluctuations decrease sleep quality.

The nurse is providing community education regarding the importance of sleep for maintaining good health. The nurse should include that sleeping less than seven hours per night can increase the risk of which health problem? Select all that apply.

Hypertension Anxiety Glucose dysregulation Depression

A client is diagnosed with narcolepsy. During the interview, the client reports vivid dream-like images when he first falls asleep. The nurse documents this as which of the following?

Hypnagogic hallucinations

An instructor is describing the sleep-wake cycle to a group of nursing students. The instructor determines that the education was successful when the group identifies that the body's biological clock is located in which of the following?

Hypothalamus

After teaching a group of nursing students about shift-work type circadian rhythm disorder, the instructor determines the need for additional education when they identify which of the following as characteristic of a person who rotates shifts?

Improved alertness during work

A nurse is teaching a client about appropriate sleep measures. During the education session, the nurse cautions the client about consuming caffeine based on the understanding that caffeine can result in which of the following? Select all that apply.

Increased sleep latency Decreased total sleep time Decreased REM sleep

A client who comes to the sleep clinic reports being tired in the morning. Upon further assessment, the client discusses difficulty falling asleep at night and waking up in a bad mood in the morning. The client also acknowledges difficulty staying awake during the day. Which of the following diagnoses would the nurse suspect?

Insomnia

A nurse preceptor working in a sleep clinic informs a graduate that the most common sleep disorder in adults is which of the following?

Insomnia

Amanda is a 42-year-old woman who has been diagnosed with severe depression. Which of the following sleep disorders is most likely to coincide with depressive disorders?

Insomnia

The nurse is counseling a client who is grieving the loss of her spouse 4 months ago. The client reports having trouble falling and staying asleep at least 3 to 4 nights per week. The nurse recognizes the client is most likely experiencing which sleep-wake disorder?

Insomnia disorder

A client reports always feeling tired. During the health history, the client reports drinking 2 to 3 cups of decaffeinated coffee each day and warm milk before bedtime. The client adds that she retires at the same time each night. She lists use of the following medications: lithium, lasix, and prednisone. What does the nurse suspect is the cause of this client's sleep disturbance?

Medications

A nurse has acted on the obligation to be fit to practice by planning which non-work activities?

Meeting a friend for lunch at noon after the last night shift

A client is prescribed Ramelteon (Rozerem). The nurse understands that this drug is classified as which of the following?

Melatonin receptor agonist

A nurse walks into a client's room to administer medications and finds the client sitting up in a chair. He is holding the newspaper but appears to be sleeping and not reading. His wife tells the nurse that he does this all the time and sometimes falls asleep while driving. For what should the nurse assess this client?

Narcolepsy

Lindsay is a professional nurse who has just completed a military tour of duty in the Middle East. She has cared for combat victims and has seen trauma that she was never prepared for in her nursing education. She presents to the counseling center with symptoms of posttraumatic stress disorder (PTSD). Which of the following sleep disturbances would the nurse expect Lindsay to report?

Nightmares

Which of the following motor disorders of sleep can be life threatening?

Obstructive apnea

A client comes to the sleep clinic and reports fatigue and daytime sleepiness. Assessment reveals a weight gain of 40 lbs over the last year following smoking cessation and a history of gastroesophageal reflux disease (GERD). The client's wife says that her husband snores so loudly, she cannot remember the last time that she slept well. From what should the nurse suspect this client is suffering?

Obstructive sleep apnea syndrome

When educating a client on insomnia, which of the following would the nurse include?

One of the major reasons for insomnia is depression.

The nurse assesses a female client who reports losing tone in her legs after laughing heavily. The nurse should anticipate the client will require which intervention?

Polysomnogram

A client is scheduled to undergo testing to assess for a sleep disorder. The nurse would expect to prepare the client for which test?

Polysomnography

An 85-year-old client has been diagnosed with insomnia disorder. Which of the following would be the priority for this client?

Promoting client safety

A nurse is describing the stages of sleep to a class of nursing students. When discussing dreaming, the nurse would identify vivid dreaming as the hallmark feature of which stage of sleep?

REM

Nightmares tend to occur during which stage of sleep?

REM sleep

A client is prescribed a melatonin receptor agonist to treat her insomnia. The nurse would identify which drug as being prescribed?

Ramelteon

A new graduate nurse is experiencing trouble re-establishing healthy sleep after completing a set of shifts on a hospital medical unit. The nurse works both 12-hour day and night shifts. Which sleep-promoting agent would be best for the nurse to normalize sleep while maintaining fitness to practice?

Ramelteon

The nurse observes a client talking while asleep accompanied by rapid leg movements. Which type of sleep disorder should the nurse suspect this client is experiencing?

Rapid eye movement sleep behavior

A client visiting the sleep clinic participates in a sleep study and is diagnosed with obstructive sleep apnea. What does the nurse explain as the cause of this disorder?

Repetitive episodes of reduced airflow

To treat transient insomnia, it is suggested that good sleep hygiene habits be established. What is an example of sleep hygiene?

Setting up a normal bedtime and awakening time

When providing education to a group of health care providers who do shift work, a nurse educator should include which statements? Select all that apply.

Sleep during the day is not the same as sleep at night Irregular bowel patterns can result from sleep associated with shift work Establishing a consistent sleep routine reduces injury

The nurse is seeing a client who reports sleeping 8 or 9 hours per night but waking up feeling unrested. The nurse is interested in determining how much actual sleep the client is getting while the client is physically laying in bed in order to identify the underlying problem preventing quality sleep. What does the nurse need to help the client investigate further?

Sleep efficiency

A nurse is giving a talk to a local woman's group about sleep and how it needs to be maintained across the lifespan. What does the nurse tell the group about the different sleep disturbances in women? Select all that apply.

Sleep is tied to hormonal levels. Many women have sleep problems during the premenstrual period. Sleep deprivation is associated with menopause.

A client with narcolepsy tells the nurse that it often feels like he is being suffocated when he is falling asleep. He also says, "I get terrified because I can't seem to move." The nurse identifies this as which of the following?

Sleep paralysis

The nurse is providing counseling to a client who is experiencing depression. When providing education to the client about the importance of each stage of sleep, which teaching point should the nurse include?

Slow-wave sleep plays an important part of helping the body repair.

A client with insomnia is instructed to avoid watching television and refraining from doing anything in the bedroom except sleep. Which intervention is being used?

Stimulus control

A nurse is developing a presentation for a community health fair about sleep. Which area would the nurse incorporate into the presentation as being responsible for the control of the circadian rhythms?

Suprachiasmatic nucleus (SCN)

A client comes to the clinic for evaluation. The nurse suspects that the client is experiencing advanced sleep phase syndrome (ASPS). Which client complaint would the nurse identify as supporting the suspicion?

Trouble staying awake in the evening and waking up in the morning feeling rested.

The nurse is seeing a client who is employed as a long haul truck driver. The client reports symptoms of insomnia over the past two weeks. The client is concerned about taking medication to aid sleep due to the risk of being over-sedated. Which non-pharmacological intervention should the nurse recommend? Select all that apply.

Tense and relax each muscle group in the body just before bedtime. Do the same thing every day when preparing for bedtime. Avoid any tea, coffee, or energy drinks during the day.

A nurse is assessing a client who reports feeling unrested throughout the day. Which factor should signal the nurse to assess further for obstructive sleep apnea (OSA)?

The client is post-menopausal

The nurse is caring for a client with both posttraumatic stress disorder (PTSD) and insomnia. Which statement about the client's comorbidities does the nurse recognize is true?

The client's risk of mental illness relapse is increased.

The nurse is caring for a client with both posttraumatic stress disorder (w) and insomnia. Which statement about the client's comorbidities does the nurse recognize is true?

The client's risk of mental illness relapse is increased.

A client with a history of both managed posttraumatic stress disorder (PTSD) and type 2 diabetes now presents with new reports of insomnia. Considering the most urgent risk for a client, what will a nurse assess for regularly?

The relapse of PTSD symptoms

As the rehabilitation nurse, you are planning a teaching activity for clients in a community-based treatment program. Health promotion regarding healthy sleep activities would include teaching the clients to do which of the following?

Try to go to bed and wake up at the same time on the weekends as during the week.

A client diagnosed with insomnia is prescribed a non-benzodiazepine hypnotic. Which medication would the nurse expect to be prescribed?

Zolpidem

A nurse cares for a client with nightmare disorder who reports multiple nightmares per night and an inability to fall back asleep after an episode. Which of the following would the nurse most likely find on the client's polysomnography report?

abrupt awakenings in REM sleep

Narcolepsy, a disorder characterized by excessive daytime sleepiness and cataplexy (sudden bilateral loss of postural muscle tone), is effectively treated with ...

administration of methylphenidate (Ritalin).

A client reports falling asleep after dinner and being wide awake at 0300. For which type of circadian rhythm sleep disorder should the nurse plan care for this client?

advanced sleep phase

Cory, an 18-year-old high school senior, stays up past midnight every night and has to be at school by 7:30 AM the next day. He often feels sleepy until mid-morning yet refuses to go to bed any earlier. An explanation for Cory's disrupted sleep-wake cycle is

circadian changes may be normal in adolescence.

The pacemaker that regulates sleep-wake cycles in humans and contributes to sleep disorders is ...

circadian rhythm.

A client reports difficulty sleeping when the clocks are changed in the spring and fall. Which should the nurse recommend to help this client achieve adequate sleep? Select all that apply.

limit the bedroom to sleeping and sex stick to a regular bedtime and rising time avoid caffeine and nicotine before bedtime

A client reports difficulty falling asleep, maintaining sleep throughout the night, and feeling not rested upon wakening in the morning. Education for home care should include ...

maintain regular sleep schedules on weekdays and weekends.

The client is a single mother studying broadcast journalism. The client works two part-time jobs in addition to school to cover family and educational expenses. Last night driving home from work the client drifted off the road and nearly had an accident. Luckily there was no harm, but the client realized the need to change a life factor, because the client is most likely suffering the negative consequences of:

sleep deprivation.