NCLEX Qs: FON Sleep
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? 1- Rapid eye movement (REM) sleep 2- Stage 1 non rapid eye movement (NREM) sleep 3- Stage 4 NREM sleep 4- Transition period from NREM to REM sleep
3- 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.
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? 1- "Antihistamines are better than prescription medications because these can cause a lot of problems." 2- "Antihistamines should not be used because they can cause confusion and increase your risk of falls." 3- "Antihistamines are effective sleep aids because they do not have many side effects." 4- "Over-the-counter medications when combined with sleep-hygiene measures are a good plan for sleep."
2- "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.
Which statement made by the patient indicates a need for further teaching on sleep hygiene? 1- "I'm going to do my exercises before I eat dinner." 2- "I'm going to go to bed every night at about the same time." 3- "I set my alarm to get up at the same time every morning." 4- "I moved my computer to the bedroom so I could work before I go to sleep."
4- "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? 1- Incontinence 2- Nausea and vomiting 3- Bradycardia 4- Respiratory depression
4- 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.
Which sleep-hygiene actions at bedtime can the nurse delegate to the nursing assistant? Select all that apply. 1- Giving the patient a backrub 2- Turning on quiet music 3- Dimming the lights in the patient's room 4- Giving a patient a cup of coffee 5- Monitoring for the effect of the sleeping medication that was given
ANS 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.
Read this case study to answer the following 5 Qs
Kyoto is a nursing student in his last semester of nursing school who works two shifts a week at a sleep clinic to fulfill his community nursing rotation. While working at the clinic, he has learned a great deal about sleep and sleep disorders. His responsibilities at the sleep center include performing assessments, administering medications, hooking patients up to all of the monitoring equipment, and providing patient education.
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 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
a. Stage I NREM sleep Involuntary muscle jerking occurs in stage I NREM sleep. In the other stages, the muscles proceed from a relaxed state to large muscle immobility.
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 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.
c. Aging decreases the amount of REM sleep a person experiences. 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.
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
d. Somnambulism 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.
Which statement made by the parent of a school-age child requires follow-up by the nurse? 1- "I encourage evening exercise about an hour before bedtime." 2- "I offer my daughter a glass of warm milk before bedtime." 3- "I make sure that the room is dark and quiet at bedtime." 4- "We use quiet activities such as reading a book before bedtime."
1- "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.
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? 1- "I'll give the baby a bottle to help her fall asleep." 2- "We'll place the baby on her back to sleep." 3- "We put the baby's stuffed animals in the crib to make her feel safe." 4- "I know the baby will not need to be fed until morning."
2- "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? 1- Have patient follow hospital routines. 2- Avoid waking patient for nonessential tasks. 3- Give prescribed sleeping medications at dinner. 4- Turn television on low to late-night programming.
2- Avoid waking patient for nonessential tasks. 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.
Which statement made by an older adult best demonstrates understanding of taking a sleep medication? 1- "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." 2- "Sleep medicines won't cause any sleep problems once I stop taking them." 3- "I'll talk to my health care provider before I use an over-the-counter sleep medication." 4- "I'll contact my health care provider if I feel extremely sleepy in the mornings."
3- "I'll talk to my health care provider before I use an over-the-counter sleep medication." 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.
The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? 1- "I feel refreshed when I wake up in the morning." 2- "I use soft music at night to help me relax." 3- "It takes me about 45 to 60 minutes to fall asleep." 4- "I take the pain medication for my leg pain about 30 minutes before I go to bed."
3- "It takes me about 45 to 60 minutes to fall asleep." 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 developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? 1- Instruct the patient to sleep in a supine position. 2- Have patient limit fluid intake 2 hours before bedtime. 3- Elevate the head of the bed to sleep. 4- Encourage patient to take an over-the-counter sleep aid.
3- 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 good sleep-hygiene practices, alcohol modification, smoking cessation, and weight reduction.
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. 1- Go to bed at the same time each night. 2- Study in your bedroom to have a quiet place. 3- Turn on the television to help you fall asleep. 4- Avoid drinking coffee or soda before bedtime. 5- Turn off your cell phone at bedtime.
ANS 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 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. 1- Take brief, 20-minute naps during the day. 2- Drink a glass of wine with dinner. 3- Eat the large meal at lunch rather than dinner. 4- Establish a regular exercise program. 5- Teach the patient about the side effects of modafinil (Provigil).
ANS 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 providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? Select all that apply. 1- Can cause urinary retention 2- Should not be used indefinitely 3- May have toxic effects on the liver 4- May cause diarrhea and anxiety 5- Are not regulated by the U.S. Food and Drug Administration (FDA)
ANS 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 contacting the health care provider about a patient's sleep problem. What is the correct order for the steps for SBAR? Place the following in correct order 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). CHOOSE THE ANSWER THAT REFLECTS CORRECT ORDER A) 2, 1, 3, 4 B) 1, 2, 3, 4 C) 2, 1, 4, 3 D) 1, 2, 4, 3
ANS C) 2, 1, 4, 3 SBAR is Situation, Background, Assessment, and Recommendation. This is the correct sequence of steps in SBAR for the patient and sleep problem.
5.Kyoto teaches an OSA patient the steps to take to improve sleep and reduce EDS. Which of the following substances can produce insomnia if consumed before bed? (Select all that apply.) A. Coffee B. Tea C. Cola D. Chocolate E. Milk
Answer: A, B, C, D Rationale: Coffee, tea, cola, and chocolate contain caffeine and xanthines that cause sleeplessness.
2. Kyoto learns about different conditions that disrupt sleep. Which of the following is the term that describes urination during the night that disrupts sleep? A. Insomnia B. Nocturia C. Apnea D. Hypoxia
Answer: B Rationale: Nocturia is urination during the night that causes the patient to get out of bed to use the bathroom, which disrupts the sleep cycle.
3. Kyoto learns about obstructive sleep apnea (OSA). OSA can cause fatigue and EDS in patients. EDS stands for ___________ ______________ _____________.
Answer: Excessive daytime sleepiness Rationale: EDS and fatigue are the most common complaints of people with OSA
1. Kyoto hooks up a patient to a monitoring device that uses electroencephalography (EEG), electromyelography (EMG), and electrooculography (EOG) to monitor stages of sleep and wakefulness during nighttime sleep. This device is a ________________.
Answer: Polysomnogram Rationale: A polysomnogram provides objective information about sleepiness and selected aspects of sleep structure by measuring eye movements, muscle-tone changes, and brain electrical activity during sleep.
4. Nurses are at high risk for _________ _____________ as a result of long work schedules and rotating shift work.
Answer: Sleep deprivation Rationale: Sleep deprivation is caused by illness, medications, emotional stress, and environmental factors. Nurses and physicians are particularly prone to sleep deprivation because of long work schedules and rotating shift work.
A nurse who was hired to work in a sleep lab understands that the most common type of sleep apnea is caused by which factor? a. Airway collapse b. Lack of exercise c. Dietary factors d. Medication use
Answer: a Airway collapse of the soft structures of the upper airway is the most common cause of sleep apnea. Lack of exercise and certain dietary factors may adversely affect sleep patterns, especially the initiation of sleep. Medications in the proper dose seldom cause sleep apnea unless improperly combined with other medications or taken with alcohol.
A mother brings her toddler for a well-child checkup and mentions that she is having a lot of trouble getting the child to go to bed. Which intervention can the nurse teach the mother to help her toddler establish good sleep habits? a. Establish and maintain a consistent bedtime routine. b. Put the child to bed immediately after the evening meal. c. Allow the child to stay up as long as desired to increase sleepiness. d. Allow the child to sleep with the parents until the child is older.
Answer: a Toddlers and preschoolers benefit from a consistent routine to help their sleep patterns. Putting the child to bed too early (right after a meal) will not help sleep; any bedtime snacks should be a light snack containing carbohydrates. The child will become too tired if allowed to stay up as long as desired, with consequent sleep disruption the next day. The American Academy of Pediatrics does not recommend that children sleep with parents.
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.
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.
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.
An elderly patient complains of difficulty sleeping after the death of his spouse of 56 years. What would be an appropriate nursing assessment for this patient? a. Assess the patient for possible use of sedatives. b. Obtain a health history regarding sleep hygiene. c. Assess the patient's weight over the past year. d. Request a sleep study to rule out sleep apnea.
Answer: b Obtaining a health history of the patient's sleep hygiene will help determine interventions that might promote relaxation and sleep. Sedatives are prescribed for only some patients with chronic, ongoing sleep disturbances that interfere with daily life after nonpharmacologic methods have been tried. Although assessing the patient's weight is an important part of a physical exam, weight is not related to the type of sleep problem described. No symptoms of sleep apnea have been reported, so the nurse would not request a sleep study.
A nurse is working a night shift after several months of working day shift. What action does the nurse take to protect patient safety? a. Take a meal break at midnight. b. Plan critical tasks for early in the shift. c. Ask another nurse to administer all medications.
Answer: b The 4 a.m. window is when most people become the sleepiest during the night, so it is important that noncritical tasks be planned for this time and that extra care be taken with patient care tasks. A meal break at midnight may be too early to prevent hunger for the entire shift and is not directly related to patient safety. It is not necessary to have another nurse administer all medications if the nurse is aware of the high risk time for care tasks. Increasing the amount of light is likely to impair the sleep of all patients on the unit.
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.
A patient complains of not being able to sleep while in the hospital. What action would be a priority for the nurse to implement? a. Administer a sleeping medication with the evening meal. b. Restrict visitors for the patient in the evening. c. Decrease noise around the patient during the night. d. Offer a hot drink of regular tea at bedtime.
Answer: c Noise is a primary cause for disturbed sleep in the hospital. Administering sleeping medications with the evening meal is too early to help the patient sleep throughout the night. Restricting visitors may be helpful if the patient requests it, but visitors often provide emotional support and reassurance to the patient, which helps with relaxation. Regular tea contains caffeine, which is not helpful in sleep promotion.
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.
A patient has been referred for polysomnography to confirm a diagnosis of narcolepsy. What behavior would the nurse expect the patient to be exhibiting? a. Excessive use of sleeping medications b. A lack of dreaming during sleep c. Consistent use of relaxation techniques d. Unexpected daytime sleeping episodes
Answer: d Narcolepsy is characterized by uncontrolled and unexpected episodes of falling asleep during the day. Because of sleeping too much, sleep medications and relaxation techniques are not needed. The patient goes almost directly to rapid eye movement (REM) sleep on falling asleep, so vivid dreaming would be expected.
At a routine clinic visit, an athlete training for a major sports event reports difficulty sleeping that is affecting the training schedule. What would be the best recommendation by the nurse for this patient? a. Increase the use of electrolyte-enriched drinks to increase stamina. b. Obtain a short-term prescription for sleeping medications. c. Plan to arise later in the morning to accommodate sleep changes. d. Avoid vigorous exercise for at least 2 hours before bedtime.
Answer: d Vigorous exercise in the hours before bedtime will cause stimulation that prevents sleep. Adjusting the training schedule to account for this effect is the preferred first step for improving the athlete's sleep, rather than starting medications that may affect alertness during the day. A regular sleep schedule is preferred to maintain sleep promotion, including getting up at the same time each day no matter when bedtime occurred.
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.
The nurse is completing a sleep assessment for a newly admitted patient. Which data reported by the patient would cause the nurse to suspect obstructive sleep apnea? (Select all that apply.) a. Morning headaches b. Sudden weight loss c. Loud snoring during sleep d. Daytime sleepiness e. Deep sleep during the night f. Increased blood pressure problems
Answers: a, c, d, f Signs of obstructive sleep apnea include headaches from hypoxemia on first awakening, loud snoring related to airway collapse, daytime sleepiness from nonrestorative sleep at night, and increased hypertension. Sudden weight loss is not associated with obstructive sleep apnea, although it can be related to other medical disorders such as cancer. Deep sleep is not obtained with obstructive sleep apnea, because the affected person experiences many awakenings during the night.
An elderly, tense patient is having trouble relaxing enough to sleep. Which measures should be implemented by the nurse to help promote sleep? (Select all that apply.) a. Give the patient a back rub. b. Take the patient for a brisk walk right before bedtime. c. Provide a warm, quiet environment. d. Encourage the patient to eat a large meal in the evening. e. Give the patient a diet cola. f. Play soft music during the 30 minutes before bedtime.
Answers: a, c, f Giving a back rub, providing a warm and quiet environment, and playing soft music enhance relaxation, which will lead to easier transition into sleep. Brisk exercise, caffeine drinks, and large meals all are contraindicated in the evening because they induce changes that will interfere with sleep.
A patient reports that the prescribed sleeping medication is no longer effective. What information would be appropriate for the nurse to recommend to the patient? (Select all that apply.) a. Take the medication with an alcoholic drink. b. Use relaxation techniques before sleep. c. Do not study in the bedroom before bedtime. d. Adjust sleep temperature for comfort. e. Sleep in a different room of the home.
Answers: b, c, d Tolerance frequently develops to sleeping medications, especially with long-term use, and additional sleep hygiene practices such as mindful relaxation, only sleeping in the bedroom, and creating a comfortable environment can be effective adjunctive measures. Alcohol plus a sleeping medication is a dangerous combination. Sleeping in an alternate room removes the patient from the familiar setting and is more likely to disrupt sleep.
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.
a. Increase physical activities during the day. 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.
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
b. Narcolepsy 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.
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.
b. Record the temperature as a normal finding. 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.
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
c. Disturbed Sleep Pattern: Altered Sleep-Wake Pattern 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.
