NUR 102 Exam 3: rest and sleep

A client in his 40s has asked the nurse how much sleep he should be getting in order to maximize his health and well- 3. being. How should the nurse respond?

A) "Most adults need between seven and nine hours, but everyone is different." B) "It's important to get a minimum of eight hours sleep each night." C) "More sleep equals better health, so the more sleep you can fit into your schedule, the better." D) "Sleep needs depend a lot on age, and at your age, six to seven hours usually suffice." Ans: A Feedback: Sleep needs and routines are highly individual, but most adults require between seven and nine hours of sleep.

Which of the following clients likely faces a risk for the nursing diagnosis of Disturbed Sleep Pattern: Difficulty 4. Remaining Asleep?

A) A client who receives IV antibiotics every three hours B) A client whose opioid analgesics result in central nervous system depression C) A client who is receiving corticosteroids that make her feel restless and agitated D) A client whose physical therapy has been scheduled in the late evening Ans: A Feedback: A client who requires medications throughout the night is likely to experience the frequent awakenings associated with Disturbed Sleep Pattern: Difficulty Remaining Asleep. Drowsiness or agitation as a result of medications may affect sleep, but are less likely to result in mid-sleep awakenings. A client who performs physical activity prior to bedtime may have difficulty falling asleep.

What independent nursing action can be used to facilitate sleep in hospitalized clients who are on bedrest?

A) Administering prescribed sleep medications B) Changing the bed with fresh linens C) Encouraging naps during the daytime D) Giving a back massage Ans: D Feedback: Simple interventions, such as offering a back massage, can promote comfort and sleep in hospitalized clients on bedrest. A sedative-hypnotic has been prescribed to help a client sleep.

A nurse working the night shift assesses a client's vital signs at 4 a.m. (0340). What would be the expected findings, based on knowledge of NREM sleep?

A) Decreased TPR and BP B) Increased TPR and BP C) No change from daytime readings D) Highly individualized, cannot predict Ans: A Feedback: Throughout the stages of NREM sleep, the parasympathetic nervous system dominates; decreases in temperature, pulse, respirations, and blood pressure occur.

5. Which group of terms best describes sleep?

A) Decreased state of activity, refreshed B) Altered consciousness, relative inactivity C) Comatose, immobility D) Alert, responsive Ans: B Feedback: Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Rest is a condition in which the body is in a decreased state of activity.

Which medication is least likely to affect sleep quality?

A) Diuretic B) Steroid C) Antidepressant D) Ambien Ans: D Feedback: Sleep quality is influenced by drugs. Drugs that decrease sleep include diuretics, steroids, and antidepressants. Ambien and chloral hydrate appear to influence the quality of sleep least and promote normal sleep.

A middle-age adult man has just started an exercise program. What would the nurse teach him about timing of exercise and sleep?

A) Exercising immediately before bedtime enhances ability to sleep B) Exercising within two hours of bedtime can hinder ability to sleep C) The time of day does not matter; exercise facilitates sleep D) The fatigue from exercise may be a hindrance to sleep Ans: B Feedback: Moderate exercise is a healthy way to promote sleep, but exercise that occurs within a two-hour interval before normal bedtime can hinder sleep.

A client reports that her naps after lunch often stretch to three hours in length and that she has great difficulty rousing 2. herself after a nap. This condition is best termed as which of the following?

A) Hypersomnia B) Insomnia C) Parasomnia D) Sleep apnea Ans: A Feedback: Hypersomnia is a condition characterized by excessive sleep, particularly during the day. Insomnia is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep. Parasomnias are patterns of waking behavior that appear during sleep. Sleep apnea is a condition in which a person experiences the absence of breathing, or diminished breathing efforts, during sleep (between snoring intervals).

Which of the following is the most common sleep disorder?

A) Hypersomnia B) Parasomnia C) Insomnia D) Dyssomnia Ans: C Feedback: Insomnia is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep. It is the most common of all sleep disorders.

A client with a sleep disorder experiences cataplexy. Which is a feature of this condition?

A) Irresistible urge to sleep, regardless of the type of activity in which the client is engaged. Sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong B) emotion C) Nightmare or vivid hallucinations experienced during sleep time D) Skeletal paralysis that occurs during the transition from wakefulness to sleep Ans: B Feedback: Cataplexy is sudden loss of motor tone that may cause the person to fall asleep; this is usually experienced during a period of strong emotion. Sleep attacks are irresistible urges to sleep, regardless of the type of activity in which the client is engaged. Hypnagogic hallucinations involve nightmares or vivid hallucinations. In sleep-onset REM periods, during a sleep attack, the person moves directly into REM sleep. Sleep paralysis is skeletal paralysis that occurs during the transition from wakefulness to sleep.

Which natural chemical does the body produce at night to decrease wakefulness and promote sleep?

A) Melatonin B) Serotonin C) Endorphins D) Dopamine Ans: A Feedback: Melatonin is a natural chemical produced at night that decreases wakefulness and promotes sleep.

Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing 11. which chemical?

A) Neonephrine B) Seratonin C) Melatonin D) Dopamine Ans: C Feedback: Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing melatonin (a natural chemical produced at night that decreases wakefulness and promotes sleep).

A client's bed partner reports the client often has irregular snoring and silence followed by a snort. Does this warrant further assessment?

A) No, snoring has varied patterns B) No, this is a description of normal snoring C) Yes, this is an indicator of obstructive apnea D) Yes, the bed partner is unable to sleep at night Ans: C Feedback: Snoring is caused by an obstruction to airflow through the nose and mouth. When snoring changes from the characteristic sawing wood sound to a more irregular silence followed by a snort, this indicates obstructive apnea.

What is the rationale for using CPAP to treat sleep apnea?

A) Positive air pressure holds the airway open. B) Negative air pressure holds the airway closed. C) Delivery of oxygen facilitates respiratory effort. D) Alternating waves of air stimulate breathing. Ans: A Feedback: Continuous positive airway pressure (CPAP) is used to treat sleep apnea. The device, worn at night, delivers positive air pressure through a facemask to hold the airway open.

A nurse educates a young couple on putting their newborn on his back to sleep. What is the rationale for this 10. information?

A) Prone position increases the risk for sudden infant death syndrome. B) Prone position decreases the risk for sudden infant death syndrome. C) Supine position may alter the size and shape of the infant's head. D) Supine position makes changing diapers and feeding difficult. Ans: A Feedback: Newborns sleep an average of 16 out of every 24 hours. It is important to teach parents to position an infant on the back. Sleeping in the prone position increases the risk for sudden infant death syndrome (SIDS).

The parents of a boy 10 years of age are worried about his sleepwalking (somnambulism). What topic should the nurse discuss with the parents?

A) Sleep deprivation B) Privacy C) Schoolwork D) Safety Ans: D Feedback: Somnambulism (sleepwalking) is a parasomnia, a pattern of waking behaviour that appears during sleep. It is more commonly seen in children and is commonly outgrown before adulthood. Safety and prevention of injury are paramount concerns.

What name is given to the rhythmic biologic clock that exists in humans?

A) Sleep-wake cycle B) Alert-unaware process C) Circadian rhythm D) Yo-yo theory Ans: C Feedback: Rhythmic biologic clocks are known to exist in plants, animals, and humans. Circadian rhythms complete a full cycle every 24 hours and in humans affect heart rate, blood pressure, body temperature, hormone secretions, and metabolism, as well as performance and mood.

A nurse is caring for a client who is sleeping for abnormally long periods of time. This condition may be caused by injury to which of the following body structures?

A) Spinal cord B) Pancreas C) Hypothalamus D) Thyroid Ans: C Feedback: The hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleeping and waking. Injury to the hypothalamus may cause a person to sleep for abnormally long periods.

An individual awakens from a sound sleep in the middle of the night because of abdominal pain. Why does this happen?

A) Stimuli from peripheral organs to the RAS B) Stimuli to the wake center in the cerebral cortex C) Messages from chemoreceptors to the brain D) Messages from baroreceptors to the spinal cord Ans: A Feedback: The reticular activating system (RAS) facilitates reflex and voluntary movements as well as cortical activities related to a state of alertness. Wakefulness occurs when the RAS experiences stimuli (including pain) from peripheral organs and cells.

A client who has a sleep disorder is trying stimulus control to improve amount and quality of sleep. What is recommended in this type of therapy?

A) Use the bedroom for sleep and sex only. B) Use the bedroom for reading and eating. C) Go to bed at the same time every night. D) Sleep alone with minimal coverings. Ans: A Feedback: Stimulus control involves using the bedroom for sleep and sex only. If not asleep within 15 to 20 minutes, the person should leave the room and return only when he or she feels sleepy. Getting up at the same time every day is also recommended.

A client is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder?

A) Waking during sleep B) Restless leg syndrome C) Uncontrollable desire to sleep D) Decrease in the amount or quality of sleep Ans: C Feedback: Narcolepsy is a condition characterized by an uncontrollable desire to sleep. Narcolepsy is considered a neurologic disorder.

Which individual is likely to require more hours of sleep?

A) a person 75 years of age B) a person 43 years of age C) a person 25 years of age D) a person 15 years of age Ans: D Feedback: Despite individual variations, growing children, especially adolescents who are in a tremendous growth period, require from 10 to 14 hours of sleep per night. This is in comparison with the accepted standard for adults, which is 8 hours. Older adults often require less sleep.

A nurse is instructing a client who has a narcolepsy about measures that might help with self-management. Which of the following statements should the nurse identify as an indication that the client understands the instructions?

a. "I'll add plenty of carbohydrates to my meals. b. "I'll take a short nap whenever I feel a little sleepy." c. "I'll make sure I stay warm when I am at my desk at work. d. "It's okay to drink alcohol as long as I limit it to one drink per day. B

A nurse is talking with a client about ways to help sleep and rest. Which of the following recommendations should the nurse give to the client to promote sleep and rest? (Select all that apply.)

a. Practice muscle relaxation techniques. b. Exercise each morning. c. Take an afternoon nap. d. Alter the sleep environment for comfort. e. Limit fluid intake at least 2 hr before bedtime. A, B, D, E

A nurse is preparing a presentation at a local community center about sleep hygiene. When explaining REM sleep, which of the following characteristics should the nurse include? (Select all that apply.)

a. REM sleep provides cognitive restoration. b. REM sleep lasts about 90 min. c. It is difficult to awaken a person in REM sleep. d. Sleepwalking occurs during REM sleep. e. Vivid dreams are common during REM sleep. A, C, E

A nurse is caring for a client who has been following the facility's routine and bathing in the morning. However, at home, the client always takes a warm bath just before bedtime. Now the client is having difficulty sleeping at night. Which of the following actions should the nurse take first?

a. Rub the client's back for 15 min before bedtime. b. Offer the client warm milk and crackers at 2100. c. Allow the client to take a bath in the evening. d. Ask the provider for a sleeping medication. C