PNC 1 PrepU - Rest and Sleep
A school nurse is speaking to a group of parents regarding the sleep needs of adolescents. Which statement by a parent indicates a need for further education?
"Academic performance in adolescents is good when they sleep about 7 hours per night." Explanation: Adolescents need about 9 hours of sleep per night. Academic performance is negatively impacted when adolescents get less sleep. Due to irregular sleep patterns, adolescents typically sleep later on weekends in an attempt to catch up on sleep. Adolescent sleep patterns change to a more owl-like pattern in which they rise later and go to sleep later. Adolescent girls have a higher risk of developing insomnia than adolescent boys.
The nurse awakens a client while the client is experiencing rapid eye movement sleep. What statement made by the client indicates they were awakened during REM sleep?
"I was having a great dream and I remember all of it." Explanation: People who are awakened during the REM state almost always report that they have been dreaming. They can usually vividly recall their dreams even if they were absurd or have no sensible meaning for them. During REM sleep the body temperature rises and does not decrease so the client shouldn't feel cold. Sleeping lightly and hearing the nurse walk in the room is not indicative of REM sleep.
The nurse is encouraging a client to begin and maintain a sleep diary. What statement made by the client indicates an understanding of the purpose of the diary?
"I will record the time I go to bed and how long it takes me to fall asleep." Explanation: Keeping notes of times of sleep and waking are important details to record in a sleep diary. The notes are usually maintained for 14 days and include specifics such as all wakeful activities and sleep patterns in strange environments.
A hospitalized client informs the evening shift nurse about not being able to sleep without a shot of whiskey each night before bed and asks if the spouse can bring in a bottle. Which is the best response by the nurse?
"Let's discuss that with your health care provider." Explanation: To promote relaxation and sleep, the nurse should be alert to the client's bedtime rituals and observe them as much as possible. To prevent interference with medical care, the nurse and client should consult with the health care provider before adding alcohol to the bedtime routine. Questioning the client about the habit may cause the client to become defensive.
A client comes to the clinic and states to the nurse, "I am traveling overseas for a project frequently and am having a difficult time adjusting because of jet lag. What is the bestresponse by the nurse?
"Light therapy can be beneficial and help ease the transition to a new time schedule or zone." Explanation: Light therapy helps ease the transition to a new schedule or time zone. It involves exposing the client's eyes to an artificial bright light that simulates sunlight for a specific and regular amount of time during the time the person should be awake. Sleeping pills may exacerbate the jet lag and cause difficulty regulating sleep patterns. The client should attempt to nap while on the plane and not try and stay awake to be able to adjust to the new time zone. Jet lag not only occurs once, it can be a repeated experience each time transition to a new time zone occurs.
A client asks the nurse if hot chocolate at bedtime will improve the client's sleep. Which is the best response by the nurse?
"Milk is a better option to help you sleep." Explanation: Milk contains L-tryptophan, a chemical that is known to facilitate sleep. Although hot chocolate may contain milk, most hot chocolate, tea and cola drinks contain caffeine. Caffeine is a stimulant and will not help to facilitate sleep.
The client has been in the intensive care unit for several days. The client appears to be sleeping throughout the night. The nurse records the data listed above. The nurse evaluates that rapid eye movement (REM) sleep is occurring at:
0100. Explanation: During REM sleep, the client's temperature, pulse, blood pressure, and respirations increase. The client may experience small muscle twitching, such as facial muscles twitching, and irregular pulse rate and respirations. During non-eye movement sleep, the client will exhibit a decrease in body temperature, pulse, blood pressure, and respirations.
A nurse is caring for a client newly diagnosed with sleep apnea. Which should the nurse teach the client about the most important reason why the continuous positive air pressure (CPAP) device should be used during sleep?
"The CPAP assures you get enough oxygen throughout the night." Explanation: The nurse can explain that during the apneic or hypopneic periods, ventilation decreases and blood oxygenation drops. The accumulation of carbon dioxide and the fall in oxygen cause brief periods of awakening throughout the night. Sleep apnea occurs in conjunction with snoring which can be difficult for a spouse but less urgent than a lack of oxygen in the body. By getting more oxygen during sleep the client may have more daytime energy, and associated health problems can be avoided when the body has proper oxygen balance. These outcomes, however, are not guaranteed and should be considered less urgent than the lack of oxygen.
A nurse explains cognitive behavioral therapy (CBT) to a client who is experiencing chronic insomnia. Which statements by the nurse best describe this therapy? Select all that apply.
-"You will meet with a therapist to work through any maladaptive sleep beliefs." -"Used with other complementary therapies, CBT is very successful." -"CBT may include progressive muscle relaxation measures, stimulus control, and sleep restriction therapy." Explanation: Cognitive behavior therapy (CBT) requires a therapist to work through any maladaptive sleep beliefs. CBT can be very successful is used with other complementary therapies. CBT can include progressive muscle relaxation measures, stimulus control, and sleep restriction therapy. Sedatives and hypnotics would not be used in conjunction with CBT. Pharmacologic approaches do not have to be attempted prior to CBT initiation. A client undergoing CBT is not asked to stay in bed during normal sleep hours if the client is not able to sleep.
The nurse has entered the room of a newly admitted client and observed a continuous positive airway pressure (CPAP) on the client's bedside table. Which action(s) will the nurse take to assess the client's use of the CPAP machine? Select all that apply.
-Discuss the client's habit of using the CPAP. -Examine the fit of the mask. Explanation: CPAP is a common treatment for sleep apnea that helps to maintain the patency of the client's airway. Untreated sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotence, and headaches. Compliance with CPAP treatment can be a major barrier. Discussing the client's habitual use of the CPAP is paramount, including the fit of the mask. Education about sleep apnea, proper disinfection methods, and the use of the CPAP are necessary teaching points, but they will not assist the nurse in assessing the client's use of the device.
A middle-aged client reports to the nurse that the client has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. What should the nurse instruct the client to try? Select all that apply.
-Establish a set time to go to sleep each night. -Perform moderate exercise three or four times each week. -Participate in an enjoyable activity each day. Explanation: Behaviors that will promote sleep include establishing a regular routine, such as time, for bedtime, exercising three to four times each week, and participating in an activity that is enjoyable each day. The client should avoid alcohol and eat a small carbohydrate snack prior to bedtime.
The nurse is teaching a first-time parent about the newborn's sleep needs. The nurse would inform the parent that newborns sleep approximately how many hours in a 24 hour period?
14 to 18 hours Explanation: Newborns sleep an average of 16 hours in a 24-hour period.
Which client could be diagnosed with insomnia?
A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m. Explanation: The 50-year-old woman appears to be suffering from early awakening insomnia. Because it has been longer than 1 month, it is considered a chronic insomnia. The 45-year-old woman appears to be suffering from insufficient sleep syndrome. She does not have an adequate amount of time for sleep each night, as seen with insomnia, but it is a self-imposed restriction of sleep. The 40-year-old man is not getting enough sleep because he has some form of sleep-disordered breathing (SDB). Although he might think he is allowing enough time for sleep, his quality of sleep is disrupted by these periods of apnea. The 20-year-old man appears to be suffering from narcolepsy. Along with the two episodes of cataplexy, he is excessively sleepy throughout the day and falls asleep at inappropriate times.
Which client will the nurse monitor most closely for excessive sleepiness?
A client diagnosed with hypothyroidism Explanation: Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow-wave sleep. Anxiety is associated with hyperarousal, not sleepiness. Glaucoma and diabetes are not linked to excessive sleepiness.
An older adult client tells the home care nurse that he doesn't seem to sleep as well as he used to. The nurse will teach the client about what age-related change to sleep patterns in older adults?
A decrease in the deep sleep stage of the sleep cycle. Explanation: The changes to the sleep cycle that usually occur in the older adult are an increase in stage I (not II) and a decrease in deep sleep. These changes lead to a less restful sleep and more frequent awakenings during the night.
A client is experiencing slow-wave sleep. What assessment finding will the nurse identify as being consistent with this sleep stage?
Decreased temperature Explanation: During slow-wave sleep, the muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle all decrease.
A client with difficulty sleeping is prescribed ramelteon. The client asks the nurse, "How does this medicine work?" Which information would the nurse include in the response?
Activates the receptors for the hormone melatonin Explanation: Ramelteon is a selective melatonin receptor agonist prescribed to facilitate the onset of sleep; it is not intended for sleep maintenance. It may be used long-term and activates receptors for melatonin. Ramelteon does not cause a change in circadian rhythms, decrease impulses to the cerebral cortex, or stimulate the reticular activating system.
A client is prescribed escitalopram, diuretics, and pseudoephedrine. The client states, "I'm tired all the time." What does the nurse understand may be happening to this client?
Decrease in R.E.M. sleep due to prescribed medications Explanation: Pseudoephedrine is a powerful stimulant and diuretics can prompt nighttime awakenings to void. Both of these effects can produce insomnia. Some clients with mental illness experience insomnia, but a direct effect of medications is more likely. There is no indication of napping or exercise.
Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern?
Do you usually go to bed and wake up about the same time each day? Explanation: The best interview question for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern would be to ask if the client usually goes to bed and wakes up about the same time each day. The other questions are possible to ask the client, but are not related to recent changes in the client's sleep-wakefulness pattern.
The nurse is caring for a client who reports insomnia. The client has recently moved from an area near a fire station in the inner city to the country. Which recommendation will the nurse make to facilitate sleep?
Find a phone app that plays sounds of the city. Explanation: Clients tend to adapt to the unique sounds where they live, such as traffic, trains, and the hum of appliance motors or furnaces. Unfamiliar sounds tend to interfere with the ability to fall or stay asleep. The nurse will recommend that the client find an app that plays sounds of the city, which mimics the sounds with which the client is most familiar. Ignoring the problem by telling the client to adapt to the new environment does not address the problem. Avoiding eating before bedtime could cause the client to wake up hungry in the middle of the night. The nurse does not recommend alcohol, a depressive drug, to clients.
The nurse is assessing an older adult client that reports feeling fatigued and tired throughout the day. What is the nurse's best action?
Have the client further evaluated for depression Explanation: Depression often goes undiagnosed in the older adult client and one of the symptoms is polysomnia. The nurse should make a referral for further investigation into this possibility. Decreasing the intake of caffeine can be beneficial for restful sleep. The client should avoid taking naps during the day so that sleep will be easier to achieve in the evening. Decreasing fluid intake and not increasing will help the client sleep so that rising to go to the bathroom is not as often.
A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage?
Hypothalamus Explanation: 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. The medulla and midbrain are part of the reticular activating system (RAS), which plays a part in the cyclic nature of sleep. The cerebral cortex does not have any role in the sleep process.
The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include?
Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. Explanation: The nurse would include the education point that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. It is normal for infants to have eye movements, groaning, or grimacing during sleep periods. School-age children become aware of the concept of death, not preschool children. Waking from nightmares or night terrors is common during the preschooler stage.
A newly admitted client with chronic obstructive pulmonary disease informs the nurse that they frequently awakens during the night. The nurse should acvocate for what intervention?
Low-flow oxygen Explanation: The pattern of frequent arousals seen in people with chronic obstructive pulmonary disease may result from the body's adaptation to maintain adequate oxygenation. Usually, these clients require low doses of oxygen at night. A cool room generally promotes sleep so a heater may exacerbate sleep disturbances. Hypnotics are not a first-line treatment for most clients.
The nurse is preparing to educate a client with restless legs syndrome who reports sleeplessness and prefers to use nonpharmacologic methods to promote sleep. Which recommendation will the nurse include in the teaching?
Massage the legs before bed. Explanation: Massaging the legs is a recommended technique for improving discomfort from restless legs syndrome. It is recommended to avoid alcohol, sleep in a cool environment, and set a regular sleep routine.
For the last 3 weeks, a nurse in a long-term care facility has administered a sedative hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation?
Most sedative hypnotics lose their effect after 1 or 2 two weeks of administration. Explanation: Although most sedative hypnotic drugs provide several nights of excellent sleep, the medication often loses its effects after 1 or 2 weeks. Alcohol and diphenhydramine should not be administered with a sedative hypnotic drug, as this can intensify the medication. Increased activity assists the client in sleeping. Carbohydrates have been shown to help a client sleep.
The nurse is caring for a client who has been increasingly fatigued and irritable. The provider has ordered for an assessment for possible sleep disorders. Which step will the nurse perform first in the sleep assessment?
Observe the client's hours of sleep and review the client's sleep diary. Explanation: Observing the sleeping patterns and checking the client's sleep diary can lead the nurse to clues about the quality of the client's sleep. Neck circumference can be a factor in obstructive sleep apnea, but it is not routinely measured during a sleep assessment. Being overweight is a common finding in clients with a sleep disorder, but visual acuity issues are not. Auscultation of the lungs and abdomen is not pertinent to the potential disorder.
A new client in the medical-surgical unit reports difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nurse identifies the nursing concern of altered sleep pattern with insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this this client's nursing concern?
Provide an opportunity for the client to talk about concerns. Explanation: Stress and anxiety interfere with a person's ability to relax, rest, and sleep. The client is scheduled for a surgical procedure in the morning. The identified nursing concern addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other interventions do not address the situation at hand, or the nursing concern that the nurse noted.
The nurse is teaching a client with seasonal affective disorder about proper use of a full-spectrum light. Which teaching will the nurse include?
Sit within 3 ft (1 m) of the light for approximately 2 hours soon after awakening. Explanation: The client should sit within 3 ft (1 m) of the artificial light for approximately 2 hours soon after awakening from sleep. Light exposure should begin in October or November, not April or May. Eyeglasses and contact lenses with ultraviolet filters should be removed before using the light. Other activities may take place, such as reading or handiwork, while periodically glancing at the light.
The nurse is planning health education sessions for adults which will focus on the role of sleep and strategies for enhancing sleep. What principle will the nurse integrate into the education plan?
Sleep sufficiency is essential for overall health and wellness Explanation: Sleep health, also called sleep sufficiency, is becoming widely recognized as an essential component of overall health. Sleep patterns change with age, but there is no evidence that older adults systematically have unrealistic expectations. There is agreement that the norms for the quanitity of sleep should remain high, even as many people sleep less than in previous generations. Napping can be consistent with sleep sufficiency when practiced in a healthy way.
A client has voiced concerns about their ongoing inability to fall asleep. What aspectss of the client's health history will the nurse identify as potential causative factors? Select all that apply.
Smokes 1 pack of cigarettes daily Drinks black tea with all meals History of hyperthyroidism Explanation: Insomnia is associated with the consumption of stimulants (e.g., caffeine, nicotine, methamphetamine, and other drugs of abuse). Insomnia is also a side effect of hyperthyroidism. Exercising 30 to 60 minutes daily can help a client fall asleep faster. For most clients, a 30-hour work week will not contribute to sleep disorders.
A client's partner expresses concern to the nurse about the client's snoring. Which assessment parameters will the nurse teach the couple to observe for the possibility of sleep apnea?
Snoring with periods of irregular silence Explanation: Snoring is caused by an obstruction of 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. Snoring does have varied patterns, but the irregular silence is different from snoring. A client with sleep apnea would experience regular arousal, rather than deep sleep.
An older adult reports occasional awakenings during the night and states, "I used to go to bed near midnight when I was younger, but now I'm sleepy by 10:30." What is the nurse's best action?
Teach the client about expected age-related sleep changes Explanation: Changes in sleep, such as more frequent awakenings or feeling sleepy earlier in the evening, are a natural part of aging. In the absence of any severe or abrupt change in sleep patterns, this is less likely to be attributable to medication effects or comorbid diagnoses. Late evening exercise can disrupt sleep but there is no need to avoid exercise for the entire latter half of each day.
The student nurse is providing an education program for preschool parents. The nursing student should include which intervention to improve the child's sleep?
The child should limit fluids after supper Explanation: Parents and other caregivers can assist children in establishing the habit of voiding as part of preparing for bedtime; limiting evening fluids may be necessary to prevnet enuresis and reduce awakenings. Drinking milk at bedtime may undermine this. Sleeping in the same room as the parents does not promote sleep sufficiency and a later bedtime may exerbate the sleep deficit.
The nurse is creating a plan of care for a client that is reporting an inability to sleep and rest. What outcome criterion will the nurse address for a goal that the client will demonstrate physical signs of being rested?
The client has decreases both in under-eye circles and in excessive yawning by 1 week. Explanation: This outcome criterion addresses the goal by stating physical, objective signs that the person is better rested. It also mentions a time frame, which makes it measurable and easier to evaluate.
A client is worried and states, "I just know I won't be able to sleep before my surgery." What sleeping pattern would the nurse anticipate?
The client will likely not be able to sleep. Explanation: The expectation that the onset of sleep will be difficult increases the person's anxiety. The anxiety floods the brain with stimulating chemicals that interfere with relaxation, which is a prerequisite for natural sleep. Given the client's anxiety about the surgery, as well as the expectation that they will not sleep, it is likely that the client will not be able to sleep. Worry may cause exhaustion, but it will not cause the client to fall asleep quickly. Since the client will likely not sleep, the nurse does not anticipate patterns of wakening for the client.
The nurse is assessing a client and determines that they are in rapid eye movement (REM) sleep. What finding indicates to the nurse that the client is in this stage?
There is rapid eye movement under the eyelids. Explanation: REM is a deep stage of normal sleep. The body and brain go through several changes, including rapid movement of the eyes, fast and irregular breathing, increased heart rate (to near waking levels), changes in body temperature, increased blood pressure, and brain activity similar to that seen while awake. Muscular jerking, regular respiration, and transitioning to wakefulness are not indicative of REM sleep.
A nurse is reviewing the medication administration record. Which order does the nurse question?
a diuretic administered twice daily at 9 a.m. and 9 p.m. Explanation: A diuretic should not be administered after 6 p.m. This will promote sleep if a full bladder does not awaken the client. Once daily dosing and every-other-day dosing is not cause for question.
The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects which primary nursing concern?
altered sleep pattern related to acute pain Explanation: The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain. Anxiety may be present, but that is a symptom of the client's physical issue rather than the primary nursing complication. The client may have impaired mobility, but it would not be due to restless leg syndrome. Also, the client's role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.
The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to:
anticipate sleeping overnight at a health care center. Explanation: Polysomnography is a sleep study. The client will be scheduled for the study at a health care center and sleep overnight as part of the study. The client should avoid sedatives, as this will aggravate OSA. Interventions for OSA include inserting an oral appliance or applying a facial mask for continuous positive airway pressure.
The nurse is instructing a parent on how to promote restful sleep for a child. What food would be the best bedtime snack for the child?
cheese and crackers Explanation: Combining foods that are high in tryptophan with healthy, complex carbohydrates improves sleep. A small protein- and carbohydrate-containing snack such as cheese and crackers about an hour before bed may be effective in promoting restful sleep for the child. A chocolate bar contains caffeine, which is central nervous system stimulant. Grapes with honey contain a high quantity of fructose, a form of processed sugar which can interfere with sleep if ingested too close to bedtime. Tuna salad contains protein but also contain high amount of fat, which can disrupt the sleep cycle.
The nurse is performing an intake assessment of a 60-year-old client who admits to having a nightcap of 4 to 6 ounces of scotch whisky each night. What effect might this alcohol be having on the client's sleep?
decreased REM sleep Explanation: Alcohol is known to decrease the amount of REM sleep. Alcohol does not typically shorten sleep cycles or increase the total amount of sleep. Delta sleep is decreased by alcohol consumption, not increased.
The nurse is discussing sleep interventions with a client. What statement made by the client indicates an understanding of sleep restriction?
limiting time in bed to actual sleep time Explanation: Sleep restriction is the concept of limiting time in bed so that sleep does not become fragmented. Shortening sleep time on purpose will promote sleep deprivation. Never sleeping in a new environment is unrealistic. Stimulants may be used to treat narcolepsy, but that is not related to sleep restriction.
Which factor necessitates the need for more sleep in the adolescent population?
rapid growth Explanation: The growth spurt that occurs during adolescence may necessitate the need for more sleep. However, the stresses of school, activities, and part-time employment may cause adolescents to have restless sleep, and many adolescents do not get enough sleep.
The nurse is caring for a client with narcolepsy. The client reports experiencing being unable to move upon awakening from sleep. The client's spouse states that the client makes sandwiches in the middle of the night, yet the client does not recall this behavior. How does the nurse document these concerns?
sleep paralysis and automatic behavior Explanation: Sleep paralysis occurs when the person cannot move for a few minutes just before falling asleep or awakening. Cataplexy occurs with a sudden loss of muscle tone triggered by an emotional change such as laughing or anger. Hypnogogic hallucinations are dream-like auditory or visual experiences while dozing or falling asleep. Automatic behavior is the performance of routine tasks without full awareness, or later memory, of having done them. This client experiences sleep paralysis and automatic behavior.
A client begins snoring and is sleeping lightly. The stage of sleep is:
stage 2. Explanation: Stage 2 is relatively light sleep from which the client is easily awakened. Rolling eye movements continue, and snoring may occur.
A nurse is instructing new parents on the proper sleeping position for their newborn. In what position does the nurse instruct the parents to place the newborn?
supine position Explanation: The nurse will teach the parents to position the newborn on the back (supine). Sleeping in the prone position increases the risk for sudden infant death syndrome (SIDS). In a high-Fowler position, the newborn is placed with the head of the bed elevated as high as possible. The side-lying position is a position for breastfeeding but not for sleeping.
A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because:
they may be disoriented on awakening. Explanation: Older adults sleep less soundly for less time, and have little or no Stage IV deep sleep. It is common for them to be confused upon awakening, which could lead to injury. Napping does not alter their safety. Somnambulism is commonly seen in children. Older adults commonly take prescribed or over-the-counter sleep aids.
The nurse makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep is unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to:
use caution when driving an automobile. Explanation: The client is describing hypersomnia and is at increased risk for a motor vehicle accident when drowsy while driving an automobile. The client is to avoid alcohol, caffeine, and late-night activities.
