Potter and Perry, Fundamentals: Chapter 43 - Sleep
Which of the following client statements made by young adults suggest a risk factor for sleep disturbance problems? (Select all that apply) A. "I have a job that requires my attention 110% of the time." B. "I really enjoy fishing; I wish we lived closer to a river or pond." C. "My wife just found out she is pregnant for the third time in 5 years." D. "My father recently suffered a heart attack, and Mom is so very worried about him." E. "The kids are so active in after-school things that we never have an evening at home." F. "Gardening always gave me such a sense of accomplishment, but I don't have much free time now."
A. "I have a job that requires my attention 110% of the time." C. "My wife just found out she is pregnancy for the third time in 5 years." D. "My father recently suffered a heart attack, and Mom is so very worried about him." E. "The kids are so active in after-school things that we never have an evening at home." It is common for the stresses of jobs, family relationships, and social activities to lead frequently to insomnia and the use of medication for sleep. The remaining options reflect a sense of loss but necessarily of stress.
A 74 year old client has been having sleeping difficulties. To have a better idea of the client's problem, the nurse should respond: A. "What do you do just before going to bed?" B. "Let's make sure that your bedroom is completely darkened at night." C. "Why don't you try napping more during the daytime?" D. Do you eat a small snack before going to bed?"
A. "What do you do just before going to bed?" To assess the client's sleeping problem, the nurse should inquire about predisposing factors, such as by asking what they do just before going to bed. Assessment is aimed at understanding the characteristics of any sleep problem and the client's usual sleep habits so that ways for promoting sleep can be incorporated into nursing care.
Although the most common effect of obstructive sleep apnea is disrupted sleep pattern, the condition can cause a serious decline in arterial oxygen levels that may result in: (Select all that apply) A. Hypertension B. Angina attacks C. Alzheimer's disease D. Cardiac dysrhythmias E. Cerebral vascular accidents F. Type 2 diabetes
A. Hypertension B. Angina attacks D. Cardiac dysrhythmias E. Cerebral vascular accident Obstructive apnea causes a serious decline in arterial oxygen saturation level. Clients are at risk for cardiac dysrhythmias, right-sided heart failure, pulmonary hypertension, angina attacks, strokes, and hypertension.
Teaching for a client who is currently taking a diuretic should include information that he or she may experience: A. Nocturia B. Nighmares C. Increased daytime sleepiness D. Reduced REM sleep
A. Nocturia For the client who is currently taking a diuretic, the nurse should inform the client that he or she might experience nighttime awakening caused by nocturia. Diuretic use does not cause nightmares or daytime sleepiness or reduce REM sleep.
The assistive nursing personnel reports that the heart rate of the sleeping 23 year old athlete, who is hospitalized following complications of a tonsillectomy, is 56. The assistive nursing personnel states that this is 10 beats per minute slower than when she took it earlier in the evening. The nurse knows that this is considered: A. Normal, and they will continue to monitor the vital signs as ordered B. Abnormally slow, and the health care provider should be notified immediately C. Abnormally slow, and the nurse will recheck the heart rate before taking any action D. Abnormally slow, signaling that the client may be hemorrhaging
A. Normal, and they will continue to monitor the vital signs as ordered A healthy adult's normal heart rate throughout the day averages 70 to 80 beats/min or less if the individual is in excellent physical condition. However, during sleep the heart rates falls to 60 beats/min or less. This means that the heart beats 10 to 20 fewer times in each minute during sleep or 60 to 120 fewer times in each hour. If the client were hemorrhaging, the heart rate would initially be tachycardic as the body attempts to compensate for the lost blood volume.
The night nurse goes quietly into the sleeping client's room to assess him. The client wakes up as soon as the nurse is in the room. The nurse knows that the client was most likely in which stage of sleep? A. Stage 1: NREM B. Stage 2: NREM C. Stage 3: NREM D. Stage 4: NREM
A. Stage 1: NREM Stage 1 NREM includes the lightest level of sleep. Sensory stimuli such as noise easily arouses the person. The stage lasts a few minutes. Decreased physiological activity begins with gradual fall in vital signs and metabolism. Awakened, person feels as though daydreaming has occurred. Stage 2 NREM is a period of sound sleep. Stage 3 NREM involves initial stages of deep sleep. Stage 4 NREM is the depends stage of sleep. It is very difficult to arouse the sleeper.
An older adult client diagnosed as being in the early stages of Alzheimer's disease shares with the nurse that her sleep is interrupted by "the nosies I hear all through the night." The nurse explains that the most likely reason for this problem is: A. The client's age B. A lack of presleep relaxation C. The amount of noise entering into the client's environment D. A manifestation of the disease process causing the brain disorder
A. The client's age With aging, sleep becomes more fragmented, and a person spends more time in lighter stages that are easily disturbed by noise. The remaining options may be a factor but not to the degree or normal aging.
A 44 year old female client shares with the nurse that she is having difficulty falling asleep at night, even though she is exhausted. The nurse knows that which of the following could be causing the sleeplessness? A. Two cups of hot cocoa every evening B. Vegetarian diet C. Afternoon exercise program D. Hot bath in the evening
A. Two cups of hot cocoa every evening Caffeine is a stimulant and can cause difficulty falling asleep. There is about 30 mg of caffeine in two cups of hot cocoa.
The nurse should instruct the client to do which of the following to promote good sleep hygiene at home? A. Use the bedroom only for sleep or sexual activity B. Eat a large meal 1 to 2 hours before bedtime C. Exercise vigorously before bedtime D. Stay in bed if sleep does not come after 1/2 after
A. Use the bedroom only for sleep or sexual activity The nurse should explain that, if possible, the bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity, besides sex. The nurse should instruct the client to avoid heavy meals for 3 hours before bedtime; a light snack may help. The nurse should also instruct the client to try to exercise daily, preferably in morning or afternoon, and to avoid vigorous exercise in the evening within 2 hours of bedtime.
A client is discussing his recent restlessness and increased irritability. Which of the following assessment questions is likely to be most helping in determining the cause of these complaints? A. "When did you start noticing these changes?" B. "Has anything caused you to change your usual routine lately?" C. "Do you have any idea what might be causing these problems?" D. "What makes you think that you are more irritable that is normal for you?"
B. "Has anything caused you to change your usual routine lately?" When the sleep-wake cycle becomes disrupted, other physiological functions usually change as well. For example, the person experiences a decreased appetite and loses weight. Anxiety, restlessness, irritability, and impaired judgment are other common symptoms of sleep cycle disturbances.
The nurse and a client are discussing possible behaviors that might be interfering with the client's ability to fall asleep. Which of the following assessment questions is most likely to identify possible problems with the client's sleep routine that possibly are contributing to the difficulty? A. "When do you usually retire for the night?" B. "What do you do to help yourself fall asleep?" C. "How much time does it usually take for you to fall sleep?" D. "Have you changed anything about your presleep ritual lately?"
B. "What do you do to help yourself fall asleep?" As people try to fall asleep, they close their eyes and assume relaxed positions. Stimuli to the RAS decline. If the room is dark and quiet, activation of the RAS further declines. At some point, the BSR takes over, causing sleep.
Which of the following symptoms should the nurse assess with a client who is deprived of sleep? A. Elevated blood pressure and confusion B. Confusion and irritability C. Inappropriateness and rapid respirations D. Decreased temperature and talkativeness
B. Confusion and irritability Psychological symptoms of sleep deprivation include confusion and irritability. Elevated blood pressure is not a symptom of sleep deprivation. Rapid respirations are not a symptom of sleep deprivation. There may be a decreased ability of reasoning and judgment that could lead to inappropriateness. Decreased temperature is not a symptoms of sleep deprivation. The client with sleep deprivation is often withdrawn, not talkative.
The nurse is caring for a 35 year old father of three young children who has experienced a compound fracture femur as a result of a work-related incident. He has expressed great concern over both his physical recovery and his long-term ability to work again. This has affected both his emotional status and his sleeping patterns. The nurse's most immediate concern is that: A. The client needs medication to prevent depression B. The lack of appropriate rest will affect his healing process C. An occupational therapy consult should be ordered to help him regain his ability to return to this job D. A psychiatric consult should be ordered to help the client deal with his various emotional concerns
B. The lack of appropriate rest will affect his healing process You must always be aware of the client's need for rest. A lack of rest for long periods causes illness or worsening of existing illness.
The nurse and a client are discussing the importance of an effective 24 hour sleep cycle. Which of the following responses by the client may be a direct result of an inadequate sleep pattern? (Select all that apply) A. Gaining weight B. Usually feeling cold C. Always feeling "tired" D. A heart that beats "really fast" E. Often feeling "blue" or depressed F. Feeling dizzy when getting up from a chair
B. Usually feeling cold C. Always feeling "tired" D. A heart that beats "really fast" E. Often feeling "blue" or depressed F. Feeling dizzy when getting up from a chair The predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood depend on the maintenance of the 24 hour circadian cycle. Weight gain is not typically a result of poor sleep patterns.
The nurse is discussing child care strategies with a mother of a newborn. The mother asks the nurse, "What causes SIDS?" Which of the following responses is most likely to answer the mother's question therapeutically? A. "SIDS is a common fear for new mothers. The best advice is to put your baby to sleep on her back." B. "We aren't sure exactly, but it may have something to do with undetected cardiac or oxygen problems." C. "Research is inconclusive, but it's thought to be a result of a nervous system problem that occurs when the baby is asleep." D. "Your pediatrician wants you to put your baby to sleep on her back because research has shown that more stomach sleepers are victims."
C. "Research is inconclusive, but it's though to be a result of a nervous system problem that occurs when the baby is asleep." Some have hypothesized that SIDS is caused by abnormalities in the ANS that are manifested during sleep, resulting in apnea, hypoxia, and/or cardiac dysrhythmias.
A new mother is concerned that her 2 week old daughter is not sleeping through the night. The nurse should respond that infants usually develop a nighttime pattern of sleep by: A. 1 month B. 2 months C. 3 months D. 6 months
C. 3 months
It is determined that the client will need pharmacological treatment to assist with the client's sleep pattens. The nurse anticipates that treatment with an anxiety-reducing, relaxation-promoting medication will include the use of: A. Barbiturates B. Amphetamines C. Benzodiazepines D. Tricyclic antidepressants
C. Benzodiazepines The benzodiazepines cause relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the CNS that suppress responsiveness to stimulation, therefore decreasing levels of arousal. Withdrawal from CNS depressants, such as barbiturates, can cause insomnia and must be managed carefully.
A female client describes the most elaborate dreams to the nurse. She states that she could see colors, hear music, and even had the sensation of flying. The nurse replies to the client that her dreams indicate that she must be: A. Depressed B. Pragmatic C. Creative D. Mentally Ill
C. Creative Personality influences the quality of dreams; for example, a creative person has elaborate and complex dreams, whereas a depressed person dreams of helplessness. Most people dream about immediate concerns such as an argument with a spouse or worries over work. Sometimes a person is unaware of fears represented in bizarre dreams.
Which of the following may improve the sleep of an older adult client? A. Drinking an alcoholic beverage before bedtime B. Using an OTC sleeping agent C. Eliminating naps during the day D. Going to bed at a consistent time even if not feeling sleepy
C. Eliminating naps during the day To promote sleep, daytime naps should be eliminated. If naps are used, they should be limited to 20 minutes or less twice a day. The client should engage in quiet activities that promote relaxation and then may go to bed.
The nurse is preparing to discuss the management of the sleeping disorder narcolepsy. In addition to the prescription of stimulants and antidepressants, which of the following non-pharmaceutical strategies should be included and shared with the client? (Select all that apply) A. Wine with meals B. Regular use of a sauna C. Light but high-protein meals D. Regular use of chewing gum E. Adoption of a regular exercise routine F. Brief daytime naps of 20 minutes or less
C. Light but high-protein meals D. Regular use of chewing gum E. Adoption of a regular exercise routine F. Brief daytime naps of 20 minutes or less Narcoleptics may be helped by brief daytime naps no longer than 20 minutes, a regular exercise program, avoiding shifts in sleep, eating light meals high in protein, practicing deep breathing, chewing gum, and taking vitamins. Clients with narcolepsy need to avoid factors that increase drowsiness.
The nurse understands that the client with which of the following conditions is at risk for obstructive sleep apnea? A. Heart disease B. Respiratory tract infections C. Nasal polyps D. Obesity
C. Nasal polyps Structural abnormalities, such as a deviated septum, nasal polyps, certain jaw configurations, or enlarged tonsils predispose a client to obstructive apnea. Individuals with mixed apnea often have signs and symptoms of right-sided heart failure. Respiratory tract infections do not predispose a client to obstructive sleep apnea. Clients with obstructive apnea are often middle-age, obese men. Obesity itself does not predispose a client to obstructive sleep apnea.
A 25 year old client's wife complains to the nurse that he sleepwalks during the night. The nurse knows that his behavior normally occurs in which stage of sleep? A. Stage 2: NREM B. Stage 3: NREM C. Stage 4: NREM D. REM
C. Stage 4: NREM Stage 4 NREM sleep is the deepest stage of sleep. It is very difficult to arouse the sleeper. If sleep loss has occurred, the sleeper will spend a considerable portion of the night in this stage. Vital signs are significantly lower than during waking hours. The stages lasts approximately 15 to 30 minutes. Sleepwalking and enuresis sometimes occur. REM sleep involves vivid, full-color dreaming. Loss of skeletal muscle tone occurs. Typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates, and increased or fluctuating blood pressure.
On a 2 week follow-up visit to the health care provider, a 64 year old female postoperative client shares with the nurse that she is having difficulty sleeping and has never had a history of sleeping problems. The nurse shares with the client that: A. Because of her age, the client should expect to begin having some problems sleeping B. It may take a while to get used to sleeping in her bed at home after getting used to sleeping on a hospital bed C. The medications used for anesthesia can disturb sleep cycles for several weeks following surgery D. She may not be sleeping as well as her partner after being in a bed by herself while being hospitalized
C. The medications used for anesthesia can disturb sleep cycles for several weeks following surgery If the client has recently had surgery, expect the client to experience some disturbance in sleep. Clients usually awaken frequently during the first night after surgery and receive little deep or REM sleep. Depending on the type of surgery, it takes several days to months for a normal sleep cycle to return.
The physiology of sleep is complex. Which of the following is the most appropriate statement in regard to this process? A. Ultradian rhythms occur in a cycle longer than 24 hours B. Nonrapid eye movement (NREM) refers to the cycle that most clients experience when in a high-stimulus environment C. The reticular activating system is partly responsible for the level of consciousness of a person D. The bulbar synchronizing regions (BSR) causes the rapid eye movement (REM) sleep in most normal adults
C. The reticular activating system is partly responsible for the level of consciousness of a person The reticular activating system locating in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness. Infradian rhythms occur in a cycle longer than 24 hours. NREM refers to the sleep cycle that most clients experience in a low stimulus environment. The bulbar synchronizing region is the area of the brain where serotonin is released to produce sleep.
A client has reported to the nurse that his sprained ankle resulted from "a careless accident. I seem so clumsy and unfocused lately." Which of the following assessment questions is most likely to reveal information regarding the cause of these symptoms? A. "How many accidents have you had lately?" B. "Have the accidents resulted in serious injuries?" C. "Have there been any changes in your daily routine lately?" D. "Do you have any idea what is responsible for this lack of focus?"
D. "Do you have any idea what is responsible for this lack of focus?" A loss of REM sleep leads to feelings of confusion and suspicion. Various body functions are altered when prolonged sleep loss occurs. Research estimates that traffic, home, and work-related accidents caused by falling asleep are often a result of sleep loss. This answer is the best question because it directly opens up the opportunity for the client to discuss possible sleep problems if they exist.
The nurse is completing an assessment of the client's sleep patterns. A specific question that the nurse should ask to determine the potential presence of sleep apnea is: A. "How easily do you fall asleep?" B. "Do you have vivid, lifelike dreams?" C. "Do you every experience loss of muscle control or falling?" D. "Do you snore loudly or experience headaches?"
D. "Do you snore loudly or experience headaches?" To assess for sleep apnea, the nurse may ask if the client snores loudly or experiences headaches after awakening. A positive response may indicate the client experiences sleep apnea.
A client is concerned that their habit of sleeping during the day and being awake at night is not "healthy or normal." The nurse's most therapeutic response to the client's concern is: A. "What makes you think that sleeping during the day and being up at night is unhealthy or abnormal?" B. Many people share your sleeping habits. As long as you feel all right, I don't think there is anything to worry about." C. Are you interested in changing your sleep habits for any particular reason? Is sleeping during the day a problem for you?" D. Everyone has a different biological clock that controls his or her sleep cycle. As long as you are sleeping and functioning well, your habit isn't abnormal or unhealthy."
D. "Everyone has a different biological clock that controls his or her sleep cycle. As long as you are sleeping and functioning well, your habit isn't abnormal or unhealthy." All persons have biological clocks that synchronize their sleep cycles. If the sleep pattern does not adversely affect the client's health or ability to function, it is not problematic.
The nurse and the parents of a 3 year old are discussing their child's sleep habits. They share a concern over the child's tendency to wake up several times during the night crying out loudly but not really being awake. The nurse addresses the parents' concern more therapeutically by responding: A. "Have you every tried reading a bedtime before putting her to bed?" B. "If she does that only a few times a week, I wouldn't be too overly concerned." C. "Children her age often become poor sleepers. Have you discussed this with her pediatrician?" D. "It is common for children to have trouble relaxing, and this behavior is the result. It's usually temporary."
D. "It is common for children to have trouble relaxing, and this behavior is the result. It's usually temporary." The preschooler usually has difficulty relaxing or quieting down after long, active days and has problems with bedtime ears, waking during the night, or nightmares. Partial wakening followed by normal return to sleep is frequent. In the waking period, the child exhibits brief crying, walking around, unintelligible speech, sleepwalking, or bedwetting.
A 9 year old client asks the nurse, "Why do I need sleep?" The nurse's most age-appropriate, informative response is: A. "Everyone needs to sleep to feel rested." B. "It gives your body a chance to really rest." C. "You'll be able to do so much better in school if you're rested." D. "Your body needs to rest in order to grow and be really healthy."
D. "Your body needs to rest in order to grow and be really healthy." Sleep contributes to physiological and psychological restoration, maintenance, and growth of the body at any age. The body needs sleep to routinely restore biological processes.
A client shares with the nurse that "My wife complains about my snoring, and I never feel rested." Which of the following responses best attempts to explain the cause of the problem to the client? A. "Sleep disturbances can really affect all aspects of your life. How long have you been experiencing this problem?" B. "You need to get help to breathe more effortlessly at night so both you and your wife can get sufficient deep stage sleep." C. "Something is interfering with your ability to breathe while you are asleep. Have you talked to your health care provider about the problem?" D. "Your upper airway is blocked, and that is making it difficult for you to breathe effectively, so you are spending most of the night in the light sleep stage."
D. "Your upper airway is blocked, and this is making it difficult for you to breathe effectively, so you are spending most of the night in the light sleep stage." The upper airway becomes partially or completely blocked, and diminished nasal airflow can result for as long as 30 seconds. The person attempts to breathe, which often results in loud snoring and snorting sounds. The effort to breathe during sleep results in arousals from deep sleep, often to the stage 2 cycle, causing interference with deep sleep and thus the client's not feeling rested.
Which of the following clients experiencing disrupted sleep patterns is most at risk for obstructive sleep apnea? A. A 15 year old boy with type 1 diabetes B. A 22 year old diagnosed with Crohn's disease C. A 49 year old man who is an avid cross-country runner D. A 58 year old diagnosed with chronic depression
D. A 58 year old diagnosed with chronic depression Many think obstructive sleep apnea affects middle-age men more frequently, particularly when they are obese. However, obstructive sleep apnea is also common in postmenopausal women, younger women, and children. Although the clients in all of the options may experience obstructive sleep apnea, the postmenopausal woman has the greatest risk.
The nurse recognizes that the sleep patterns of older adults differ and older adults generally: A. Are more difficult to arouse B. Require more sleep than middle age adults C. Take less time to fall asleep D. Have a decline in stage 4 sleep
D. Have a decline in stage 4 sleep As people age, there is a progressive decrease in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep, sleep. Older people do not become more difficult to arouse, and do not require more sleep than the middle-age adult.
A 74 year old male client who normally sleeps on his right side recently underwent a right-side hip replacement surgery and now has trouble sleeping. One of the interventions that the nurse might try with this client is to: A. Request medication to help the client sleep while in the hospital B. Carefully prop the client on his operative side using pillows to support the hip C. Schedule therapy for the evening to help the client become tired so he can sleep D. Question the client to learn more about his normal sleep pattern
D. Question the client to learn more about his normal sleep pattern Knowing a client's usual, preferred sleep pattern allows a nurse to try to match sleeping conditions in a health care setting with those in the home.
A 22 year old male client shares with the nurse that he is always tired. In assessing the client's sleep pattern to determine the quantity of sleep the client is getting, the nurse should ask: A. "On a scale from 0 to 10, how much sleep do you think you get each night?" B. "What time do you usually go to bed?" C. "What time do you usually get up?" D. "Do you have a bedtime ritual?"
A. "On a scale from 0 to 10, how much sleep do you think you get each night?" This question helps quantify the length of sleep that the client receives. A brief subjective method to assess sleep is a numeric scale with a 0 to 10 sleep rating. Ask individuals to separately rate their quantity and quality of sleep on the scale.
An 11 year old boy in middle school is currently experiencing sleep-related fatigue during classes. Which of the following is the most appropriate response by the school nurse when counseling the child's parents regarding this assessment? A. "What are the child's usual sleep patterns?" B. "Establish bedtimes for the child, and withhold his allowance whenever those times are not adhered to." C. "We need to explore other health-related problems, because sleep problems are not likely the cause of his fatigue." D. "The bulbar synchronizing region of the child's central nervous system is causing these insomniac problems."
A. "What are the child's usual sleep patterns?" A school-age child will be tired the following day if allowed to stay up later than usual. The nurse should ask a question to assess the child's usual sleep patterns. The nurse should first assess the child's usual sleep patter to determine if the child is adhering to a bedtime. A sleep problem is often the cause of fatigue.
Which of the following clients is most likely to experience difficulty returning to sleep? A. A 60 year old with benign hypertropic prostatic disease B. A 15 year old with type 1 diabetes C. A 35 year old diagnosed with hypothyroidism D. A 55 year old diagnosed with hypertension
A. A 60 year old with benign hypertropic prostatic disease Nocturia, or urination during the night, disrupts sleep and the sleep cycle. This condition is common in older people with reduced bladder tone or persons with cardiac disease, diabetes, urethritis, or prostatic disease. After a person awakens repeatedly to urinate, returning to sleep is difficult. The answer represents the client with the greatest tendency to be awakened during the night.
The nurse knows that which of the following habits may interfere with a client's sleep? A. Listening to classical music B. Finishing office work C. Reading novels D. Drinking warm milk
B. Finishing office work At home, a client should try not to finish office work or resolve family problems before bedtime. Noise should be kept to a minimum.
The client asks the nurse, "How will I know if I'm really rested?" The nurse's most therapeutic response is: A. "Everyone's definition of rested is different. How would you define rested?" B. "When you aren't tired when you get up in the morning or after an afternoon nap." C. "When you are mentally, physically, and emotionally ready to go about your daily activities." D. "You are rested if you fall asleep easily and sleep uninterruptedly for at least 6 to 8 hours."
C. "When you are mentally, physically, and emotionally ready to go about your daily activities." When people are at rest they are in a state of mental, physical, and spiritual activity that leaves them feeling refreshed, rejuvenated, and ready to resume the activities of the day.
A 63 year old client is discussing the recent problem the client is experiencing with falling asleep. The nurse is discussing strategies to minimize this problem. Which of the following bedtime snacks would be the most likely to induce sleep? A. One slice of cheese on four wheat crackers and a glass of skim milk B. Two cups or air-popped popcorn and a glass of fruit juice C. Two fig cookies and a cup of decaffeinated tea D. One small pear and a glass of soy milk
A. One slice of cheese on four wheat crackers and a glass of skim milk One substance that promotes sleep in many people is L-tryptophan, a natural protein found in foods such as milk, cheese, and meats.
New research indicates that to increase safety the nurse should instruct parents to do which of the following? A. Provide a stuffed toy for comfort B. Cover the infant loosely with a blanket C. Place the infant on his or her back D. Use small pillows in the crib
C. Place the infant on his or her back Infants are usually placed on their backs to prevent suffocation or on their sides to prevent aspiration of stomach contents.
A client hospitalized for a myocardial infarction in a cardiac critical care unit is most likely to experience sleep deprivation as a result of: A. A drug-disrupted circadian sleep pattern B. Generally diminished cardiac output C. Unfamiliar environmental stimuli D. Increased emotional stressors
C. Unfamiliar environmental stimuli Hospitalization, especially in intensive care units, makes clients particularly vulnerable to the extrinsic and circadian sleep disorders that cause "ICU syndorme of sleep deprivation." Constant environmental stimuli within the ICU, such as strange noises from equipment, the frequent monitoring and care given by nurses, and ever-present lights, confuse clients and lead to sleep deprivation.
A 70 year old client is reporting to the nurse a concern over "taking longer to fall asleep and waking up three to four times during the night." The most therapeutic nursing response to the client's concern is: A. "I think you need to mention your concerns to your health care provider." B. "Older adults seem to need less sleep. Do you still feel rested in the morning?" C. "I suggest that you plan for a nap in the afternoon to make up for that missed sleep." D. "As we age, those kinds of problems seem more common. Does this disruption in your sleep cause you to be tired or irritable?"
D. "As we age, those kinds of problems seem more common. Does this disruption in your sleep cause you to be tired or irritable?" An older adult awakens more during the night, and it takes more time for an older adult to fall asleep. The answer provides an opportunity for a discussion about the effect this problem may be creating.
Which of the following information provided by the client's bed partner is most associated with sleep apnea? A. Restlessness B. Talking during sleep C. Somnambulism D. Excessive snoring
D. Excessive snoring Partners of clients with sleep apnea often complain that the client's snoring disturbs their sleep.
The mother of a 2 year old child is frustrated because the child does not want to go to bed at a scheduled bedtime. The nurse should suggest that the parent: A. Offer the child a bedtime snack B. Eliminate one of the naps during the day C. Allow the child to sleep longer in the mornings D. Maintain consistency in the same bedtime ritual
D. Maintain consistency in the same bedtime ritual The nurse should advise the parent to maintain a regular bedtime and wake-up schedule and to reinforce patterns of preparing for bedtime. A bedtime routine used consistently helps young children avoid delaying sleep. If a bedtime snack is already apart of that routine, then this is allowable.
