psych exam 4

Which drug does the nurse identify as a benzodiazepine used to treat patients with insomnia? Multiple choice question Silenor Estazolam Doxylamine Diphenhydramine

Estazolam Estazolam is a benzodiazepine used to treat patients with insomnia. Silenor is an antidepressant used to treat patients with insomnia. Diphenhydramine and doxylamine are antihistamines used to treat patients with insomnia.

A patient tells the nurse, "I eat whenever I'm stressed." What would be the nurse's best response to confirm if the patient has developed ineffective coping when stressed? Multiple choice question "Have you gained any weight recently?" "How do you feel about your body image?" "Can I check you for increased blood pressure?" "Do you continue to eat even after you feel full?"

"Do you continue to eat even after you feel full?" The patient reports eating when stressed, which could indicate ineffective coping. The nurse can confirm that the patient has ineffective coping behaviors if the patient continues to eat after feeling full. Therefore, this statement would be the nurse's best response. Confirming if the patient has gained weight does not necessarily confirm if the patient has ineffective coping skills because weight gain can be related to a number of issues. Increased blood pressure may be a result of obesity from overeating or of stress-related anxiety but it does not confirm ineffective coping skills. A patient with a disturbed body image may be self-conscious about his or her body, but this does not necessarily confirm ineffective coping strategies.

A patient reports symptomology that supports the diagnosis of sleep paralysis. The nurse effectively assesses the patient by asking, Multiple choice question "Do you ever have nightmares?" "Is it difficult for you to fall asleep?" "Have you ever fallen asleep while driving?" "Do you have a history of obsessive-compulsive behavior?"

"Have you ever fallen asleep while driving?" Patients with sleep paralysis often also exhibit symptoms of narcolepsy, such as extreme sleepiness, resulting in falling asleep at inappropriate times.

Review the following information. Which assessment question best demonstrates the implementation of the suggested evidence-based practice intervention for a patient diagnosed with depression? Multiple choice question "How much sleep do you get each night?" "How is your depression affected when you are sleeping well?" "Describe for me why you believe you have problems sleeping." "Do you believe your mental health problem is related to a sleep disorder?"

"How is your depression affected when you are sleeping well?" This study highlights the prevalence of sleep disruption among patients with serious mental illness and calls for better assessment, monitoring, and management of sleep complaints in this population to improve clinical outcomes and reduce the use of resources, such as hospitalization and emergency department use. Asking the patient to describe how the depression is affected by effective sleep patterns best addresses the need for assessment techniques that focus on the effect of sleep on depression as well as the effect of depression on the sleep. Comanagement of sleep disturbance may result in improved symptom management, improved quality of life, and a return to baseline levels of functioning. Asking "How much sleep do you get each night?", "Describe for me why you believe you have problems sleeping?", and "Do you believe your mental health problem is related to a sleep disorder?" focus on the sleep patterns exclusively.

Which statement demonstrates that a patient understands good sleep hygiene techniques? Multiple selection question "I drink water or milk in the evenings." "I get up between 7:30 and 8:00 AM every morning." "Don't telephone after 10:00 PM because I'll be in bed." "Napping in the afternoon is a personal indulgence of mine." "My television is a flat screen model on the living room wall."

"I drink water or milk in the evenings." "I get up between 7:30 and 8:00 AM every morning." "Don't telephone after 10:00 PM because I'll be in bed." "My television is a flat screen model on the living room wall." Good sleep hygiene guidelines include limiting caffeinated beverages to one or two a day and none in the evening, maintaining a regular sleep/wake schedule, avoiding daytime napping, and reserving the bedroom for sleep and a place for intimacy.

Which statement is least likely to be made by a patient diagnosed with bulimia nervosa during the assessment interview? Multiple choice question "I eat three meals each day and purge every evening." "I feel as though my eating and purging are out of my control." "I'm concerned about what others think about my binging and purging." "When I eat I feel calm, but then I realize I have to make myself vomit or gain weight."

"I eat three meals each day and purge every evening." Most patients with bulimia purge after each meal.

Which patient statement or behavior supports the diagnosis of anorexia nervosa? Multiple selection question "I know I weigh 90 pounds; I still look fat!" "Nobody will like me if I look so grossly obese." Engages in both a pre- and post-meal exercising ritual "I understand this isn't a healthy way to live but I can't be fat." Places one potato onto the plate and cuts it into many, small pieces.

"I know I weigh 90 pounds; I still look fat!" "Nobody will like me if I look so grossly obese." Engages in both a pre- and post-meal exercising ritual Places one potato onto the plate and cuts it into many, small pieces. thoughts and behaviors that are associated with anorexia nervosa include a view of the self as fat even when emaciated , peculiar handling of food (e.g., cutting food into small bits), possible development of a rigorous exercise regimen, and cognition so disturbed that the individual judges self-worth by his or her weight. Saying "I understand this isn't a healthy way to live but I can't be fat" demonstrates self-reflection that usually is lacking in the patient diagnosed with such an eating disorder.

One criterion for the diagnosis of primary insomnia is met when the patient reports Multiple choice question "I was diagnosed with depression 2 months ago." "I've had problems falling asleep for 3 weeks now." "I have these terrible nightmares when I fall asleep." "I've actually missed work because I'm too tired to go."

"I've actually missed work because I'm too tired to go." A criterion for primary insomnia listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) is disruption of the normal routine as a result of the sleep disturbance.

After discovering her husband masturbating, a wife complains to the nurse, "I guess he's bored with me, but at least he isn't having an extramarital affair." Which response should the nurse provide? Multiple choice question "Perhaps a referral to a sex therapist would be helpful." "How often do you and your husband usually have sex?" "Did he use any strange objects when he was masturbating?" "Masturbation is normal human behavior and can add to his arousal."

"Masturbation is normal human behavior and can add to his arousal." The nurse should support the patient to express her feelings as well as provide education. Masturbation is a normal part of human behavior and can contribute to the husband's arousal. A referral to a sex therapist is premature. Asking about the patient's sexual frequency and details of the masturbation seek irrelevant information.

A male who has hypoactive sexual desire disorder asks the nurse what would cause this problem. Which would be the best response from the nurse? Multiple choice question "It just happens with age." "You should stop taking your antidepressant." "You must have been excessively masturbating." "You should have your testosterone level assessed."

"You should have your testosterone level assessed." A hormone imbalance, such as a low testosterone level, can cause male hypoactive sexual desire disorder. Older age can be a risk factor for decreased sexual desire in males, but this cannot be determined without further assessment. Depression is a risk factor, so the patient should not stop taking an antidepressant. Excessive masturbation is not a risk factor for hypoactive sexual desire disorder.

Which disease process has been associated with obstructive sleep apnea? Multiple selection question Diabetes Peptic ulcer Hypertension Migraine headache Cardiovascular disease

Obstructive sleep apnea has been associated with hypertension, diabetes, cardiovascular disease, and stroke. Research does not confirm the association of peptic ulcers and migraine headaches with obstructive sleep apnea.

Assessment of a patient suspected of experiencing bulimia nervosa calls for the nurse to perform which of the following? Multiple choice question Body fat analysis Inspection of body cavities Inspection of the oral cavity A range of motion assessment

Repeated vomiting often causes dental erosions and caries.

A patient diagnosed with anorexia nervosa presents to the clinic with a body mass index (BMI) of 15 kg/m 2. Based on BMI, which level of severity does the nurse document? Multiple choice question Mild Severe Extreme Moderate

A BMI of 15 to 15.99 kg/m 2 is considered severe. A BMI of 16 to 16.99 kg/m 2 is moderate. A BMI of less than 15 is extreme. A BMI of 17kg/m 2 or more is mild.

A nurse is assessing a patient with sleep-related breathing disorder. Which investigation does the nurse anticipate will be prescribed? Multiple choice question Hypnogram Polysomnography (PSG) Multiple sleep latency test (MSLT) Maintenance of wakefulness test (MWT)

A polysomnography is a test used to diagnose and evaluate a patient with sleep-related breathing disorder. A hypnogram is a graphical representation of sleep architecture of nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. The multiple sleep latency test is a daytime nap test that measures sleepiness in a sleep-conducive setting. The maintenance of wakefulness test is used to evaluate the ability to stay alert in a sleep-conducive situation and document adequate alertness.

After assessment, the nurse finds that a patient has difficulty sleeping, most probably caused by impaired circadian rhythm. The nurse learns that the patient has a fear of hospitals. Which assessment tool would be helpful in arriving at the diagnosis? Multiple choice question Actigraphy Polysomnography Multiple sleep latency test Maintenance of wakefulness test

Actigraphy There are four methods of diagnosis of sleep disorders based on the type and severity of the disorder. Actigraphy is the diagnostic procedure used to diagnose circadian rhythm disorders. It involves a watchlike device used for recording the sleep pattern. It is a simple method and does not require sophisticated equipment and facilitated sleep rooms. Polysomnography, the multiple sleep latency test, and the maintenance of wakefulness test are not used to diagnose circadian rhythm disorders. Polysomnography and the multiple sleep latency tests are used to diagnose patients suspected of narcolepsy. The maintenance of wakefulness test is used to detect a patient's ability to stay awake in an environment conducive to sleep. Because these procedures require sophisticated equipment, they are not used for patients who have fear of hospitalization.

A patient is suspected of having circadian rhythm disorder, which can be confirmed by monitoring the patient's body movements and sleep patterns. Which investigation should the nurse anticipate to be prescribed for this patient? Multiple choice question Actigraphy Hypnogram Polysomnography (PSG) Multiple sleep latency test (MSLT)

Actigraphy is a test used to monitor body movements for a time, which helps to evaluate sleep patterns and sleep duration. A hypnogram is a graphical representation of sleep architecture of nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. Polysomnography is a test used to diagnose and evaluate a patient with sleep-related breathing disorder. The multiple sleep latency test is a daytime nap test that measures sleepiness in a sleep-conducive setting.

The nurse is assessing a patient with low weight, lanugo, and cool extremities. The nurse finds that the patient has a fear of gaining weight. What disorder does the nurse suspect as the cause for the presence of these symptoms? Multiple choice question Bulimia nervosa Binge eating disorder Anorexia nervosa Rumination disorder

Anorexia nervosa is an eating disorder in which the patient has intense fear of weight gain and refuses to maintain optimal weight. The patient is underweight, and presents with lanugo (downy hair on face and back) and cool skin on the extremities due to starvation. In bulimia nervosa, the patient has recurrent episodes of uncontrollable bingeing. This is followed by inappropriate compensatory behaviors, such as excessive exercise, induced vomiting, and misuse of laxatives. In binge eating disorder, the patient has recurrent episodes of uncontrollable bingeing followed by a feeling of distress but the patient shows no compensatory behavior. In rumination disorder, the patient regurgitates the food, which is followed by rechewing and reswallowing or spitting.

A patient reports symptoms suggesting a sexual arousal disorder. The nurse appropriately assesses this patient for a possible cause by asking Multiple choice question "When did the problem first occur?" "Are you allergic to any particular foods?" "Do you take any antidepressant medications?" "Is there a specific time of the month when this problem occurs?"

Antidepressants are capable of causing a decreased sexual arousal.

When conducting an assessment interview the nurse is prompted to inquire about the existence of a dysfunctional sleep disorder when the patient reports being prescribed which classification of medications? Multiple selection question Antihistamine Anticonvulsant Antidepressant Broad-spectrum antibiotics Second-generation antipsychotics

Antihistamine Anticonvulsant Antidepressant Second-generation antipsychotics Many patients use medication to address their sleep problems. Many antidepressants, anticonvulsants, antihistamines, and second-generation antipsychotics are also used off-label (without specific approval from the Food and Drug Administration) for their sedative properties in the treatment of insomnia disorder. Antibiotics are not prescribed for their hypnotic/sedative properties.

A nurse is screening patients for sleep disorders. Which questions should the nurse ask to yield information related to hypersomnia? Multiple selection question "Are you troubled by nightmares?" "Do you have difficulty falling asleep?" "Have you experienced uncontrollable sleepiness?" "Have your family members complained that you snore?" "Do you feel a strange sensation in your legs that disturbs your sleep?"

Asking patients targeted questions about uncontrollable sleepiness and snoring may help the nurse recognize certain sleep disorders associated with hypersomnia such as narcolepsy and sleep apnea. Asking questions about nightmares, difficulty falling asleep, or unpleasant sensations in the legs would be more useful in identifying sleep disorders associated with insomnia. These include arousal sleep disorder, nightmare disorder, and restless leg syndrome. Inquiring about different unpleasant sensations in the legs gives information about hypersomnia caused by restless leg syndrome.

A nurse is assessing a child who does not like certain foods in the daily diet. On examination, the nurse notes that the body mass index (BMI) of the child is very low. What should the nurse anticipate the diagnosis to be? Multiple choice question Encopresis Rumination Elimination disorder Avoidant/restrictive food intake disorder

Avoidant or restrictive food intake is a feeding disorder where the patient avoids or restricts certain foods right from childhood. Encopresis is an elimination disorder in which the child involuntarily or intentionally passes feces. Rumination is a feeding problem where there is regurgitation with chewing again and then swallowing or spitting. Elimination disorder is related to involuntary or intentional passage of urine or feces.

What positive outcome does the nurse plan when managing a patient with sleep deprivation? Multiple choice question Proper sleep induction Work and sleep balance Consistent sleep pattern Appropriate hours of sleep

Balance between work and sleep should be the outcome of treatment for sleep deprivation. Sleep deprivation is caused by an imbalance between the hours of sleep required and the hours of sleep obtained. Proper sleep induction, consistent sleep pattern, and appropriate hours of sleep should be the outcomes to treatment for insomnia. Insomnia causes difficulty in falling asleep or staying asleep. Proper sleep induction overcomes the difficulty in falling asleep. Consistent sleep pattern maintains sleep throughout the night with minimal awakening. Managing appropriate hours of sleep such as avoiding daytime sleeping or unnecessary sleeping helps in sleep maintenance and gives refreshing sleep.

A patient who travels often and therefore experiences jet lag regularly reports the use of over-the-counter (OTC) melatonin supplements. The nurse responds by informing the patient that Multiple choice question Hypertension is a common side effect of melatonin supplement therapy. Melatonin is a naturally secreted hormone and thus is a safe supplement. Research has supported the effectiveness of using melatonin supplements for jet lag. Currently no standardized, safe therapeutic dosage range for melatonin supplements has been established.

Because melatonin is an OTC product, the Food and Drug Administration has no input on the identification of effective dosage ranges or standardization of nutraceutical ingredients.

The nurse recognizes bariatric surgery as a treatment for which disorder? Multiple choice question Rumination Binge eating Bulimia nervosa Anorexia nervosa

Binge eating Bariatric surgery is an option to treat binge eating disorder as the patients are obese due to overeating, with no compensatory activities such as exercise. Patients with anorexia nervosa are underweight as they starve themselves due to fear of weight gain. They do not need bariatric surgery. Patients with bulimia nervosa tend to overeat, which is followed by compensatory behaviors, such as excessive exercise or misuse of laxatives. They are usually normal in weight or close to ideal weight and they do not need bariatric surgery. In rumination disorder the patient regurgitates the food, which is followed by rechewing and reswallowing or spitting. It does not cause obesity and bariatric surgery is not necessary.

A nurse is attending to a patient with bulimia nervosa. What reason does the nurse suspect for the presence of gastric dilation in the patient? Multiple choice question Binge eating Induced vomiting Use of laxatives Ipecac intoxication

Binge eating can cause gastric dilation or rupture. Induced vomiting causes reflux of hydrochloric acid over the tooth enamel, causing dental cavities. Ipecac intoxication can cause cardiac failure. Use of laxatives causes electrolyte imbalances.

A patient presents with decreased cardiac output. The nurse notes that the patient experiences bingeing and then exercises excessively to make up for the calories gained. What should the nurse suspect? Multiple choice question Binge eating Bulimia nervosa Anorexia nervosa Weight management

Bulimia nervosa is having repeated episodes of binge eating followed by inappropriate behaviors to compensate such as exercise, induced vomiting, or purgation. Binge eating is repeated episodes of overindulgence in eating followed by a feeling of guilt and distress but no compensatory behavior. Anorexia nervosa is having intense fear of weight gain and refusing to maintain optimal weight. Weight management has a specific plan of diet and exercise and does not include bingeing followed by excessive exercise.

Bupropion, although seemingly effective, is contraindicated in patients who purge. What is the reason for this? Multiple choice question An increased risk of seizures Historically poor patient compliance The potential to cause gastric ulcers The long-term effects on liver function

Bupropion, although seemingly effective, is contraindicated in patients who purge because of an increased risk of seizures.

The nurse is assessing a patient with narcolepsy. The nurse notices that the patient has a brief episode of bilateral loss of muscle tone when laughing. What should the nurse interpret it as? Multiple choice question Cataplexy Sleepwalking Sleep paralysis Hypnagogic hallucination

Cataplexy is a brief episode of bilateral loss of muscle tone with consciousness occurring with a strong emotion like laughing, anger, or frustration. Sleepwalking is a set of behaviors like walking or talking during sleep. Sleep paralysis is being unable to speak or move while waking from sleep. Hypnagogic hallucinations are auditory or visual hallucinations occurring at the initiation of sleep.

A patient with anorexia nervosa displays indecisive behavior, passivity, and an inability to maintain eye contact. When formulating a plan of care for the patient, what is the most appropriate nursing diagnosis the nurse can make? Multiple choice question Ineffective coping Disturbed body image Chronic low self-esteem Altered health maintenance

Chronic low self-esteem The most appropriate nursing diagnosis based on these characteristics is chronic low self-esteem. Destructive behavior toward the self, poor concentration, inability to meet role expectations, and inadequate problem-solving are signs and symptoms of ineffective coping. The signs and symptoms of a disturbed body image include excessive self-monitoring and describing the self as fat despite emaciation. Altered health maintenance is a change in the ability of an individual's ability to perform the functions necessary to maintain health or wellness.

A patient is being evaluated for possible mental illness. Upon assessment, the nurse asks about the patient's sleep patterns. Why is the nurse asking this question? Multiple choice question Patients with mental illness require less sleep. Antipsychotic medication may cause insomnia. Sleep deprivation can mimic psychiatric disorders. Patients with mental illness always have sleep disorders.

Chronic sleep deprivation can mimic psychiatric illness. Most antipsychotic medications cause somnolence, not insomnia. People with mental illness do not necessarily always have sleep disorders. Patients will mental illnesses sometimes require more sleep.

An older adult who reports taking a late afternoon nap every day to make up for disrupted sleep at night still feels tired. The nurse explains that Multiple choice question A noontime nap includes very little REM sleep A late afternoon nap does not compensate for nighttime sleep The elderly always need less than 6 hours of sleep each night An afternoon nap includes a great deal of rapid eye movement (REM) sleep

Daytime naps do not compensate for a lack of nighttime sleep. Daytime naps differ in structure from normal nighttime sleeping as a result of a circadian cycle.

A nurse assesses an adolescent female with anorexia nervosa. Which physical findings support the diagnosis? Multiple selection question Oily skin Facial lanugo Pulse rate of 39 Sensitivity to heat Temperature of 96.7°

Decreased body temperature and pulse rate are common findings in anorexia nervosa. Lanugo (fine body hair) often appears on the face. There is sensitivity to cold because of the loss of insulating body fat. The skin is dry.

What is a coping mechanism used excessively by patients with anorexia nervosa? Multiple choice question Denial Humor Altruism Projection

Denial

Which assessment finding suggests that phentermine and topiramate extended-release (Qsymia) is contraindicated for the patient? Multiple selection question Diagnosis of glaucoma Diagnosis of hyperthyroidism Is prescribed a monoamine inhibitor Is prescribed a selective serotonin reuptake inhibitor Is opposed to oral birth control medications on a religious basis

Diagnosis of glaucoma Diagnosis of hyperthyroidism Is prescribed a monoamine inhibitor Is opposed to oral birth control medications on a religious basis Phentermine and topiramate extended-release is made up of two different drugs. One half of phentermine and topiramate extended-release is the antiseizure medication topiramate and the other half is phentermine, the safer part of Fen-phen. Women who take this drug must also use birth control because it is associated with birth defects. Contraindications include glaucoma, monoamine inhibitor use, and hyperthyroidism. Selective serotonin reuptake inhibitor is a consideration but not a contraindication.

Which area will the nurse focus on when evaluating whether a patient has experienced improved sleep quality? Multiple selection question Daytime sleepiness is lessened. Fewer dreams are experienced each night. The time it takes to fall asleep is decreased. There are fewer awakenings during the night. The time it takes to fall back to sleep after awakening is decreased.

Evaluation is based on whether or not the patient experiences improved sleep quality as evidenced by decreased sleep latency, fewer nighttime awakenings, a shorter time to get back to sleep after awakening, and improvement in daytime symptoms of sleepiness. Dream monitoring is not a factor in this evaluation.

After reviewing the following information, select the intervention that best addresses the evidence-based practice needs of a unit that cares for patients diagnosed with anorexia Monitor the websites the unit's patients visit during their free time. Track which gender visits pro-eating-disorder websites more frequently. Examine the correlation of how often the patients view websites that support dysfunctional eating behaviors and the severity of their disorder. Discuss the unreliability of the information provided on websites that support behaviors associated with eating disorders as part of the unit's therapy sessions.

Discuss the unreliability of the information provided on websites that support behaviors associated with eating disorders as part of the unit's therapy sessions. patients with anorexia nervosa often try to rationalize their food choices as a lifestyle and not a mental disorder with life-threatening consequences. It is more difficult to change this attitude when the online environment provides "evidence" for the truth of this belief. Discussing the unreliability of this information best addresses the identified implication to nursing practice. Monitoring websites the patients use, the frequency of the viewing, and tracking which gender views pro-eating-disorder websites fail to address the misinformation these sites are providing. p. 339

The nurse identifies which drug type as the mainstay of treatment for a patient with restless leg syndrome (RLS)? Multiple choice question Narcotics Anticonvulsants Benzodiazepines Dopamine agonists

Dopamine agonists such as pramipexoleare are the main course of treatment for restless leg syndrome. This is because restless leg syndrome is caused by the dysfunction of the brain's basal ganglia circuits that use dopamine as a neurotransmitter. Narcotics, anticonvulsants, and benzodiazepines are also effective, but not as effective as dopamine agonists.

Which drug has a long duration of action in treating insomnia? Multiple choice question Doxepin Zaleplon Triazolam Eszopiclone

Doxepin is an antidepressant drug used to treat insomnia. The onset of action of the drug starts in 30 minutes, and it has a long-lasting effect. Zaleplon, triazolam, and eszopiclone do not have long durations of action for treating insomnia. Zaleplon is a benzodiazepine-like drug and has an ultra-short duration of action. Triazolam is a benzodiazepine drug and has a short duration of action. Eszopiclone is a benzodiazepine-like drug and has an intermediate duration of action.

A nurse is assessing a patient with anorexia nervosa. Which clinical findings does the nurse expect? Multiple selection question Dry skin Emaciation High blood pressure Decreased urine output Decreased urinary concentration

Dry skin Emaciation Decreased urine output Anorexia nervosa causes imbalance in nutrition leading to dehydration and dry skin. It can also lead to emaciation. In some patients, fluid intake is also decreased leading to decreased urine output. Patients with anorexia nervosa usually have low blood pressure due to deficiency of proteins. The low urinary output results in increased concentration of urine.

What does the nurse teach a patient with sleep disorder about sleep hygiene? Multiple choice question Drink tea before bedtime. Watch television before bedtime. Perform exercise before bedtime. Eat limited meals before bedtime.

Eat limited meals before bedtime.

Which precautions should the nurse implement when performing a sexual assessment? Multiple selection question Eliminate distractions. Have a relaxed posture. Maintain good eye contact. Incorporate personal biases. Take consistent notes during assessment.

Eliminate distractions. Have a relaxed posture. Maintain good eye contact. When performing a sexual assessment, the nurse should maintain privacy and facilitate open communication by eliminating distractions, maintaining good eye contact, and having a relaxed posture. Constant note-taking during the assessment can distract the patient. The nurse must avoid personal biases and attitudes during the assessment interview.

The nurse is teaching a class to a group of men at a senior citizens center. Which sexual disorders would the nurse include in a presentation for this group? Multiple selection question Asexuality Homosexuality Erective dysfunction Premature ejaculation Hypoactive sexual desire

Erective dysfunction Premature ejaculation Hypoactive sexual desire Sexual dysfunction disorders common in older males include hypoactive sexual desire, erectile dysfunction, and premature ejaculation. Homosexuality and asexuality are not sexual disorders.

The nurse is learning about factors that contribute to insomnia in a patient. What is a perpetuating factor that contributes to insomnia? Multiple choice question Medical disorders History of depression Excessive use of alcohol Changes in role or identity

Excessive use of alcohol is a perpetuating factor that contributes to insomnia. Perpetuating factors are attributes and sleep practices that maintain the sleep complaint. Predisposing factors such as history of depression are individual factors that make patients vulnerable to insomnia. Medical disorders and changes in role or identity are precipitating factors, which are external events that trigger insomnia.

The nursing instructor is teaching nursing students about cognitive-behavioral therapy for insomnia (CBT-I). What statement made by a nursing student indicates a need for further learning? Multiple choice question "I have to ask what constitutes healthy sleep for the patient." "I have to educate the patient regarding sleep and sleep needs." "I have to help the patient to set realistic expectations about sleep." "I have to find the total number of hours the patient spends sleeping."

Finding information about the total number of hours spent sleeping is not important and has no value. Focusing on the number of hours slept increases the insomnia experience. Therefore, focus should be kept on the quality rather than quantity of sleep. Educating the patient about sleep and setting realistic expectations helps the patient to understand the importance and influence of sleep for a healthy life. Asking about the patient's feelings about healthy sleep helps to clarify any misconceptions about sleep.

Which statement regarding gender identity disorder and its effect on the individual is true? Multiple selection question Gender dysphoria is considered a psychiatric disorder. Gender identity involves identifying with one's biological sex. Gender dysphoria refers to an uneasiness with one's biological sex. These individuals do not usually consider themselves to be homosexual. Biological sex or assignment determines whether one identifies as a male or as a female.

Gender identity involves identifying with one's biological sex. Gender dysphoria refers to an uneasiness with one's biological sex. These individuals do not usually consider themselves to be homosexual. While the sex of a child is determined at birth, gender identity, the sense of maleness or femaleness, usually is not established until a child is about 3 years old. Unfortunately, biological assignment (sex) does not necessarily determine whether individuals think of themselves as male or female. When biological sex differs from gender identity, the individual may suffer from gender dysphoria, or feelings of unease about their incongruent maleness or femaleness. These individuals do not usually consider themselves to be homosexual. It should be noted that gender dysphoria is no longer considered a psychiatric disorder.

During assessment of a patient with anorexia nervosa, it is not likely that the nurse would note indications of which of the following? Multiple choice question Introversion Social isolation High self-esteem Obsessive-compulsive tendencies

High self-esteem Most patients with eating disorders have low self-esteem.

A patient is admitted to the hospital with severe anorexia. Upon assessment, the nurse notes the patient's skin is yellow. Which physiological response may cause this finding? Multiple choice question Hypoalbuminemia Hypercarotenemia Hyperbilirubinemia Estrogen deficiency

Hypercarotenemia causes the skin to appear yellow in patients with severe anorexia. Estrogen deficiency causes decreased bone density. Hypoalbuminemia results in peripheral edema. Hyperbilirubinemia is the result of excessive red blood cell breakdown, not anorexia.

A patient diagnosed with anorexia nervosa and which assessment finding meets the criteria for hospitalization? Multiple choice question Oral temperature 98.1°F Heart rate 56 beats per minute Serum potassium level 2.6 mEq/L Systolic blood pressure 88 mm Hg

Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances warrant hospitalization because of risks regarding cardiac regulation. Other criteria for hospitalization include severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute and systolic blood pressure less than 70 mm Hg.

Health teaching and promotion for a patient diagnosed with a sexual disorder is focused on Multiple choice question Modifying deviant sexual behaviors Identifying triggers that produce depression or anxiety Recognizing the impact of his or her behavior on others Reforming the behaviors into more socially acceptable actions

Identifying triggers that produce depression or anxiety

A patient who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meal daily and engages in a rigorous exercise program. What is the nursing diagnosis for this patient? Multiple choice question Death anxiety Ineffective denial Disturbed sensory perception Imbalanced nutrition: less than body requirements

Imbalanced nutrition: less than body requirements

The nurse is assessing a patient who complains of dissatisfaction with sleep quality and difficulty initiating sleep. On interviewing, the nurse finds that the patient awakens early and has difficulty returning to sleep. What disorder does the nurse analyze as the cause for these symptoms? Multiple choice question Insomnia disorder Nightmare disorder Hypersomnolence disorder Circadian rhythm sleep disorder

In insomnia there is dissatisfaction with sleep quality and difficulty in falling asleep or maintaining sleep. The patient wakes early, has difficulty returning to sleep, and has nonrefreshing sleep. Hypersomnolence disorder is characterized by excessive daytime sleep. There are recurrent periods of sleep and unintended lapses into sleep. The patient may not feel refreshed even after sleeping for long hours. In nightmare disorder, frightening dreams scare and awaken the patient. Circadian rhythm sleep disorder is caused when the sleep timing of a person is misaligned with external factors affecting the duration and timing of sleep.

An adult complains, "I fall asleep as soon as I go to bed but wake up between 3 and 4 AM every morning; then, I can't go back to sleep. It's causing me problems concentrating at work and I don't have enough energy to take care of my family." Which nursing diagnosis applies to this scenario? Multiple choice question Insomnia Impaired comfort Sleep deprivation Disturbed sleep pattern

Insomnia Criteria for insomnia include absenteeism, changes in affect, energy, mood, quality of life, concentration, and sleep. Patients with insomnia report a lack of energy, sleep disturbances, and early wakening. Sleep deprivation is associated with acute confusion, agitation, anxiety, apathy, fatigue, poor concentration, irritability, lethargy, malaise, perceptual disorders, and slowed reactions. Changes in normal sleep pattern, decreased ability to function, dissatisfaction with sleep, awakening, no difficulty falling asleep, and not feeling well rested are criteria for the diagnosis disturbed sleep pattern. Impaired comfort is a nursing diagnosis that relates to unpleasant sensations such as pain, itching, or gastrointestinal distress.

What nursing diagnosis would be most appropriate for a patient who reports disruption in the amount and quality of sleep? Multiple choice question Insomnia Sleep deprivation Disturbed sleep pattern Readiness for enhanced sleep

Insomnia is the disturbance in both quality and quantity of sleep that causes impaired functioning. Sleep deprivation refers to long periods without sleep. Disturbed sleep pattern occurs when changes in sleep routine cause impaired functioning. Readiness for enhanced sleep is a pattern of periodic suspension of consciousness that provides rest and sustains a desired lifestyle.

A nurse is planning management for patients suffering from insomnia. What positive outcomes should the nurse plan for? Multiple selection question Proper sleep induction Consistent sleep pattern Adequate hours of sleep Appropriate hours of sleep Feeling refreshed after sleep

Insomnia refers to a sleep disorder characterized by difficulty in falling asleep or staying asleep as desired. Proper sleep induction is important for patients with insomnia because they may have difficulty falling asleep. Consistent sleep pattern is essential to maintain sleep throughout the night with minimal awakening. Appropriate hours of sleep should be managed according to the patient's schedule, and daytime sleeping should be avoided. Adequate hours of sleep are essential in the case of patients with sleep deprivation. Feeling refreshed after sleep is important for patients with sleep deprivation and disturbed sleep pattern.

What are the likely causes of low libido? Multiple selection question Depression Hypertension Prostatectomy Hypothyroidism Alcoholic neuropathy

Low libido or lack of sexual desire is a type of sexual dysfunction that can result from a variety of causes. These include psychiatric conditions such as depression, neurological disorders such as alcoholic neuropathy, and endocrine disorders such as hypothyroidism. Hypertension and prostatectomy (surgical removal of prostate gland) may result in impotence (erectile dysfunction) but libido is intact.

A nurse is educating a group of patients about sleep hygiene to ensure good quality of sleep. Which instructions should the nurse include in the teaching? Multiple selection question Sleep at the work table. Maintain a sleep schedule. Avoid soda before bedtime. Watch television before bedtime. Avoid heavy meals before bedtime.

Maintaining a proper sleep schedule is important for good quality, refreshing sleep. Heavy meals should be avoided before bedtime to reduce the risk of indigestion and sleep disturbance. Soda should be avoided before bedtime because it often contains caffeine, which is a diuretic and causes night awakening for urination. Sleeping at the work table is not advisable; only the bedroom should be reserved for sleep. Watching television before bedtime can cause sleep disturbance; instead an environment that promotes sleep should be created.

How does the patient with bulimia differ from the patient with anorexia nervosa? Multiple choice question The patient with bulimia maintains a normal weight. The patient with bulimia exercises more rigorously. The patient with bulimia purges to keep weight down. The patient with bulimia holds a distorted body image.

Many bulimics are at or near normal weight, whereas patients with anorexia nervosa are underweight.

A nurse is caring for a patient with bulimia nervosa. Which factors should the nurse discuss when educating the patient about the eating disorder? Multiple selection question Meal planning Effects of purging Effects of starvation Relaxation techniques Eating forbidden foods

Meal planning Effects of purging Relaxation techniques Bulimia nervosa is characterized by repeated episodes of binge eating followed by inappropriate behaviors like induced vomiting or purgation to compensate. Meal planning will help the patient follow a healthy diet and avoid bingeing and purging. Understanding the effects of purging is important to be able to avoid it and maintain a healthy routine. Following relaxation techniques can help in relieving stress by ways other than using food and help in recovery. Understanding the effects of starvation are more important in case of patients with anorexia nervosa as there is avoidance of food due to fear of weight gain. These patients should also be encouraged to eat forbidden foods.

Which assessment finding supports the diagnosis of anorexia nervosa in a teenage female? Multiple selection question Bradycardia Amenorrhea Hypertension Hypothyroid function Prolonged QT interval

Medical complications associated with anorexia nervosa include bradycardia, prolonged QT interval, and ST-T wave abnormalities, symptomatic hypotension, amenorrhea, and abnormal thyroid functioning resulting in hypothyroidism.

Which diagnostic laboratory test is considered pertinent to the assessment of a patient suspected of having bulimia nervosa? Multiple selection question Liver function Glucose level Thyroid function Electrolyte levels Complete blood count

Medical evaluation usually includes a thorough physical examination, as well as pertinent laboratory testing, including: electrolyte levels, glucose level, thyroid function tests, and complete blood count. Although it may be appropriate in some cases, liver function testing is not considered pertinent to the assessment process.

What is true about medications used to treat insomnia? Multiple choice question They have a short half-life. They include benzodiazepines. They are all controlled medications. They are only prescribed for one week.

Medications used to treat insomnia include benzodiazepines, nonbenzodiazepines, melatonin receptor agonists, orexin receptor antagonists, and certain tricyclic antidepressants. They are generally prescribed for two weeks, not one week. Although benzodiazepines are control level IV, not all of them are controlled. Some medications have long half-lives, resulting in a "hangover effect" the next morning when the patient awakens.

A nurse is planning care management for a patient with an eating disorder. The patient is thin and weak but refuses to eat due to fear of weight gain. What actions should the nurse perform? Multiple selection question Monitor diet at meal times. Teach relaxation techniques. Ensure adequate food intake. Allow additional food availability. Ensure rigorous exercise program.

Multiple selection question Monitor diet at meal times. Teach relaxation techniques. Meal times should be monitored to ensure that the entire meal is properly taken by the patient. Relaxation techniques should be practiced to provide support and build a positive self-image. Adequate food intake should be ensured to adequately meet the caloric needs of the patient. Allowing additional food availability may lead to binge eating. Therefore, availability of food should be restricted to scheduled meals and snacks. A rigorous exercise program will make the patient weaker. Physical activity should be limited until optimal weight is achieved.

A patient reports being unable to move just before falling asleep. On further assessment, the nurse finds that the patient has visual hallucinations. The patient's lab reports reveal alterations in hypocretin levels. Which disorder is likely responsible for the patient's condition? Multiple choice question Insomnia Narcolepsy Nightmare disorder Restless leg syndrome

Narcolepsy is a sleep disorder characterized by loss of muscle tone in response to strong emotions (cataplexy), hallucinations, and inability to move before falling asleep (sleep paralysis). Hypocretin, a neurotransmitter, is responsible for the condition in patients. It is a sleep-inducing chemical messenger, and the levels are altered in the condition. Disturbances in hypocretin levels do not indicate insomnia, nightmare disorder, or restless leg syndrome. Excessive consumption of caffeine and alcohol is responsible forinsomnia. Nightmare disorder is characterized by sudden awakening of patients because of frightening dreams. Restless leg syndrome is due to excessive intake of selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors.

Which intervention would be removed from the plan of care for a patient diagnosed with bulimia nervosa? Multiple choice question Assist patient to identify trigger foods. Teach that fasting sets one up to binge eat. Support importance of avoiding forbidden foods. Teach patient to plan and eat regularly scheduled meals.

No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy.

A patient with anorexia nervosa was discharged from a specialized eating-disorder unit three weeks ago, weighing 123 lb. The patient returns to the outpatient clinic for a follow-up visit. The patient's ideal body weight is 154 lb, but the current body weight is 112 lb. What is the nurse's priority action? Multiple choice question Notify the health provider. Obtain a 24-hour diet recall. Request to view the nutrition log. Proceed with the treatment plan.

Notify the health provider. The nurse's priority action is to notify the healthcare provider. The patient weights 75% below his or her ideal body weight and will require immediate medical stabilization. Obtaining a 24-hour diet recall, requesting to view the nutrition log, and proceeding with the treatment plan are actions that may be taken once the healthcare provider is consulted.

Medications to treat insomnia usually are prescribed for no longer than Multiple choice question 2 weeks 3 weeks 1 to 2 days 1 to 2 months

Nurses often provide education about the benefits of a particular sleep medication, the side effects, untoward effects, and the fact that medications usually are prescribed for no longer than 2 weeks because tolerance and withdrawal may result.

Which individuals have the highest risk for obstructive sleep apnea hypopnea syndrome (OSAHA)? Multiple selection question 58-year-old obese man 35-year-old woman who has a fractured femur 18-year-old woman diagnosed with an eating disorder 9-year-old child diagnosed with a urinary tract infection 74-year-old woman diagnosed with chronic obstructive pulmonary disease

Obesity is an important risk factor for obstructive sleep apnea. Central sleep apnea is seen in older individuals, those with advanced cardiac or pulmonary disease, or those with neurologic disorders. Patients with eating disorders, urinary tract infections, and fractures are not at high risk for OSAHA.

As the nurse prepares to administer lorcaserin to a patient diagnosed with binge eating disorder, the tablet accidentally falls on the floor. What are the nurse's best actions? Multiple selection question Omit the dose. Reschedule the dose for a later time. Obtain a replacement dose for administration. Complete a controlled substance discrepancy form. Ask the patient, "Are you willing to take this pill after it fell on the floor?"

Obtain a replacement dose for administration. Complete a controlled substance discrepancy form. Lorcaserin makes people feel full after eating smaller meals by activating a serotonin 2c receptor in the brain and blocking appetite signals. It is a Schedule IV drug; therefore, the nurse should complete a controlled substance discrepancy form for a wasted dose. The nurse should also obtain a replacement dose for administration rather than omitting the dose. It is not appropriate to ask the patient to consider taking a contaminated drug or reschedule the dose for a later time.

What musculoskeletal change may occur in a patient diagnosed with bulimia nervosa? Multiple choice question Myopathy Osteopenia Osteoporosis Muscle wasting

Osteopenia can occur in patients diagnosed with bulimia nervosa. Myopathy, muscle wasting, and osteoporosis are musculoskeletal conditions that occur as a result of anorexia nervosa, not bulimia nervosa.

When considering an anorexic patient's poor sense of self-esteem, which outcome will be included in the patient's plan of care? Multiple selection question Patient will ingest nutrients to meet metabolic needs. Patient reports a decrease in stress and anxiety levels. Patient is involved actively in decision making related to treatment. Patient verbalizes confidence in managing needed eating changes. Patient's diagnostic results will demonstrate electrolytes are in balance.

Patient is involved actively in decision making related to treatment. Patient verbalizes confidence in managing needed eating changes. Outcomes appropriate for issues related to chronic low self-esteem include verbalizing a positive level of confidence, making informed life decisions, and expressing independence with decision-making processes. Meeting metabolic needs and maintaining normal electrolyte balance relates to physiological needs, while reporting less stress and anxiety relates to the patient's coping abilities.

What is the nurse's initial intervention when beginning the management of care for an individual diagnosed with a maladaptive eating disorder? Multiple choice question Personally reflect on weight-related biases. Establish a therapeutic patient-focused relationship. Evaluate the individual's current state of physical and emotional health. Assure the individual that the treatment plan will be agreed upon mutually.

Personally reflect on weight-related biases. Before working with patients with maladaptive eating regulation responses, nurses must closely examine their own feelings and prejudices about weight and body size. Although establishing a therapeutic patient-focused relationship, evaluating the individual's current state of physical and emotional health, and assuring the individual that the treatment plan will be agreed upon mutually all reflect appropriate interventions, there is a different intervention among the options that has priority in this situation.

A patient with binge-eating disorder is prescribed Qsymia. What side effects are most likely to be observed in the patient? Multiple selection question Diarrhea Glaucoma Paresthesia Hypersalivation Taste alteration

Qsymia contains topiramate and phentermine. It is known to cause side effects such as glaucoma, paresthesia (tingling of hands and feet), and taste alteration due to the presence of topiramate. Other side effects of Qsymia include dryness of the mouth and constipation. It does not cause hypersalivation or diarrhea.

Which benzodiazepine drug should the nurse expect to be prescribed for treating insomnia? Multiple choice question Trazodone Ramelteon Quazepam Doxylamine

Quazepam The pharmacologic approach to insomnia includes several classes of drugs, like benzodiazepines, melatonin receptor agonists, antidepressants, and antihistamines. The primary goal of pharmaceutical agents in treating insomnia is sedation. Quazepam is the benzodiazepine drug used to treat insomnia. It has an onset of action within 20 to 45 minutes, with a long-lasting effect. Trazodone, doxylamine, and ramelteon are not benzodiazepine drugs. Trazodone is an antidepressant drug used to treat insomnia. Doxylamine is an antihistamine drug used to treat insomnia. Ramelteon is a melatonin receptor antagonist approved by the Food and Drug Administration (FDA) to treat insomnia.

An older adult patient is reporting symptomology that suggests rapid eye movement (REM) sleep behavior disorder (RSBD). The nurse is correct in recognizing that this patient is at risk for developing Multiple choice question Lymphoma Hypertension Acute renal failure Parkinson's disease

RSBD is seen in elderly men as they begin to develop neurologic conditions such as Parkinson's disease.

Which medication is a melatonin receptor agonist? Multiple choice question Silenor Zolpidem Doxylamine Ramelteon

Ramelteon is a melatonin receptor agonist, used in the treatment of insomnia. Silenor is an antidepressant. Zolpidem is a benzodiazepine-like drug. Doxylamine is an antihistamine used to treat allergies.

The nurse is caring for a patient with arousal disorder. On observation the nurse finds the calf and shoulder muscles of the patient to be weakened and paralyzed. Which question by the nurse is appropriate during the assessment? Multiple choice question "Do you ever wake up suddenly after a dream?" "How do you feel after waking up in the morning?" "Do you have a tendency to act out your dreams?" "Have you ever done unusual activity during sleep?"

Rapid eye movement (REM) sleep behavior disorder is an arousal disorder characterized by relaxed skeletal muscles (muscle atonia). The assessment interview includes questions about the effect of dreams on the patient's mental status. Patients with this disorder usually act out their dreams. Questions about sudden waking, morning mental status, and unusual activity during sleep are not included in the assessment. Sudden awakening is a characteristic of nightmare disorder. Assessment of metal status after waking up is included for insomnia patients. Tendency toward unusual activity during sleep is due to sleepwalking disorder (somnambulism).

Therapeutic nutrition is initiated for a patient hospitalized with anorexia nervosa. Two days later, the nurse notes that the patient has developed peripheral edema. What is the nurse's correct analysis of this situation? Multiple choice question The patient's electrolyte balance has improved. The patient may be experiencing refeeding syndrome. Peripheral edema is the consequence of preexisting low bone density. The therapeutic nutrition program has improved the patient's hydration.

Refeeding syndrome is a potential complication of initiation of therapeutic nutrition for patients diagnosed with anorexia nervosa. An assessment finding associated with this problem is peripheral edema. Serum electrolytes, particularly sodium and potassium, are likely to be abnormal in this situation. Low bone density is an assessment finding associated with estrogen deficiency or low calcium intake. Peripheral edema is not a finding associated with normal hydration.

A nurse is learning about the sexual response cycle. Which phase does the nurse identify as the last phase in this cycle? Multiple choice question Desire Orgasm Resolution Excitement

Resolution is the last phase of the sexual response cycle. The sexual tension built up in the earlier phases reduces to baseline level after cessation of sexual stimulation. Desire is the first phase of the cycle. The second phase of the sexual response cycle is excitement, in which sexual tension increases. Orgasm is the third phase of the sexual response cycle, in which sexual tension peaks.

Based on the presence of which symptoms does the nurse identify a patient's condition as bulimia nervosa? Multiple selection question Amenorrhea Constipation Scars on hand Dental erosion Parotid swelling

Scars on hand Dental erosion Parotid swelling Bulimia nervosa is an eating disorder where the patient has recurrent episodes of uncontrollable binging that is followed by inappropriate compensatory behaviors, such as excessive exercise and induced vomiting. Due to self-induced vomiting, the patient presents with scars on hands and dental erosion. The reflux of hydrochloric acid over the tooth enamel causes dental cavities. The parotid glands swell due to an increase in serum amylase levels. Patients are usually normal in weight due to excessive caloric intake with purging. They do not have amenorrhea. Amenorrhea is seen more often in patients with anorexia nervosa. Such patients also have constipation due to starvation.

The nurse is teaching a group of nursing students about the causes of insomnia. Which statement by the nurse is appropriate in terms of multiple awakenings in individuals with insomnia? Multiple choice question "Galanin is a neurotransmitter responsible for wakefulness." "Adenosine is a neurotransmitter responsible for wakefulness." "Norepinephrine is a neurotransmitter responsible for wakefulness." "Gamma-aminobutyric acid is a neurotransmitter responsible for wakefulness."

Several circadian and homeostatic processes in vivo influence the regular sleep-wake pattern in individuals. Neurotransmitters are chemical agents that pass signals that induce or disrupt the sleep cycle. Norepinephrine is a neurotransmitter that is responsible for wakefulness in patients with insomnia. Drugs that cross the blood-brain barrier cause insomnia by inducing the secretion of norepinephrine. Galanin, adenosine, and gamma-aminobutyric acid (GABA) are not involved in inducing wakefulness in patients with insomnia. They are neurotransmitters that transmit signals for sleep and have major roles in treating insomnia.

The patient is diagnosed with sexual masochism. Which assessment data would the nurse expect to record? Multiple choice question The patient secretly watches people in dressing rooms. The patient urinates on his or her partner during sexual activity. The patient makes his or her partner suffer for sexual satisfaction. The patient rubs or touches nonconsenting people for sexual gratification.

Sexual masochism is characterized by making one's partner suffer by being beaten, humiliated, or bound. Voyeurism is described as secretly watching people in dressing rooms or other intimate settings. A frotteuristic disorder is characterized by rubbing or touching a nonconsenting person for sexual gratification. Urophilic disorder involves a person urinating on his or her partner during sexual activity.

The nurse appropriately assesses an obese, hypertensive patient with type 2 diabetes for sleep disorders when asking, Multiple choice question "Do you snore when you sleep?" "Do you regularly have nightmares?" "Is getting to sleep a problem for you?" "How much sleep do you usually get each night?"

Short sleep duration has been associated with obesity, cardiovascular disease, hypertension, and diabetes. "How much sleep do you usually get each night?"

Which term describes the distribution of sleep and wakefulness across the sleep period in a patient? Multiple choice question Sleep efficiency Sleep continuity Sleep architecture Sleep fragmentation

Sleep continuity is described as the distribution of sleep and wakefulness across the sleep period. Sleep efficiency is the ratio of sleep duration to time spent in bed. The structural organization of nonrapid eye movement (NREM) and rapid eye movement (REM) sleep is known as sleep architecture. Disruption of sleep stages such as multiple brief arousals and frequent shifts in sleep staging is known as sleep fragmentation.

The nurse is attending to a patient with sleep deprivation. While interviewing the patient the nurse learns that the patient became obese during periods of sleep deprivation. What does the nurse analyze as the reasons for the patient's obesity? Multiple selection question Changes in leptin levels Changes in ghrelin levels Changes in interleukin levels Changes in C-reactive protein levels Changes in tumor necrosis factor levels

Sleep deprivation is known to dysregulate the levels of leptin and ghrelin, which may cause obesity. Leptin is a hormone that regulates satiety or feelings of fullness. Ghrelin is a hormone that regulates hunger. Sleep deprivation also changes the levels of proinflammatory markers such as tumor necrosis factor, C-reactive protein, and interleukin, which promote inflammation. They do not cause obesity.

The nurse is educating a patient with sleep disorder about other health problems associated with sleep disorders. What does the nurse teach the patient? Multiple choice question Many psychiatric disorders are associated with hypersomnia. Obstructive sleep apnea has been associated with hypotension. Sleep disruption may be a precipitating factor in triggering psychiatric disorders. Sleeping 5 hours per night prevents cardiovascular and neurologic dysfunction.

Sleep disruption may be a precipitating factor in triggering psychiatric disorders. According to research done by Roth et al in 2006, sleep disruption may be a precipitating factor in triggering psychiatric disorders. According to research done by Cappuccio et al in 2010, sleeping less than 6 hours per night affects cardiovascular and neurologic function. A study done by Tracova et al in 2008 has shown that obstructive sleep apnea is associated with hypertension. Many psychiatric disorders are associated with insomnia rather than hypersomnia.

The nurse is learning about sleep-related hypoventilation. Sleep-related hypoventilation is most commonly seen in patients having which disease? Multiple choice question Neurologic disorders Advanced cardiac disease Lung parenchymal disease Advanced pulmonary disease

Sleep-related hypoventilation is mostly seen in patients with lung parenchymal disease. Sleep-related hypoventilation is associated with sustained oxygen desaturation during sleep in the absence of apnea or respiratory events. Central sleep apnea is seen in patients with advanced cardiac or pulmonary disease or with neurologic disorders. Respiration stops during sleep without associated ventilator effort, and it is caused by instability of the respiratory control system.

Which statement by a patient being educated in the sleep disorders clinic indicates a need for further teaching? Multiple choice question "Getting enough sleep will increase my productivity at work." "Getting less than 6 hours of sleep at night may increase my risk for medical problems." "Because I have to drive for my job, getting enough sleep will help me avoid accidents." "I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can."

Sleeping more than 8 hours per night is associated with up to a twofold increased risk of obesity, diabetes, hypertension, incident cardiovascular disease, stroke, depression, and substance abuse. Getting less than 6 hours of sleep at night may increase the risk for medical problems, getting enough sleep increases productivity at work, and getting enough sleep will help avoid accidents are all true statements.

A patient is seeking treatment for suspected narcolepsy. The patient reports daytime sleepiness, bilateral loss of muscle tone, and hypnagogic hallucinations. What category of medications would the nurse expect the physician to prescribe on a trial basis? Multiple choice question Hypnotics Stimulants Antipsychotics Muscle relaxants

Stimulants are the first-line treatment for narcolepsy as they can induce wakefulness. Antipsychotics, muscle relaxants, and hypnotics are all likely to increase sleepiness, so they are less likely to be used to treat narcolepsy.

A patient diagnosed with depression has reported fatigue and poor concentration. When the patient is told that the results of the sleep study show that he or she has excessive rapid eye movement (REM) sleep cycles, the patient asks the nurse to explain what those results mean. What is the nurse's best answer in response to the patient's concerns? Multiple choice question "It means that you are sleep deprived." "REM sleep stands for rapid eye movement sleep." "Too much REM sleep deprives you of deep restoring sleep." "Depressed individuals generally experience prolonged periods of REM sleep."

Studies show that in depressed persons, REM sleep is excessive, the deeper stages of sleep are decreased, and dreams may be unusually intense. Thus, although they may sleep six to nine hours each night, people with depression frequently report fatigue, poor concentration, and irritability associated with sleep deprivation. Sleep deprivation or depressed individuals experiencing prolonged periods of REM sleep may be true; however, they do not fully explain the importance of excessive REM cycle sleep to the patient.

How can the nurse working with patients diagnosed with eating disorders help families develop effective coping mechanisms? Multiple choice question Stressing the need to suppress overt conflict within the family Urging the family to demonstrate greater caring for the patient Teaching the family about the disorder and the patient's behaviors Encouraging the family to use their usual social behaviors at meals

Teaching the family about the disorder and the patient's behaviors Families need information about specific eating disorders and the behaviors often seen in patients with these disorders. This information can serve as a basis for additional learning about how to support the family member.

Which drug prescribed for patients with insomnia is a habit-forming drug? Multiple choice question Silenor Ramelteon Trazodone Temazepam

Temazepam is a benzodiazepine used to treat patients with insomnia, and it is a habit-forming drug because it causes drug tolerance and physiologic dependence. Habit-forming drugs can make the patient dependent on the drugs. Silenor and trazodone are antidepressants used to treat patients with insomnia, and they are not habit-forming drugs. Ramelteon is a melatonin receptor agonist used to treat patients with insomnia, and it is not a habit-forming drug.

Which hormone regulates hunger? Leptin Insulin Ghrelin Melatonin

The hormone ghrelin regulates hunger. Leptin is a hormone that causes feelings of fullness, thereby acting as a satiety hormone. Insulin regulates blood sugar levels. Melatonin regulates sleep.

A nurse is educating a female patient who complains of sleep disturbances at night. The patient works from home, sleeps in the afternoon, and completes household chores in the evening. What appropriate sleep hygiene advice should the nurse provide? Multiple choice question Begin going out for work. Avoid sleeping in the afternoon. Watch television before bedtime. Perform exercise before bedtime.

The nurse should advise the patient to avoid sleeping in the afternoon. This can help in regulating the sleep pattern and making sound sleep at night more likely. Working from home or going out may not affect the sleep pattern but managing time of sleep is important. Exercise can be performed during the day but should be avoided just before bedtime. Watching television before bedtime may have a stimulating effect and may interfere with sleep.

A patient with a history of anorexia nervosa is currently being treated with fluoxetine for obsessive-compulsive behavior. The patient asks the nurse, "Will this medication help keep my anorexia from worsening?" What is the nurse's best response? Multiple choice question "The medication will prevent a relapse of anorexia." "You will be taking a different medication to treat your anorexia." "The medication is being used to treat obsessive-compulsive behavior." "The medication will treat both the anorexia and obsessive compulsive behavior."

The nurse's best response is, "The medication is being used to treat obsessive compulsive behavior." Fluoxetine is a selective serotonin reuptake inhibitor that is useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. There are no drugs approved for the treatment of anorexia nervosa, so fluoxetine won't help; there are no drugs that will be prescribed for the anorexia, and fluoxetine cannot treat both.

What is the nurse's priority while trying to improve the condition of a patient with a binge-eating disorder? Multiple choice question Treat bradycardia Treat hypotension Ensure steady weight loss Restore electrolyte imbalance

The nurse's priority for a patient with binge-eating disorder is to allow steady and slow weight loss as the patient is obese due to overeating. Bradycardia, hypotension, and electrolyte imbalance are present in patients with anorexia nervosa due to dehydration and starvation. Bradycardia, hypotension, and electrolyte imbalance are also present in patients with bulimia nervosa due to induced vomiting. Treating bradycardia, electrolyte imbalance, and hypotension is the nurse's priority for patients with anorexia nervosa and bulimia nervosa.

Which diagnosis would be given priority for a patient diagnosed with bulimia nervosa? Multiple choice question Disturbed body image Chronic low self-esteem Risk for injury: electrolyte imbalance Ineffective coping: impulsive responses to problems

The patient who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss.

A patient reports insomnia and shares that a friend has recommended a nonprescription hormone product that can be purchased at the local health food store. The nurse suspects that the medication is Multiple choice question Lithium Melatonin A tranquilizer A benzodiazepine

The use of melatonin appears to be helpful in treating sleep problems in the elderly. However, this practice is not without risk. Melatonin products are not approved by the United States Food and Drug Administration; therefore, variation may exist in the purity, safety, and effectiveness of the products.

What role does culture play in the sleep quality of people living in the United States and other developed nations? Multiple choice question Herbal remedies for sleep are more prevalent. Technology has impacted sleep quality negatively. United States citizens work harder, so they sleep less. More people in the United States use alcohol to sleep.

Up to 90% of Americans use some form of technology in the hour before sleep; this has had a negative impact. Although there is a correlation between work and sleep, this is not specific to the United States and other developed countries. Although alcohol may induce sleep, it does not provide good quality of sleep. Regardless, the United States is not the only developed country in which alcohol is used medicinally. Herbal remedies such as melatonin and valerian have risen in popularity in recent years, but there is no evidence these treatments are used more than in other countries.

Which statements by a patient diagnosed with pedophilic disorder indicate treatment was effective? Multiple selection question "I will limit my sexual activities to watching online videos of children." "When I get urges to have sex with children, it's best for me to stay at home." "I am taking cyproterone acetate (CPA) as prescribed by my health care provider." "I plan to volunteer at a day care center so I have supervision when I'm near children." "I have new software that prohibits me from visiting sexually-oriented sites on the internet."

When I get urges to have sex with children, it's best for me to stay at home." "I am taking cyproterone acetate (CPA) as prescribed by my health care provider." "I have new software that prohibits me from visiting sexually-oriented sites on the internet." Desirous outcomes for pedophilic disorder include identifying triggers for maladaptive sexual fantasies and describing techniques to control these fantasies, practicing self-restraint, identifying feelings that lead to impulsive actions, consequences of actions, and alternatives, expressing determination to live and a sense of control, identifying strategies to manage urges, and refraining from self-destructive urges. CPA, an inhibitor of testosterone, may be used to treat sex offenders. This drug decreases libido and breaks the individual's pattern of compulsive deviant sexual behavior. Watching online videos of children or being near children at a day care center show continued involvement with children that is likely to stimulate harmful behavior.