Rest and Sleep
The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? A. Have patient follow hospital routines. B. Avoid waking patient for nonessential tasks. C. Give prescribed sleeping medications at dinner. D. Turn television on low to late-night programming.
B. Avoid waking patient for nonessential tasks.
The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? A. Incontinence B. Nausea and vomiting C. Bradycardia D. Respiratory depression.
D. Respiratory depression. Benzodiazepines in older adults should be used on a short-term, limited basis. Respiratory depression is an adverse effect of benzodiazepines in older adults. Other adverse effects for which to assess include next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination.
A patient informs the nurse that he is working the night shift and has difficulty sleeping during the day. What suggestions can the nurse offer to assist him with sleeping in the daylight hours? A. Make the bedroom warmer. B. Use room-darkening window shades. C. Drink warm tea at the end of the shift. D. Go to the gym to work out before going home to sleep.
B. Use room-darkening window shades. Light is the strongest time cue for the sleep-wake rhythm. Darkening the room will help the hypothalamus to adjust to this change in sleep pattern. Measures to facilitate sleep include a quiet and cool room, no caffeine intake 4 to 6 hours before bedtime, and avoiding exercise 6 hours before bedtime. Scheduling sleep and waking time to just before going to work may also increase alertness and vigilance at work.
The most commonly reported cause of sleep disturbance in the hospital is ______ A. nosy family members B. pain C. frequent vital checks D. noise
B. pain The second most commonly reported cause is NOISE.
Sleep is a ____________ experience!
subjective
How many stages of non-REM sleep are there?
4
Physical activity or exercise increases the need for stage____sleep. Physical exercise will stimulate the body for about 2 hours , which will make it harder to fall asleep.
4
during which stage of non-rem sleep is growth hormone secreted?
stage 4
During this stage of sleep adrenal hormone is secreted and dream vivid, intense dreams with strong emotional tones. A. stage 1 non-rem sleep B. between stage 3 and 4 non-rem sleep stage. C. REM sleep. D. None of the Above.
C. REM sleep.
what are the average sleep requirements of Infants: Young Adults: Adults:
Infants 16 hours Young Adults 9 hours Adults 8 hours.
Daytime sleep attacks, with Pathological REM sleep
Narcolepsy
(10-20 minutes) Easily wakened, but know they are asleep. which stage of non-rem sleep is this?
stage 2
during REM sleep, there is increased gastric acid secretion. The pain can wake people up at night.
Stomach ulcers
__________ take longer in falling asleep, have more nighttime awakenings, wake up earlier, and need more naps.
The elderly
______________ need less sleep than children. 20-25% of adult sleep is REM 10% is stage 4
Adults
Sleep-induced loss of upper airway Muscle tone causes cessation of airflow Classic sign: loud snoring alternating with apnea Continuous positive airway pressure therapy (CPAP) increases air pressure in the throat so it does not collapse upon inspiration A. Obstructive sleep apnea (OSA) B. Chronic obstructive pulmonary disease (COPD) C. Central sleep apnea D.Sleep related groaning
A. Obstructive sleep apnea (OSA)
Hormone of darkness is A. estrogen B. melatonin C. progesterone D. insulin
B
The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? (Select all that apply.) A. Can cause urinary retention B. Should not be used indefinitely. C. May have toxic effects on the liver. D. May cause diarrhea and anxiety E. Are not regulated by the U.S. Food and Drug Administration (FDA)
B, C, E. Herbal products help promote sleep. These products need to be used cautiously because they are not regulated by the U.S. Food and Drug Administration. They should not be used long term and can interact with prescribed medications. Kava needs to be used cautiously because it can be toxic to the liver.
This is a very active stage of sleep. Brain wave pattern resembles waking. There is increased flow of blood to the brain, increased metabolic activity & oxygen use. The pulse, respirations & BP fluctuate. The eyes move rapidly back & forth, but the rest of the body is profoundly relaxed - little muscle tone. Duration - shorter early in the night, longer later in the night. Average - 20 min.
REM (Rapid Eye Movement) sleep.
a state of relief from work, worry, or effort; or a recreation or other activity a person engages in to relax.
Relaxation
a state of being physically and mentally relaxed and free from anxiety while awake and alert.
Rest
"Creeping-crawling" sensations in lower extremities
Restless Leg Syndrome
A state during which an individual lacks conscious awareness of environmental surroundings and from which one can be easily aroused
Sleep
lasts a few minutes) This is the transition from waking to sleeping. The person is easily wakened and will say they were not asleep, but just resting. Nevertheless, the brainwave patterns are distinctly different, and characteristic of sleep, not wakefulness. which stage non-rem sleep is this?
stage 1
15-30 minutes) Beginning of deep sleep. The person relaxed, little movement, body functions & all VS slow down or drop. The person will only awaken to significant stimuli. which state of non-rem sleep is this?
stage 3
(15 - 30 minutes) Deepest sleep, stage of deepest relaxation. Muscles very relaxed, VS low & slow. May be some dreams in this stage, but they are very dull, about very ordinary activities - "What shall I fix for dinner?" Research indicates that these dreams are psychomotor, or "doing" dreams, and serve to consolidate "how to" memory. which state of non-rem sleep is this?
stage 4
Stimulants - decrease sleep & suppress REM sleep - - - -
-Caffeine -Amphetamines -Cocaine -Nicotine
Research indicates that women have changes in their sleep patterns related to: - - -
-Menstruation -Pregnancy -Menopause
The school nurse is teaching health-promoting behaviors that improve sleep to a group of high-school students. Which points should be included in the education? (Select all that apply.) A. Go to bed at the same time each night. B. Study in your bedroom to have a quiet place. C. Turn on the television to help you fall asleep. D. Avoid drinking coffee or soda before bedtime. E. Turn off your cell phone at bedtime.
A, D, E. Going to bed at the same time each night, avoiding drinking coffee and soda before bedtime, and turning off electronic devices are effective sleep-hygiene practices for adolescents. Use of electronic devices is a main cause of sleep disruption in adolescents.
The nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? (Select all that apply.) A. Take brief, 20-minute naps during the day. B. Drink a glass of wine with dinner. C. Eat the large meal at lunch rather than dinner. D. Establish a regular exercise program. E. Teach the patient about the side effects of modafinil (Provigil).
A, D, E. Taking short naps, no longer than 20 minutes, during the day and regular exercise are management strategies that help reduce the feeling of sleepiness. Modafinil is a stimulant used to treat narcolepsy; therefore it is important for patients to understand its side effects.
The nurse teaches a patient with a sleep disorder about sleep hygiene. Which statement, if made by the patient, indicates understanding of the instructions? A. "I will go to bed at the same time whether I am sleepy or not." B. "I should set the temperature in my bedroom under 70° F at night." C. "I must stop drinking alcoholic beverages 2 hours before I go to bed." D. "I can use the prescribed sleeping pills every night to help me stay asleep."
B. "I should set the temperature in my bedroom under 70° F at night." Good sleep hygiene should include a cool, dark, and quiet bedroom; going to bed only when sleepy; avoiding sleeping pills or using them cautiously; and avoiding alcohol for at least 4 to 6 hours before bedtime.
______________ 20-30% of sleep is REM & spend more time in stage 4 than adults. Adolescents need more stage 4 and thus more total sleep than younger children .
Children
Sleep disturbances that involve the amount, quality, or timing of sleep Insomnia Hypersomnia Narcolepsy Sleep apnea (OSA) Restless legs syndrome Sleep Deprivation
Dyssomnias
in small quantities promote relaxation, enhance falling asleep. But suppresses REM sleep. Larger quantities result in wakening about 2-3 hours later when the person can't enter REM sleep. A. caffeine B. cannabis C. melatonin D. zinc and magnesium E. alcohol
E. alcohol
true or false opiods enhance REM sleep and are usually given to help with sleep disorders.
False opiods suppress REM
______________ sleep most of the time. 50% is REM sleep They spend more time in Stage 4 than adults
Newborns
Disruptive disorders that occur during arousals from (REM) sleep or (NREM) sleep Related to mental disorder General medical condition Substance-induced Nightmare disorder Sleep terrors disorder Sleepwalking disorder (somnambulism) Nocturnal enuresis Bruxism
Parasomnias
_______________ ( bedwetting in particular) are deep sleep occurrences, and child has no conscious control. Stress can make it worse, but the problem occurs first, and then the situation itself creates stress.
Parasomnias
this hormone is secreted by pineal gland; stimulated by hypothalamus Helps body's circadian clock adjust to changes in light/dark cycle
melatonin.
A patient informs the nurse that she is having difficulty getting to sleep and staying asleep. Which studies does the nurse anticipate educating the patient about? A. EEG B. Self-report C. Actigraphy D. Polysomnography
B. Self-report The diagnosis of insomnia is based on self-report of difficulty falling or remaining asleep. EEG is used with polysomnography sleep studies to diagnose other sleep disorders. Actigraphy measures gross motor activity.
The nurse providing care to a group of patients during the night sets a goal of promoting restful sleep. How would the nurse best define sleep? A. An unconscious state in which arousal is not easily accomplished B. A basic but unorganized behavior that is not necessary for survival C. A state of chemical balance among acetylcholine, norepinephrine, and serotonin D. A state during which a person lacks conscious awareness but can easily be aroused
D. A state during which a person lacks conscious awareness but can easily be aroused Sleep is a state during which an individual lacks conscious awareness of environmental surroundings and from which one can be easily aroused. Sleep is a basic, highly organized behavior.
A patient in the intensive care unit is becoming more irritable from lack of sleep. What nursing action will best help facilitate the patient's sleeping? A. Give the patient a back rub. B. Keep the lights on during the day. C. Talk to the patient when waking up at night. D. Cluster activities to allow longer rest periods.
D. Cluster activities to allow longer rest periods Combining patient care activities to avoid frequently disturbing the patient's sleep will help the patient get more sleep and thus be less irritable. A back rub may help, but keeping the lights off in the room at night and only talking to the patient if the patient wants to talk will best facilitate sleep.
A state of rest accompanied by altered consciousness, and relative inactivity
Sleep
Which sleep-hygiene actions at bedtime can the nurse delegate to the nursing assistant? (Select all that apply.) A. Giving the patient a backrub B. Turning on quiet music C. Dimming the lights in the patient's room D. Giving a patient a cup of coffee E. Monitoring for the effect of the sleeping medication that was given
A, B, C. Giving the patient a backrub, turning on quiet music, and dimming the lights are all appropriate sleep-hygiene measures. These activities are within the scope of practice for the nursing assistant. Coffee, tea, cola, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night and should not be ingested before bedtime. Monitoring medication effect is a registered nurse activity.
Which question is most appropriate when the nurse is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)? A. "Do you smoke?" B. "Do you tend to awaken early in the morning?" C. "Are you under a lot of stress at work or at home right now?" D. "Do you have a history of chronic obstructive pulmonary disease?"
A. "Do you smoke?" Smoking is a major etiologic factor in OSA. Early wakening and stress are associated with insomnia, not OSA in particular. COPD exacerbates the hypoxemia associated with OSA but does not precipitate the onset of OSA itself.
Which statement made by the parent of a school-age child requires follow-up by the nurse? A. "I encourage evening exercise about an hour before bedtime." B. "I offer my daughter a glass of warm milk before bedtime." C. "I make sure that the room is dark and quiet at bedtime." D. "We use quiet activities such as reading a book before bedtime."
A. "I encourage evening exercise about an hour before bedtime." Best evidence related to sleep hygiene recommends avoiding exercise within 2 hours of bedtime. Exercise should be in the morning or afternoon. Encourage the parent to use quiet activities before bedtime to promote sleep.
What principle should guide the nurse's practice when providing care for older patients? A. Drug therapy should be used conservatively. B. Older adults require less sleep than younger adults. C. Cognitive-behavioral interventions are less effective than among younger adults. D. Patient teaching should focus on older adults accepting age-related changes in their sleep cycles.
A. Drug therapy should be used conservatively. Drug therapy for sleep difficulties should be used conservatively in older adults. They do not necessarily need less sleep, and cognitive-behavioral therapies should still be used. Changes in sleep cycles do accompany aging, but teaching should not simply focus on accepting, rather than addressing, these changes.
A 72-year-old patient asks the nurse about using an over-the-counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse's best response? A."Antihistamines are better than prescription medications because these can cause a lot of problems." B. "Antihistamines should not be used because they can cause confusion and increase your risk of falls." C. "Antihistamines are effective sleep aids because they do not have many side effects." D. "Over-the-counter medications when combined with sleep-hygiene measures are a good plan for sleep."
B. "Antihistamines should not be used because they can cause confusion and increase your risk of falls." (Older adults should avoid the use of over-the-counter antihistamines. These medications have a long duration of action in older adults and can cause confusion, constipation, urinary retention, and increased risk of falls.)
Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? A. "I'll give the baby a bottle to help her fall asleep." B. "We'll place the baby on her back to sleep." C. "We put the baby's stuffed animals in the crib to make her feel safe." D. "I know the baby will not need to be fed until morning."
B. "We'll place the baby on her back to sleep." This is based on the current evidence that shows that parents need to place an infant on his or her back to prevent suffocation. Bottles, stuffed animals, and pillows should not be placed in the bed with an infant.
Which patient is at highest risk for obstructive sleep apnea (OSA)? A. 82-yr-old man with Parkinson's disease who has dysphagia B. 68-yr-old obese man who smokes one pack of cigarettes per day C. 18-yr-old woman with cystic fibrosis who has recurrent pneumonia D. 35-yr-old woman with a BMI of 22 kg/m2 who has seasonal allergies to pollen
B. 68-yr-old obese man who smokes one pack of cigarettes per day. Risk of OSA increases with obesity (BMI >30 kg/m2), age older than 65 years, neck circumference greater than 17 inches, craniofacial abnormalities, and acromegaly. Smokers are more at risk for OSA, and OSA is more common in men than women (until menopause).
Which individual most clearly exhibits the signs and symptoms of primary insomnia? A. A patient in the habit of having a cappuccino in the late evening while watching TV B. A patient whose increased sleep latency is not clearly attributable to any particular cause. C. A patient who has experienced frequent nighttime awakenings since the recent death of a spouse D A patient whose corticosteroid therapy causes him to feel "edgy" and unable to fall asleep at night.
B. A patient whose increased sleep latency is not clearly attributable to any particular cause. Insomnia that is not directly attributable to a cause is considered primary or idiopathic. The stimulants such as caffeine, prescription medications, or psychologic trauma result in secondary insomnia.
An obese patient is scheduled to begin treatment with continuous positive airway pressure (CPAP). When developing the plan of care, what outcome would be appropriate for this patient? A. The patient will be calm. B. The patient will have no airway collapse. C. The patient will have increased gas exchange. D. The patient will breathe through the nose rather than mouth.
B. The patient will have no airway collapse. CPAP maintains sufficient positive pressure (5-25 cm H2O) in the airway during inspiration and expiration to prevent airway collapse. CPAP does not exclusively require the patient to breathe through his or her nose.
A patient diagnosed with narcolepsy wants to know what can be done to cure it. What is the best response the nurse can give this patient? A. "If you take your medicine and naps, you will be cured." B. "Patient support groups may be able to help you feel better." C. "Drug therapy and behavioral strategies will be used to help treat it." D. "Safety precautions must only be when you are driving an automobile."
C. "Drug therapy and behavioral strategies will be used to help treat it." Narcolepsy cannot be cured. Measures to treat narcolepsy include drug therapy for promoting wakefulness during the day, sleep hygiene measures, and other behavioral strategies to enhance nighttime sleep. A patient support group may help the patient feel better, but it will not cure narcolepsy. Safety precautions are needed with driving, but also with other activities as falling asleep or losing muscle control can transform actions that are ordinarily safe (e.g., walking down a long flight of stairs) into hazards.
Which statement made by an older adult best demonstrates understanding of taking a sleep medication? A. "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." B. "Sleep medicines won't cause any sleep problems once I stop taking them." C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." D. "I'll contact my health care provider if I feel extremely sleepy in the mornings."
C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." The statement, "I'll talk to my health care provider before I use an over-the-counter sleep medication" shows an understanding of the risks of over-the-counter sleep medications. The use of nonprescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption even when they initially seemed effective. Caution older adults about using over-the-counter antihistamines because of their long duration of action that can cause confusion, constipation, urinary retention, and increased risk of falls.
The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? A. "I feel refreshed when I wake up in the morning." B. "I use soft music at night to help me relax." C. "It takes me about 45 to 60 minutes to fall asleep." D. "I take the pain medication for my leg pain about 30 minutes before I go to bed."
C. "It takes me about 45 to 60 minutes to fall asleep." Good sleep-hygiene practices indicate that individuals should fall asleep within 30 minutes of going to bed. Taking 45 to 60 minutes to fall asleep indicates a potential sleep problem and requires follow-up on sleep-hygiene practices. If an individual does not fall asleep within 30 minutes, encourage him or her to get out of bed and do a quiet activity until he or she feels sleepy.
The nurse is contacting the health care provider about a patient's sleep problem. What is the correct order for the steps for SBAR? 1) Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 2) "Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 3) "I'm calling to ask if you would order a hypnotic such as zolpidem (Ambien) to use on a prn basis." 4) Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1° C (98.8°F). A. 2, 1, 3, 4 B. 1, 2, 3, 4 C. 2, 1, 4, 3 D. 1, 2, 4, 3
C. 2, 1, 4, 3 SBAR is Situation, Background, Assessment, and Recommendation. This is the correct sequence of steps in SBAR for the patient and sleep problem.
The nurse is developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? A. Instruct the patient to sleep in a supine position. B. Have patient limit fluid intake 2 hours before bedtime. C. Elevate the head of the bed to sleep. D. Encourage patient to take an over-the-counter sleep aid.
C. Elevate the head of the bed to sleep. Lifestyle changes and modifications of sleep habits should be included on a plan of care for a patient with OSA. Individuals should sleep with the head of the bed elevated and use a side or prone position. Other modifications include good sleep-hygiene practices, alcohol modification, smoking cessation, and weight reduction.
A patient on the surgical unit after coronary artery bypass grafting complains of vivid nightmares. What assessment should the nurse complete to determine the most likely cause of the nightmares? A. Ask the patient about a history of posttraumatic stress disorder. B. Determine if the patient has a history of sleep apnea or narcolepsy. C. Evaluate the medications the patient is receiving for possible side effects. D. Review the documentation record to determine if the patient had a fever last night.
C. Evaluate the medications the patient is receiving for possible side effects. Medication side effects are the most common cause of nightmares in patients in acute care settings. Drug classes most likely to cause nightmares are sedative-hypnotics, â-adrenergic antagonists, dopamine agonists, and amphetamines.
The nurse is caring for a patient who is diagnosed with narcolepsy and cataplexy. What therapeutic drug regimen will the nurse educate the patient about? A. Valerian and diazepam B. Melatonin and ropinirole. C. Modafinil and desipramine. D. Diphenhydramine and low dose fluoxetine
C. Modafinil and desipramine Narcolepsy drug management includes amphetamine-like stimulants or nonamphetamine wake-promotion drugs (e.g., modafinil) to relieve excessive daytime sleepiness and antidepressant drug therapy (e.g., desipramine) to control cataplexy. Drugs that often cause drowsiness such as diazepam, melatonin, and diphenhydramine are not indicated for use in patients with narcolepsy.
A patient is experiencing insufficient sleep and having health issues as a result. What disorder does the nurse inform the patient can be related to sleep disorders? A. Insufficient sleep is linked to a decreased risk for type 2 diabetes mellitus. B. Inadequate sleep in people with hypertension leads to future decreases in blood pressure. C. Short sleep duration may result in metabolic changes that are linked to obesity. D. Radiation for cancer treatment is associated with fragmented sleep and fatigue.
C. Short sleep duration may result in metabolic changes that are linked to obesity. Short sleep duration may result in metabolic changes that are linked to obesity. Insufficient sleep is linked to an increased risk for type 2 diabetes mellitus. Inadequate sleep leads to further elevations in blood pressure in people with hypertension. Chemotherapy for cancer treatment is associated with fragmented sleep and fatigue, but inadequate sleep does not contribute to cancer.
A patient is seeking care for problems related to an inability to sleep and stay asleep over the past several months. What does the nurse anticipate teaching the patient regarding? A. Melatonin B. Benzodiazepines C. Sleep hygiene practices D. Over-the-counter sleep aids
C. Sleep hygiene practices. Sleep hygiene practices are effective in the management of insomnia and should be the first line of therapy. Melatonin may be helpful for jet lag but has a short duration of action. Benzodiazepines have a prolonged half-life and may result in daytime sleepiness. Over-the- counter sleep aids may lead to tolerance or have anticholinergic side effects.
The nurse is preparing a patient to have a sleep study to determine if sleep apnea is present. What should the nurse teach the patient to do until the test can be completed? A. Take sleep medications. B. Use the spouse's CPAP mask. C. Sleep in a side-lying position. D. Do not use pillows when sleeping.
C. Sleep in a side-lying position. Conservative treatment for mild obstructive sleep apnea (OSA) begins with sleeping on one's side. Sleep medication often makes OSA worse. CPAP is adjusted for the patient and used with more severe symptoms after diagnosis. Elevating the head of the bed may eliminate OSA.
The patient reports episodes of sleepwalking to the nurse. Through understanding of the sleep cycle, the nurse recognizes that sleepwalking occurs during which sleep phase? A. Rapid eye movement (REM) sleep B. Stage 1 non rapid eye movement (NREM) sleep C. Stage 4 NREM sleep. D. Transition period from NREM to REM sleep
C. Stage 4 NREM sleep Stage 4 NREM sleep is the deepest stage of sleep. It is difficult to rouse the sleeper in this stage. During this stage sleepwalking and enuresis (bed-wetting) sometimes occur.
does not correlate with sleep stages, but with lying down. Lying down results in more blood returning to the heart, and makes congestive heart failure worse. Happens early in the night, called nocturnal dyspnea.
Congestive heart failure
the stresses on the heart from increased BP and pulse during REM sleep, and the increased levels of adrenal hormones, lead to early morning angina and heart attacks.
Coronary artery disease
Which statement made by the patient indicates a need for further teaching on sleep hygiene? A. "I'm going to do my exercises before I eat dinner." B. "I'm going to go to bed every night at about the same time." C. "I set my alarm to get up at the same time every morning." D. "I moved my computer to the bedroom so I could work before I go to sleep."
D. "I moved my computer to the bedroom so I could work before I go to sleep." This statement requires further teaching. Good sleep-hygiene practices state that the bedroom should only be used for sleeping. Work and study should not be done in the bedroom.
True or False Sleep needs are affected by the balance or lack of balance between physical activity, mental work, stimulation, and relaxation.
True.
