Chapter 17: Sleep and Sleep-Wake Disorders
A nurse discusses sleep-promoting strategies with a client who reports insomnia. Which strategy would the nurse suggest?
"Get out of the bed. Do something else for a while, and then return to bed."
A nurse is discussing good sleep habits with an older adult. Which statement made by the client tells the nurse that further instruction is necessary?
"I will stay up later to make sure that I am very tired.
A parent brings a 10-year-old child to the clinic because of sleepwalking at least two to three times per week. The parent is very concerned and asks the nurse what should be done when the child is found to be sleepwalking. What is the nurse's best response?
"Make sure the environment is safe and place bolts on doors and windows."
A nurse is obtaining a client's sleep history. The client asks about obtaining a prescription for melatonin. What is the nurse's best response?
"Melatonin is available without a prescription, but speak to your health care provider about it."
A public health nurse is conducting an education session for new parents. Which statement by a participant about a child's sleep patterns most warrants further assessment?
"My daughter is 8 months old now, but she's still only awake a few hours a day."
The nurse is caring for a client who reports, "My legs just won't rest. I can't stop moving them!" Which statement is an appropriate response by the nurse?
"That must be annoying. Sometimes getting up and walking for a while helps."
A parent of a 14-year-old teen expresses concern over the late hours the teen keeps. Which response by the nurse best explains a possible etiology for the late hours?
"The onset of puberty often lengthens the circadian rhythm, causing an increase in evening wakefulness."
A nurse is discussing the use of naso-oral continuous positive airway pressure (NCPAP) with a client. What is the nurse's most appropriate response when the client asks what the purpose of this equipment is?
"This device will generate a positive pressure that will promote your taking a breath."
A nurse understands that promoting periods of uninterrupted sleep for clients is important because sleep performs which functions? Select all that apply.
-Allows the body systems to restore their energy and repair their tissues -Provides time for entering information that has been acquired into memory -Restores mental and physical functioning
The nurse is caring for a client in the intensive care unit who has been unable to sleep well for days. Which symptoms may be associated with sleep deprivation? Select all that apply.
-Anxiety -Irritability -Inability to concentrate
Which medications may cause sleep disturbance? Select all that apply.
-Decongestants -Bronchodilators -Corticosteroids
A nurse is discussing sleep hygiene with a client who reports having chronic insomnia. Which are appropriate recommendations? Select all that apply.
-Establish a regular wakeup time. -Maintain a quiet sleep environment that is neither too cold nor too hot. -Avoid caffeinated beverages.
A nurse has a client who is undergoing a sleep laboratory study. Which event would the nurse expect to be measured? Select all that apply.
-Eye movement -Muscle movement -Heart rate -Oxygen level
A nurse has just returned to her home on the East Coast of the United States after attending a nursing conference on the West Coast. Which symptoms are related to circadian rhythm and may be experienced by the nurse? Select all that apply.
-Insomnia -Daytime sleepiness -Decreased alertness and performance
A nurse practitioner is conducting a "Stay Healthy" seminar for nurses and is covering the need for adequate sleep time and quality of sleep. During the presentation, which interventions may help support sleeping during the day for those who work nights? Select all that apply.
-Room-darkening window shades -Going to sleep around 12:00 pm -An eye mask
A nurse is treating a client who has been diagnosed with mild obstructive sleep apnea. Which of these are behavioral treatment measures for this disorder? Select all that apply.
-Weight loss -Avoidance of alcohol -Proper bed position
A nurse is planning follow-up care for a client with obstructive sleep apnea (OSA). Which assessment(s) will the nurse perform, related to the complications of OSA? Select all that apply.
-blood pressure -history of traffic accidents -blood tests for polycythemia -depression screening
Place the following characteristics of stages of sleep in the order they occur when a client progresses from stage 1 to stage 4 sleep, with rapid eye movement (REM) sleep occurring after stage 4. Use all options.
1) During this stage, people can be easily aroused. 2) This stage lasts approximately 10 to 25 minutes, during which EEG activity includes predominantly theta waves. 3) This stage lasts only a few minutes, leading to deeper sleep. 4) The deepest sleep occurs during this stage. 5) The brain is highly active with vivid dreams occurring.
A nurse is caring for a client who is 2 days postpartum. The client asks the nurse how many hours of the day she should expect her infant to sleep. What is the most appropriate answer?
16-20 hours
The multiple sleep latency test (MSLT) is a diagnostic sleep study used to evaluate daytime sleepiness. Which result of an MSLT would be considered abnormal?
6 minutes
At what age is an infant typically able to sleep through the night and have consistent nap times?
9 months
What is the length of time a client undergoes a complete sleep cycle?
90-110 minutes
The nurse is caring for a group of assigned clients. Which client is at most risk for the development of obstructive sleep apnea (OSA)?
A male client who is obese with hypertension and a neck circumference of 44 cm
The nurse is caring for a group of clients in the hospital. Which client is at most risk for obstructive sleep apnea?
A male client with a neck circumference of 44 having a laparoscopic cholecystectomy
One of the stages of sleep is the rapid eye movement, or REM, stage. What is it that the brain cannot do during REM sleep?
Acquire new sensory information
A nurse is preparing a client for a procedure that will measure muscle motion, which helps determine sleep duration and efficiency. The nurse will be teaching the client about the device, as the procedure will be performed while the client is at home. Which procedure is the nurse going to be teaching about?
Actigraphy
A nurse has an 80-year-old female client who states she is tired and ready to sleep at 7:00 PM each night and is ready to rise at 4:00 AM each morning. Which symptom is the client exhibiting?
Advanced sleep phase syndrome
An older adult client is unable to stay awake past 7:30 pm and gets up every morning at 4:30 am. Which disorder does the nurse see that the sleep pattern may indicate?
Advanced sleep phase syndrome
A nurse is performing an intake assessment for a client admitted to the hospital with hypertension. The client informs the nurse that she drinks alcohol in the evening to help her sleep. What does the nurse know about the induction of sleep through alcohol intake?
Alcohol induces sleep initially and disrupts and fragments sleep.
A nurse is caring for the following clients. Which client should the nurse evaluate first?
An 18-year-old male who appears to be sleepwalking in the hallway
A physician is providing care for a 40-year-old client who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The client is requesting a prescription for "sleeping pills." Which statement forms a valid basis for the care provider's plan for treatment?
Behavioral therapies, counseling, and education may be of some use for the client.
A nurse sees that a client who is undergoing a sleep study has a device on his wrist. What is the device measuring?
Body movements
A nurse is caring for a client who has severe arthritis with associated pain. The client reports symptoms of depression, fatigue, and an inability to sleep. The nurse suspects a diagnosis of:
Chronic insomnia
Following several months of sleep difficulties, a client has undergone testing and has been diagnosed with primary insomnia. The nurse should teach the client about what characteristic of this diagnosis?
Clinicians were unable to identify a plausible psychological or physiologic cause for the client's insomnia.
A nurse is obtaining a sleep history from a 19-year-old college student. The student states, "I sleep through my 8 AM class more often than not. I just can't seem to wake up at that early hour." The nurse suspects that the student is experiencing:
Delayed sleep phase syndrome (DSPS)
A parent brings a 15-year-old adolescent into the clinic, stating "I cannot wake him up in the morning. He has been late for school several times and I do not know what to do any longer." Which sleep syndrome is the nurse aware is common in adolescents?
Delayed sleep phase syndrome (DSPS)
A client with symptoms of restless legs syndrome (RLS) unrelated to iron deficiency is placed on medication for treatment. Which type of first-line medication would the nurse anticipate using?
Dopaminergic agents
A nurse is caring for a client undergoing a multiple sleep latency test (MSLT). What is the purpose of this test?
Evaluate daytime sleepiness.
A client states that she has been experiencing insomnia for several weeks and that the situation is getting worse. The client states that she will likely require prescription medications to help her sleep. Which principle will guide the primary care provider's plan of care?
Hypnotic medications should only be used on a short-term basis.
When caring for a client with diagnosed obstructive sleep apnea, for what priority nursing assessment should the nurse be monitoring
Impaired airway
A nurse observes clusters of rapid eye movements (REMs) in a sleeping client. Additional characteristics of the sleep cycle that this client is experiencing include:
Increased cerebral activity
A parent informs the nurse that their family was on vacation, staying in a hotel, and woke up to the sound of a knock at the door. When they opened the door, their 8-year-old child was standing at the door not knowing where he was. This was not the first occurrence of sleepwalking for this child. Which objective should be the priority concern?
Injury during an episode of sleepwalking
The nurse is discussing a 6-year-old pediatric client's sleep characteristics with the child's mother. The mother states that her child sometimes awakens her with fits of crying and appears to be very frightened. The mother asks the nurse what she should do when this happens. What is the most appropriate direction from the nurse?
Instruct the mother to help the child settle without trying to awaken the child.
A nurse is caring for a client who experiences a compelling urge to move limbs during the evening or night, with the condition worsening at rest and inactivity. Which supplement can the nurse anticipate administering to this client?
Iron
A nurse is caring for a client diagnosed with Alzheimer disease who sleeps at irregular intervals, having no consistent sleep-wake cycle. The nurse suspects that the client is experiencing:
Irregular sleep-wake rhythm
A client is being seen by a primary care physician for sleep difficulties. The client is a nurse and works rotating shifts, is complaining of insomnia, and asks the nurse if melatonin would help. What would be the most accurate response about melatonin?
It is thought to be safe, but research is lacking.
The nurse has a client who appears to be sleepwalking. Which intervention would be most appropriate for the nurse?
Lead the client back to bed.
The client states having periods of being "unaware of surroundings" and "falling asleep during the day." The client is scheduled for an electroencephalogram (EEG) to determine if there is seizure activity or a sleep disturbance. What will the nurse teach the client about the purpose of the EEG?
Measuring the combined activity among neurons to a given stimulus
A nurse is caring for a client who weighs 325 pounds. The client's spouse reports that the client snores loudly and stops breathing frequently when sleeping. For which possibly related symptom will the nurse assess?
Morning headaches
A young adult client comes to the clinic reporting that he is extremely sleepy during the day with memory lapses, even when going to bed early, waking up several times during the night, and brief periods of muscle weakness. Which syndrome do these manifestations indicate?
Narcolepsy
The spouse of a blind client calls the nurse practitioner to ask what is causing the client such a difficult time sleeping and what can be done. What might the client be suffering from, and which would be the most accurate response?
Non-24 hour sleep-wake syndrome; regulate wake and sleep times.
A person who has a lack of synchronization between internal sleep-wake rhythms and the external 24-hour day may be experiencing which type of circadian rhythm disorder?
Non-24-hour sleep-wake syndrome
A client who has idiopathic right-sided heart failure is admitted to the cardiac intensive care unit after experiencing frequent episodes of fatigue and depression over the past month. The physician orders a sleep study to rule out obstructive sleep apnea (OSA). What does the physician explain is the reason for the test?
OSA can increase pulmonary pressures.
A client with a history of snoring and tiredness in the morning would most likely be diagnosed with which type of apnea?
Obstructive sleep apnea
A nurse is taking a sleep history of a client who reports daytime tiredness. The client's wife reports that the client moves his large toes during sleep. This sleep-related movement disorder is termed:
Periodic limb movements disorder (PLMD)
A client states that she falls asleep and feels like she is flying but cannot move. Which phase of sleep does the nurse recognize the client is in?
REM
The nurse practitioner is examining a client who delivered a healthy baby 2 weeks prior to the visit. The client is complaining of severe mood swings, anxiety, and just feeling down overall. The nurse practitioner asks the client about frequency and duration of sleep disturbances in an effort to determine interruption in which sleep stage?
REM
In which stage of sleep does dreaming occur most frequently?
Rapid eye movement sleep
Sleepwalking can occur in both adults and children. Typically, what does someone who is sleepwalking do?
Refuse to respond to communication efforts of other people
What is the priority nursing concern for a client who reports sleepwalking?
Risk for injury
In order to best treat transient insomnia, it is suggested that the client adopt which sleep habit?
Setting up a normal bedtime and wake-up time.
A nurse is caring for a client who reports a terrifying experience of being unable to move, speak, or take a deep breath upon awakening. What has the client likely experienced?
Sleep paralysis
A parent brings a 6-year-old child in for a wellness checkup and tells the nurse that the child sometimes wakes up screaming at night. When the parent goes to check on the child, the parent observes the child "sitting up in bed, screaming, sweating, and breathing rapidly." The nurse knows that these symptoms may indicate:
Sleep terrors
Which parasomnia occurs primarily in children in the non-REM stage and may result in emotional experiences that are frightening
Sleep terrors
Which parasomnia occurs primarily in children in the non-REM stage and may result in emotional experiences that are frightening?
Sleep terrors
A nurse enters a client's room to administer medications and finds the client resting in bed with eyes closed. The nurse checks the client's name bracelet and calls the client by name. The client arouses easily and states, "I must have dozed off." Which stage of sleep does the nurse recognize this client was in?
Stage 1
A nurse observes a client jerk suddenly while appearing to be asleep. The nurse had assessed the client just 10 minutes prior to this observation, and at that time the client was awake and oriented. The nurse suspects that the client is in which sleep phase?
Stage 1
A nurse is caring for a client who has been diagnosed with chronic insomnia. Which behavioral therapies would focus on reassociating the bed and the bedroom with sleep rather than sleeplessness.
Stimulus control therapy
What body function is responsible for the control of the circadian clock with input of light-dark awareness?
Suprachiasmatic nucleus (SCN)
Restless legs syndrome (RLS) is a disorder that has its peak onset in middle age. Diagnosis of RLS is based on a history of what?
Symptoms that become worse in the evening
A client is suspected of having narcolepsy. Which aspect of the client's medical history and sleep analysis would contribute to a confirmation of the diagnosis?
The client states that she has frequently awakened unable to move or speak.
A person with advanced sleep phase syndrome (ASPS) would likely display which symptoms?
Trouble staying awake in the evening and waking up early in the morning feeling rested
Actigraphy can be used to diagnose sleep disturbances. The actigraph is worn on the wrist and is used most commonly with:
a sleep diary.
The nurse is caring for a client who has been diagnosed with narcolepsy. The client reports that his muscles become extremely weak when he becomes excited. The nurse understands that the client is describing which of the following?
cataplexy
People diagnosed with restless legs syndrome (RLS) should be assessed for which coexisting condition?
iron deficiency
A 60-year-old male reports that he is always tired. No matter how much he sleeps, he does not feel rested. His wife also states that he is a terrible snorer, and she is not getting any sleep either. The client's health problem can best be diagnosed by:
polysomnography.
A client is undergoing overnight testing at a sleep clinic. The client's diagnostic testing includes an electro-oculogram (EOG) and electromyelogram (EMG). Evaluation of the findings from these diagnostic tests will allow the care team to determine:
the quantity of the client's REM sleep.
