Chapter 27 PrepU: Somatic Symptom and Dissociative Disorders: Nursing Care of Persons with Somatization, Chapter 28 PrepU : Sleep Disorders: Nursing Care of Persons with Insomnia and Sleep Problems, Chapter 14 PrepU: Management of Anger, Aggression a...

Which of the following is a priority when caring for clients diagnosed with insomnia? a) Safety b) Mobility c) Nutrients d) Security

Safety Explanation: Safety is a priority for people with primary insomnia. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Nutrients, mobility, and security are not priorities in this client population.

A client has been diagnosed with somatic symptom disorder. The client's assessment reveals high levels of anxiety. Which would the nurse expect to be prescribed?

Selective serotonin reuptake inhibitors (SSRIs).

Somatic symptom disorder is characterized by what?

Severe physical symptoms unexplainable by any organic or physical pathology.

The client is a single mother studying broadcast journalism. The client works two part-time jobs in addition to school to cover family and educational expenses. Last night driving home from work the client drifted off the road and nearly had an accident. Luckily there was no harm, but the client realized the need to change a life factor, because the client is most likely suffering the negative consequences of:

Sleep deprivation.

The nurse is seeing a client who reports sleeping 8 or 9 hours per night but waking up feeling unrested. The nurse is interested in determining how much actual sleep the client is getting while the client is physically laying in bed in order to identify the underlying problem preventing quality sleep. What does the nurse need to help the client investigate further?

Sleep efficiency.

A client with narcolepsy tells the nurse that it often feels like he is being suffocated when he is falling asleep. He also says, "I get terrified because I can't seem to move." The nurse identifies this as which of the following? a) Hypersomnolence b) Cataplexy c) Sleep paralysis d) Hypnagogic hallucinations

Sleep paralysis Explanation: Sleep paralysis, the inability to move or speak when falling asleep or waking up, is often described as terrifying and is accompanied by a sensation of struggling to move or speak. Although the diaphragm is not involved, patients may also complain of not being able to breathe or feeling suffocated. These episodes are typically brief in duration and usually terminate spontaneously or when the individual is touched.Cataplexy is the bilateral loss of muscle tone triggered by a strong emotion, such as anger or laughter. This muscle atonia can range from subtle (drooping eyelids) to dramatic (buckling knees). Respiratory muscles are not affected. Hypnagogic hallucinations are intense dreamlike images that occur at sleep onset and usually involve the current environment.Hypersomnolence refers to excessive sleepiness.

Which of the following parasomnias occur primarily in children in the Non-REM stage and may result in emotional experiences that are frightening? a) Sleepwalking b) Sleep terrors c) Nightmares d) Confusional arousals

Sleep terrors Explanation: Sleep terrors occur primarily in children, and in the non-REM sleep stage resulting in frightening thoughts. Nightmares occur in the REM sleep stage.

The client has a somatic symptom illness. During individual therapy, the client yells at the nurse, "You are all quacks! Can't you see I am sick?" Which knowledge statement would help the nurse to work most effectively with this client?

Client progress is expected to be very slow.

When describing somatic symptom disorder to a group of nurses, which would the nurse include as a significant obstacle in providing psychiatric care for clients with that disorder?

Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented.

Assessment of a client reveals that the client has been inflicting illness on her daughter to gain the attention of medical personnel. The nurse identifies this as which of the following?

Factitious disorder imposed on another.

In which disorder is the individual motivated solely by the desire to become a health care client?

Factitious disorder.

Is the following statement true or false? - A patient with somatic symptom disorder often displays an altered mental status.

False. - Assessment of a patient with somatic symptom disorder usually will reveal that the patient's mental status is intact.

Is the following statement true or false? - In factitious disorder, the intentional production of symptoms is in others, usually children.

False. - In factitious disorder, physical or psychological symptoms (or both) are fabricated to assume the sick role. In factitious disorder imposed on another, the intentional production of symptoms is in others, usually children.

Is the following statement true or false? - Individuals with somatic symptom disorder experiences symptoms that remain consistent but increase in severity with time.

False. - With somatic symptom disorder, symptoms are changeable, diffuse, complex, and highly variable, often moving from one body system to another.

According to the Centers for Disease Control and Prevention, approximately what percentage of Americans sleep less than seven hours per night?

33%

A client asks the nurse, "What causes insomnia?" Which response by the nurse would be most appropriate?

"No one factor is associated with causing insomnia."

Pain Management

- Previously considered pain separate disorder - Identify strategies to relieve pain - Examine stressors in lives - Develop nonpharmacologic strategies - Complementary and alternative treatments - Relaxation techniques - Identifying thoughts and feelings about pain - Including family members

The family members of a client with somatic symptom illness report to the nurse that every time they invite the client to join in an activity the client declines, saying things like, "I wish I could, but I feel so terrible." Which approach should the nurse suggest to encourage activity?

"I know this is difficult, but exercise is important. It will be a short walk."

The nurse has been teaching a client ways to improve sleep patterns at home. The nurse evaluates teaching to have been effective when the client states which of the following?

"I need to take any caffeine-containing cold medicine no later than mid-afternoon."

A nursing instructor is teaching a class on sleep and rest to first year nursing students. The instructor realizes a need for further education when one of the students makes which statement? a) "Changes in sleep patterns may be a sign of other medical conditions." b) "Pain is a cause of sleep disturbance." c) "Sleep disturbance is part of normal aging." d) "Sleep disturbance can be caused by nocturia

"Sleep disturbance is part of normal aging." Explanation: Sleep disturbance is not a normal part of aging; this mistaken belief may be a barrier for clients to seek help for genuine problems. The other statements are true.

When discussing options for medications to aid sleep, the client asks the nurse why it would be beneficial to take a benzodiazipine receptor agonist. Select the nurse's best response.

"The body absorbs the medication quickly. You will be able to fall asleep faster."

Mental Health Nursing Interventions - Activity

- Activity Enhancement o Establish daily routine o Encourage exercise - Nutrition Regulation o May have special nutritional needs o Healthy versus junk food - Relaxation o Simple techniques, distraction, guided imagery

Evidence-based Nursing Care for Persons with Factitious Disorder - Nursing Interventions

- Be aware of anger and sense of betrayal due to fabrications and deceits of patient - All care should be centralized in one facility - Behavioral techniques - All teams need to communicate on regular basis - Family members need to be aware and included

Psychosocial Interventions - Reduction of Patient Anxiety about Illness

- Cognitive behavior therapy - Stress management - Group interventions - Antidepressants - Maintaining journal to monitor symptoms

Mental Health Nursing Assessment - Physical health assessment

- Discuss physical symptoms - Review of systems - Pain (most common symptom) - Physical functioning (Box 27.3) o Sleep o Fatigue o Activity o Sexual functioning - Medication assessment o Large number of medications used o Often overreact to medication o Self-medication with OTC and/or substance abuse o Provider shopping o Prescribed incorrect medication

Factitious Disorders - Etiology

- Experienced severe sexual abuse, trauma, and/or distress - Desperate attempt to receive love and attention - Fabricate detailed and exaggerated medical history - Once confronted with evidence of fabrication, become enraged and often leaves health care system - Usually consists of intermittent episodes

Psychosocial Interventions - Counseling

- Focus on problem solving - Improving problem-solving and decision-making skills

Psychosocial Interventions - Psychoeducation

- Health teaching - Emphasize positive health care practices - Focus on "staying healthy" not illness - Encourage "me" time

Mental Health Nursing Assessment - Strengths assessment

- Individual may have difficulty identifying any personal strengths - Focus on daily activities - Elicit motivation to feel better

Factitious Disorders - Clinical course and diagnostic criteria

- Injure self covertly - Trick health care provider into believing true physical or psychiatric disorder is present - Extremely creative - Pseudologia fantastica - Inflict injury on self - Put self in life-threatening situations through various actions - May manifest primarily psychiatric symptoms - Become psychotic, depressed, or suicidal - May have combination of both physical and psychiatric

Continuum of Care

- Inpatient care o Should have consistency of providers - Emergency care o May be for physical or stress responses related to psychosocial crisis oMay be suicidal - Community treatment o Spend lifetime in health care system with little continuity of care

Factitious Disorders

- Intentional injury (covertly) or illness to receive attention of health care workers - Motivation by desire to be a patient and develop dependent relationship - Two types: o Factitious disorder o Factitious disorder imposed on another inflicts injury on another for own attention - Originally called Münchausen's syndrome - Different from malingering

Somatization

- Manifestation of psychological distress as physical symptoms - Possibly resulting in functional changes, somatic descriptions, or both - Common in other psychiatric disorders - Historically linked to a woman's body, mind, or soul - Problems are not linked to uterus - Men are also affected by somatization - Crosses all cultures - Recognized in almost every society - In many cultures, expression of physical discomfort more acceptable than acknowledging psychological distress

Mental Health Nursing Assessment - Psychosocial assessment

- Mental status may be within normal limits - Intense focus on bodies and physical symptoms - Cognition may be distorted but not impaired - Compare thorough history of major psychological events with chronology of physical problems; especially sexual abuse or trauma - Mood: labile, shifting from extremely excited or anxious to depressed and hopeless Social network - Believe they are disabled, unable to work - Rarely satisfied with health care providers - Consists of series of health care providers, however, instead of family and friends Family issues - Chaotic with multiple problems - Other family members with psychiatric disorders - Disruption of family social life

Somatic Symptom Disorder (SSD) - Comorbidity

- Most common: depression, anxiety - Others: PTSD, panic disorder, social phobia, OCD, psychotic disorders, personality disorders - Older adults: higher risk for depression - Received treatment for IBS, polycystic ovary disease, chronic pain

Illness Anxiety Disorder

- New classification in DSM-5; formerly called hypochrondriasis (or hypochondria) - Most were also diagnosed with somatic symptom disorder - Some individuals either do not have somatic symptoms or have very mild symptoms, but are still preoccupied with having or developing a medical illness - Encouraged to seek mental health treatment for anxiety and preoccupation - History of serious childhood illness or family member has serious illness

Mental Health Nursing Interventions - Medication interventions

- None specially recommended - Treat comorbid conditions - Antidepressants: duloxetine (Box 27.5) - Anxiety: SSRIs, benzodiazepines; buspirone - Nonpharmacologic approaches: biofeedback, relaxation - Administering and Monitoring Medications - Ensure taking correctly - Avoid self-medicating - Managing Side Effects o Often have atypical reactions o Encourage patient to give enough time to be effective - Monitoring for Drug Interactions o Meds for physical problems versus psychiatric medications o Taking alternative medications o Encourage use of single pharmacy to better monitor medications

Somatic Symptom Disorder (SSD) - Diagnostic criteria

- One or more symptoms that cause persistent distress or significant disruption in daily lives for at least 6 months - Excessive thoughts about the seriousness of the symptoms, feelings, or behaviors related to the symptoms or health concerns - Symptoms may or may not be explained by medical evidence - Varies between populations

Somatic Symptom Disorder (SSD) - Family Responses to Disorder

- Physical symptoms of one becomes focus of family life - All activities planned around patient - Reduces family resources for other family members

Factitious Disorders - Epidemiology and Risk Factors

- Prevalence unknown - Age range: 19 to 64 years - Median age of onset: early 20s - Predominately women - No genetic pattern identified - Presence of comorbid psychiatric disorders - Health care professionals, nurses, pharmacists, physicians over-represented in occurrence

Factitious Disorder Imposed on Another

- Previously known as factitious disorder by proxy or Münchausen's by proxy - Individual inflicts injury on another person - Often mother inflicting injuries on her child - Most severe form of child abuse o Frequently results in child being removed from mother's care o Different other forms where health care workers are unwittingly involved in subjecting child to physical harm and emotional distress through tests, procedures and medication trials

Teamwork and Collaboration: Working Toward Recovery

- Providing long-term general management of the chronic condition - Treating symptoms of comorbid psychiatric and physical problems - Providing care in special settings, including group treatment and use of complementary and alternative medicine - The cornerstones are trust and believing

Evaluation and Treatment Outcomes

- Recovery outcomes for patients with SSD should be realistic - Small successes should be expected - Specific outcomes should be identified, such as gradually increasing social contact - Over time, a gradual reduction in the number of health care providers the individual contacts should occur, and a slight improvement in the ability to cope with stresses should follow

Conversion Disorder (Functional Neurologic Symptom Disorder)

- Severe emotional distress or unconscious conflict expressed through physical symptoms - Neurologic symptoms and sensory problems but test result is negative; symptoms "real" for the patient - Symptoms follow the person's own perceived conceptualization of the problem - Etiology: possible neurologic changes in the brain or childhood trauma - Nursing management: acknowledgment of symptoms, development of trusting therapeutic relationship, development of problem-solving approaches

Psychosocial Interventions

- Social relationships - Groups interventions - Family interventions - Wellness strategies

Somatic Symptom Disorder (SSD)

- Term somatoform no longer used in the DSM-5 Clinical Course - Difficult to manage - Symptoms tend to change, are diffuse and complex, vary and move from one body system to another - Symptoms may last for 6 to 9 months - Perceive self as "sicker than the sick" - Report all aspects of health as poor - Tend to "provider shop" - The most common characteristics are: o Reporting the same symptoms repeatedly o Receiving support from the environment that otherwise might not be forthcoming o Expressing concern about the physical problems inconsistent with the severity of the illness

A nurse working in a sleep laboratory is talking to patients about the importance of adequate sleep. The nurse informs them that the timing and patterns of sleep changes as people age. What does the nurse say is the normal amount of sleep needed for INFANTS? a) 10 to 12 hours b) 18 to 20 hours c) 14 to 15 hours d) 8 to 10 hours

14 to 15 hours Explanation: Infants normally spend more time each day asleep than awake. Their 14 to 15 hours of daily sleep usually consists of one or two naps and 10 to 12 hours of nighttime sleep.

After reviewing information about sleep patterns and changes occurring over the lifespan, a group of nursing students demonstrates understanding when they identify that NEWBORNS require how much sleep per day? a) 17 to 18 hours b) 13 to 14 hours c) 8 to 9 hours d) 11 to 12 hours

17 to 18 hours Explanation: Newborns need 17 to 18 hours of sleep each day, which occurs in 3- to 4-hour episodes throughout the day. By age 6 months, 12 hours of sleep at night and two 1- to 2-hour naps each day are needed. After age 5 years, children gradually need less sleep. Preadolescents need about 10 hours of sleep each night, and napping is rare. A teenager's sleep need is only slightly less, at about 9 hours. During young adulthood, about 8 hours of sleep is needed.

Which of the following individuals would be expected to have the highest risk of developing sleep apnea? a) A man with poorly controlled diabetes and hypertension b) A female with chronic insomnia and atrial fibrillation that is treated with warfarin c) A woman with restless leg syndrome and chronic obstructive pulmonary disease d) A male client with a diagnosis of unstable angina and peripheral vascular disease

A man with poorly controlled diabetes and hypertension Explanation: Male gender, diabetes and hypertension are all associated with sleep apnea. COPD, angina, PVD and atrial fibrillation are not noted to be strongly associated with sleep apnea.

Which of the following findings during sleep observations of clients in a sleep lab would be most likely to be considered pathologic? a) A man experiences periods of apnea of 5 to 15 seconds in duration b) A woman's intrinsic clock involves a sleep-wake cycle that is consistently two hours longer than the actual length of a day c) A woman spends the majority of her sleeping hours in REM sleep d) A man's PCO2 is increased and his PO2 decreased during deep sleep

A woman spends the majority of her sleeping hours in REM sleep Explanation: While vital, REM sleep does not normally occupy the majority of sleeping hours. Brief apneic spells are not uncommon and the circadian rhythm often does not match the 24-hour length of day. It is normal for PCO2 to increase and PO2 to decrease during deep sleep.

A physician is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for "sleeping pills" to help him through this time. Which of the following statements forms a valid basis for the physician's plan for treatment? a) Melatonin supplements will be the safest and most effective long term pharmacological treatment b) Behavioral therapies, counseling and education may be of some use for the client c) Sedatives and hypnotic drugs will not provide safe relief of the man's health problem d) The man is suffering from primary insomnia

Behavioral therapies, counseling and education may be of some use for the client Explanation: Behavioral therapies may be beneficial in the treatment of insomnia. Drugs may be of use in the short term and should be used judiciously rather than completely avoided. The efficacy of melatonin is unproven and his insomnia would likely be categorized as secondary insomnia, given the obvious contribution of stressors.

Somatic Symptom Disorder (SSD) - Etiology

Biologic theories - Possible biologic dysfunction common in depression and chronic fatigue syndrome - Genetic Psychological theories - Social or emotional communication - Interaction of cognitive (negative views) with physical factors (pain, discomfort) - Personality trait of alexithymia - Sexual abuse, rape, and domestic violence Social theories - Cultural expressions - Moral issues, not health - Physical manifestations not labeled psychiatric disorder

Somatic Symptom Disorder Across the Life-Span

Children - Usually not diagnosed until adolescence; linked to abuse - Headache, fatigue, nausea, and abdominal pain usually as common symptoms - Link between childhood sexual abuse and somatization, substance use, and depression in adults Older adults - Lifelong pattern of symptoms - Often unrecognized, overlooked, or minimized by health care providers as part of the normal aging process

When assessing a patient with somatic symptom disorder, which complaint would the nurse most likely expect to hear? A.Diarrhea B.Muscle weakness C.Menstrual irregularity D.Pain

D. - Although gastrointestinal, pseudoneurologic, and reproductive problems may be verbalized, pain is the most common complaint in patients with somatic symptom disorder.

A client who works the night shift reports an inability to sleep during the day. Which should the nurse suggest to help this client sleep?

Darken the room when planning to sleep.

A client comes to the clinic reporting insomnia that began with depression that was diagnosed about 2 months ago. The client informs the nurse that she goes to bed at the same time each night, drinks a glass of warn milk prior to bedtime, and mediates for 20 minutes before turning out the lights. What does the nurse suspect is the cause of this client's insomnia?

Depression.

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder?

Develop a sound, positive nurse-client relationship.

In planning care for clients with a somatic symptom disorder, an appropriate long-term outcome for treatment would be that the client will ...

Develop alternative coping mechanisms.

A client has been prescribed zolpidem for insomnia disorder. What common side effect should be included in the medication teaching for this client?

Drowsiness.

Somatic Symptom Disorder (SSD) - Epidemiology & Risk Factors

Epidemiology: - The estimated prevalence ranges from 5% to 7% - Age of Onset: usually before age 30 years, first symptoms in adolescence - Gender, Ethnic, Cultural Differences: Primarily nonwhite, less educated women Risk factors: - Familial tendency - Sexual trauma exposure

Mental Health Nursing Interventions

Establishing Recovery and Wellness Goals - Define short-term recovery goals - Focus on what patient believes is realistic and possible - Learn triggers Physical Health Interventions - Conservative medical treatment - Avoid aggressive pharmacologic treatment - Use of pain management, activity enhancement, nutrition regulation, relaxation, pharmacologic interventions

Which of the following is the primary symptom to occur in narcolepsy?

Excessive sleepiness.

Which of the following characteristics differentiates functional neurologic symptom disorder from malingering disorder?

Functional neurologic symptom disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

Which of the following observations of a female client in a sleep lab would indicate to clinicians that she is in REM sleep? a) She has a low level of cerebral activity and her EEG indicates low voltage and mixed frequencies. b) Delta waves are evident on her EEG and heart and respiration rates are slowed. c) Rolling eye movements are observed and she has moderate muscle activity. d) Her motor movements are suppressed and muscle tone is flaccid.

Her motor movements are suppressed and muscle tone is flaccid. Explanation: REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves and low levels of cerebral activity are associated with stages 1 through 4 of sleep.

A client is seen in the primary care clinic reporting headaches. The client appears extremely distressed and insists that the client must have a brain tumor. Which mental health diagnosis is most probable for this client?

Illness anxiety disorder.

Which statement accurately describes how somatic symptoms are distinguished from factitious disorders and malingering?

In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms.

A nurse preceptor working in a sleep clinic informs a graduate that the most common sleep disorder in adults is which of the following? a) Sleep-related breathing disorder b) Insomnia c) Parasomnias d) Sleep-related movement disorders

Insomnia Explanation: Insomnia, which is a perception of insufficient sleep or not feeling rested after habitual sleep, is the most common sleep disorder in adults.

After teaching a group of nursing students about sleep-wake disorders, the instructor determines that the education was successful when the students identify which of the following as the most prevalent disorder? a) Insomnia b) Obstructive sleep apnea syndrome c) Parasomnia d) Narcolepsy

Insomnia Explanation: Of all the sleep-wake disorders and sleep-related problems, insomnia is the most prevalent.

The nurse is assisting a client in understanding the drawback of using benzodiazepine receptor agonists (BzRAs) to promote sleep. Which drawback is the most important to inform the client about?

It is possible to develop a dependence on the medication.

Which type of circadian rhythm sleep disorder occurs across time zones? a) Delayed sleep type b) Advanced sleep phase type c) Shift type work d) Jet lag type

Jet lag type Explanation: Jet lag occurs after travel across time zones, particularly in coast-to-coast and international travel. Individuals with delayed sleep phase type or "night owls" tend to be unable to fall asleep between 2 and 6 AM; hence, their whole sleep patterns shift, and they have difficulty rising in the morning. The endogenous sleep-wake cycle is normal but is mismatched to the imposed hours of shift work. In advanced sleep phase type, the opposite of the night owls occurs. These individuals are "larks" or earlier risers. They are unable to stay awake in the evening and consistently wake up early.

A nursing student has learned that the sleep-wake cycle is partially regulated by which of the following hormones? a) Estrogen b) Melatonin c) Cortisol d) Cholecystokinin

Melatonin Explanation: Melatonin, a hormone released from the pineal gland, aids in the regulation of the sleep-wake cycle

Evidence-based Nursing Care for Persons with Factitious Disorder

Mental Health Nursing Assessment - History of medical and psychological illnesses - Identify physical disabilities - Early childhood experiences - Family assessment Priority of Care - Consequences of self-injury - High risk for self-abuse - Decrease self-injurious behavior - Positive coping behaviors

Factitious disorder imposed on another is commonly inflicted by which family member upon a child?

Mother.

A nurse is reading a journal article about sleep-wake disorders. The article mentions a REM disorder. Which of the following would the nurse expect to be discussed? a) Sleep walking b) Nightmare disorder c) Restless leg syndrome d) Sleep terrors

Nightmare disorder Explanation: Nightmare disorder is a rapid eye movement (REM) disorder that generally occurs during the second half of the major sleep episode. Non-rapid eye movement (NREM) sleep arousal disorders, including sleepwalking and sleep terror types, usually occur the first third of the major sleep episode. Restless legs syndrome is considered a sleep disorder and is classified as a parasomnia.

A client with a somatic symptom illness asks what is causing the physical symptoms. Which would be the appropriate explanation for the nurse to offer?

Physical symptoms are an involuntary way of dealing with psychic conflict.

A client complains of sleepiness during the day and occasional slight memory lapses. During the assessment, his wife states she is bothered by his snoring, especially when he is sleeping on his back. She often rolls him over in his sleep. The nurse suspects the client has ... a) sleep deprivation b) parasomnia c) narcolepsy d) obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome.

After educating a group of nursing students on somatic symptom disorder, the instructor determines that the education was successful when the group identifies which of the following as the most common problem?

Pain

Evidence-Based Mental Health Nursing Care

Priority of Nursing Care - Physical issues - Depression and suicidal behavior - Social isolation Development of a Therapeutic Relationship - Requires time and patience - Very important to break cycle of provider shopping - Refocus patient on psychosocial problems related to physical manifestations

Sleep disturbances may be caused by multiple factors. Which of the following is not a common contributor to sleep disturbances? a) Prolonged periods of wakefulness b) Length of daylight hours between winter and summer months c) Working the occasional night shift d) Rapid geographical relocation across several time zones

Prolonged periods of wakefulness Explanation: Homeostasis is the coordinated physiological processes that maintain most steady states in an organism. The need for sleep increases as the time awake increases. Prolonged periods of wakefulness result in decreased alertness, increased sleepiness, and greater amounts of slow-wave (NREM stage 4) sleep. But once sleep occurs, homeostasis is accomplished and the accumulated "sleep debt" is replenished. The client awakes feeling rested.

A client is telling a nurse about a dream that was beautiful, as if the client was actually in a garden with vivid colors and bright flowers. The client was in which stage of sleep during this dream? a) REM b) N3 c) N2 d) N1

REM Explanation: REM sleep is the stage when dreams have vivid content, full color, and sounds. The person is difficult to wake at this stage.

A client visiting the sleep clinic participates in a sleep study and is diagnosed with obstructive sleep apnea. What does the nurse explain as the cause of this disorder?

Repetitive episodes of reduced airflow. Explanation: Obstructive sleep apnea is associated with repetitive episodes of reduced airflow or cessation of airflow resulting from collapse of the upper airway.

When assessing a client with somatic symptom disorder, which would the nurse most likely note?

Reports of physical symptoms do not have a demonstrable organic basis to fully account for them.

When describing the stages of sleep, which of the following would the nurse identify as the deepest state of sleep? a) Slow-wave sleep b) NREM sleep stage 2 c) REM sleep d) NREM sleep stage 1

Slow-wave sleep Explanation: Slow-wave sleep, or the deepest state of sleep, characterizes stages 3 and 4 of NREM sleep. Light sleep characterizes NREM sleep stage 1 and 2. REM sleep is a deep sleep but the brain is active.

What body function is responsible for the control of the circadian clock with input of light-dark awareness? a) Suprachiasmatic nucleus (SCN) b) Thalamus c) Visual stimulation d) The rotation of the moon

Suprachiasmatic nucleus (SCN) Explanation: The SCN is responsible for the control of the circadian clock through receiving lights-dark input from the retina. Visual stimulation is involved, but the SCN seems to be the control center. While the suprachiasmatic nucleus is part of the hypothalmus, the thalamus is not involved.

When describing the course of illness associated with somatic symptom disorder, which would the nurse include?

The client will report going to many different providers without satisfaction.

Which of the following statements about somatic symptom disorder is most accurate?

The disorder manifests differently in different populations.

Which statement about the etiology of somatic symptom disorder is accurate?

The exact etiology is unknown.

A person with advanced sleep phase syndrome (ASPS) would experience which symptoms? a) Trouble staying awake in the evening and waking up in the morning feeling rested. b) Difficulty falling asleep at night and awakening in the morning. c) Trouble staying awake and falling asleep at inappropriate times. d) Sleeping 10 to 12 hours per day and awakening with feelings of sadness.

Trouble staying awake in the evening and waking up in the morning feeling rested. Explanation: With ASPS a person has trouble staying awake in the evening, goes to bed early and wakes up in the morning feeling rested. Falling asleep at inappropriate times is more related to narcolepsy, and waking up feeling sadness is most related to depression. Trouble going to sleep and trouble waking in the morning is related to delayed sleep phase syndrome.

Psychosomatic

Used to describe, explain, and predict the psychological origins of illness and disease

Narcolepsy, a disorder characterized by excessive daytime sleepiness and cataplexy (sudden bilateral loss of postural muscle tone), is effectively treated with ... a) SSRIs. b) administration of methylphenidate (Ritalin). c) behavior modification techniques. d) discouraging daytime napping.

b) administration of methylphenidate (Ritalin).

A client complains of sleepiness during the day and occasional slight memory lapses. During the assessment, his wife states she is bothered by his snoring, especially when he is sleeping on his back. She often rolls him over in his sleep. The nurse suspects the client has ... a) narcolepsy b) parasomnia c) sleep deprivation d) obstructive sleep apnea syndrome

obstructive sleep apnea syndrome Explanation: Clients with OSA experience sleep disruption and excessive daytime sleepiness. They typically snore loudly and gasp or choke during sleep, which is more severe when they lie supine. They may be unaware that they have apnea or hypopnea or that they snore during sleep. They are at risk for lapses in memory, slowed reaction time, and falling asleep while working, operating machinery, or driving a motor vehicle.

A nursing instructor is teaching about the importance of sleep for all body systems. What does the instructor identify as types of sleep deprivation? (Select all that apply.) a) Chronic b) Partial c) Indirect d) Complete e) Acute

• Acute • Chronic • Partial • Complete Explanation: Sleep deprivation may be acute or chronic and partial or complete.

A client with insomnia is prescribed a melatonin receptor agonist. When teaching the client about this drug, the nurse would incorporate which of the following as an effect of melatonin? Select all that apply. a) Increases alertness b) Maintains reproductive rhythm c) Decreases body temperature d) Shifts circadian rhythm e) Enhances immune function

• Decreases body temperature • Enhances immune function • Shifts circadian rhythm Explanation: Melatonin has been shown to shift circadian rhythm, decrease body temperature, alter reproductive rhythm, enhance immune function, and decrease alertness. Normally, levels of melatonin increase with decreasing exposure to light.

After teaching a class about circadian rhythm disorders, a nursing instructor determines that the teaching was successful when the class identifies which of the following as a subtype? Select all that apply. a) Delayed sleep phase b) Shift work c) Jet lag d) Nightmare e) Sleep terror

• Delayed sleep phase • Jet lag • Shift work Explanation: Subtypes of circadian rhythm disorders include a delayed sleep phase, jet lag type, and shift work type. Nightmare and sleep terror are separate disorders.

A nurse working in a sleep clinic is speaking to a group of young and middle adults. The nurse informs them that research shows which of the following to be known causes that contribute to sleep problems in their age group? (Select all that apply.) a) Minimum noise level b) Family stress c) Academic pressure d) Negative life events e) Positive life events

• Family stress • Positive life events • Negative life events • Academic pressure Explanation: Family stress, positive and negative life events, and academic pressure may contribute to sleep problems in this age group. Minimum noise level is not a factor in this age group.

A nursing instructor is teaching about changes in older adults and lists which of the following seen in relation to their sleep? (Select all that apply.) a) Flattened circadian rhythm b) Insomnia c) Advanced sleep phase syndrome d) Increased total time for sleep e) Absence of naps

• Flattened circadian rhythm • Advanced sleep phase syndrome • Insomnia Explanation: Older adults experience a flattened circadian rhythm and a decrease in total time of sleep. They experience advanced sleep phase syndrome, which involves falling asleep early in the evening and waking early in the morning. Insomnia is very common in older adults. Napping also is common among older adults and may result in decreased nocturnal sleep.

A nurse is reading a journal article about children and somatic symptom disorder. Which of the following would the nurse expect to find as the most common symptoms reported by children with this disorder? Select all that apply.

• Headache • Abdominal pain • Fatigue • Nausea

When doing a report on sleep apnea to present to a nursing class, a first-year student learns that certain ethnic groups are at increased risk for sleep apnea. Which groups are included? (Select all that apply.) a) American Indian b) Asian American c) African American d) Greek American e) Latino

• Latino • African American • Asian American Explanation: Latino, African, and Asian Americans may all be at a greater risk for certain sleep disorders such as sleep apnea.

A patient reporting sleep deprivation has been told to reduce caffeine consumption. Which of the following does the nurse tell the patient contains caffeine? (Select all that apply.) a) Over-the-counter cold preparations b) Cola c) Chocolate d) Coffee e) Fruit juices

• Over-the-counter cold preparations • Cola • Chocolate • Coffee Explanation: Caffeine-containing beverages include coffee, tea, cola, chocolate, and some noncola drinks. OTC cold preparations also contain caffeine.

A nurse working in a sleep laboratory is talking to a patient being evaluated for a sleep disorder. The nurse identifies which of the following as a result of sleep deprivation? (Select all that apply.) a) Development of diabetes b) Enhanced work performance c) Problems with memory d) Problems with decision making e) Injuries

• Problems with memory • Problems with decision making • Injuries • Development of diabetes Explanation: Sleep deprivation has been linked with problems with memory, learning, and decision making; poor work performance; injuries; and other negative consequences. Evidence also suggests that sleep deprivation can lead to diabetes and cardiovascular disorders.