Chapter 31 Sleep

26.Which of the following bedtime snack(s) helps to promote sleep in a patient? a. Cereal and milk b. A full meal c. Chips and cola d. Coffee and toast

ANS: A A bedtime snack containing protein and carbohydrates such as cereal and milk or cheese and crackers, which contain L-tryptophan, may help to promote sleep. A full meal before bedtime often causes gastrointestinal upset and interferes with the ability to fall asleep. Coffee, tea, cola, and chocolate cause a person to stay awake or wake up throughout the night. PTS:1DIF:Cognitive Level: Applying (Application) REF: 863 OBJ: Identify factors that promote or disrupt sleep. TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

27.A patient arrives at the ambulatory clinic for a routine physical. The nurse inquires about the patient's sleep pattern. The patient has a history of sleep pattern disturbances. The nurse evaluates that the patient is sleeping better when he or she states which of the following? a. "I don't take melatonin as frequently." b. "I increased my alcohol consumption before bedtime." c. "I decreased my activity level." d. "I take more daytime power naps."

ANS: A Melatonin is a neurohormone produced in the brain that helps control circadian rhythms. It is a popular nutritional supplement in the United States used to aid sleep. The recommended dose is 0.3 to 1 mg taken 2 hours before bedtime. Alcohol interrupts sleep cycles and reduces the amount of deep sleep. Early morning and late afternoon napping interferes with sleeping. Exercise is beneficial to improve nighttime sleep. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF: 863 OBJ: Describe ways to evaluate the effectiveness of sleep therapies. TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

9.A 57-year-old patient is concerned about the inability to fall/stay asleep at night. This started about 3 months ago. The nurse asks about recent changes in lifestyle and activities of daily living. Which of the following changes is probably most responsible for the change in sleeping pattern? a. Changing to a later evening mealtime b. Using blackout blinds c. Exercising 3 hours before bed time d. Buying a new support mattress

ANS: A Alterations in routine that disrupt sleep patterns include performing unaccustomed heavy work or exercise, engaging in late-night social activities, and changing evening mealtime. Eating a large, heavy, and/or spicy meal within 3 to 4 hours of bedtime sometimes results in indigestion that interferes with sleep. The physical environment in which a person sleeps has a significant influence on the ability to fall and remain asleep. Exercising 2 or more hours (patient exercised 3 hours) before bedtime allows time for the body to cool and maintain a state of fatigue that promotes relaxation. A new support mattress will promote relaxation and sleep. Proper ventilation, a comfortable temperature, and a darkened (blackout blinds) or softly lit room are essential for restful sleep. PTS:1DIF:Cognitive Level: Applying (Application) REF: 852 OBJ: Identify factors that promote or disrupt sleep. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

24.The nurse encourages a postoperative patient to get adequate amounts of sleep after discharge from the health care facility. When the patient asks why, how should the nurse respond? a. Sleep restores biological processes. b. Sleep stimulates appetite on waking. c. Sleep causes a mental and physiological calm. d. Sleep produces dreams that decrease epinephrine.

ANS: A Because the patient is postoperative, the primary reason for sleep it to help the body to heal by restoring biological processes. Sleep allows the body to restore biological processes. During deep slow-wave (NREM stage 4) sleep, the body releases human growth hormone for the repair and renewal of epithelial and specialized cells such as brain cells. Protein synthesis and cell division for the renewal of tissues also occur during rest and sleep. The basal metabolic rate is lowered during sleep, which conserves the body's energy supply. REM sleep is important for cognitive restoration. During REM sleep patients experience rapid eye movement, fluctuation in heart and respiratory rate, increased/fluctuating blood pressure, loss of skeletal muscle tone, and increase in gastric secretions. (This is not a mental and physical calm.) During REM sleep there is increased oxygen consumption and epinephrine is released, not decreased. Sleep does not cause an increase in appetite as the metabolic rate slows down. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:849OBJ:Explain the functions of sleep. TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

15.A patient recently came to the clinic with complaints of having difficulty sleeping. After the primary health care provider assesses the patient the nurse instructs the patient and partner on how to keep a sleep-wake diary. Entries in the diary often include _____ of sleep-wake activities. a. 24 hours b. 72 hours c. 1 to 2 weeks d. 7 to 9 hours

ANS: A Entries in the diary often include 24-hour information on waking and sleeping activities such as exercise, work activities, mealtimes, and alcohol and caffeine intake. They should also include time and length of daytime naps, evening and bed routines, the time the patient tries to fall asleep, time and number of awakenings, and the time of morning awakening. 72 and 1 to 2 weeks are too long, whereas 7 to 9 hours is not long enough. PTS:1DIF:Cognitive Level: Applying (Application) REF:856OBJ:Conduct a sleep history. TOP:Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

14.A nurse is admitting a patient to the hospital. The patient admits to a history of sleep problem. Which of the following questions will help the nurse understand the severity of the patient's sleep problem? a. "How long does it take you to fall asleep?" b. "Tell me why you think you have a sleep problem." c. "Have you been told that you snore loudly?" d. "When did you notice the problem?"

ANS: A Severity questions include: How long does it take you to fall asleep? How often during the week do you have trouble falling asleep or staying asleep? Nature of the problem question includes: Tell me what type of problem you have with your sleep. Signs and symptoms question includes: Have you been told that you snore loudly? Onset and duration question includes: When did you notice the problem? PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:856OBJ:Conduct a sleep history. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

1.A nurse is caring for a patient who suffers from a sleep pattern disturbance. To promote adequate sleep, what are the most appropriate nursing interventions? (Select all that apply.) a. Straighten and change any soiled bed linens. b. Synchronize the medication, treatment, and vital signs schedule. c. Provide personal hygiene before bedtime. d. Discuss with the patient the benefits of beginning a long-term nighttime medication regimen. e. Assist the patient to use the toilet before bed.

ANS: A, B, C, E You will make the patient more comfortable in an acute care setting by providing personal hygiene before bedtime. A warm bath or shower is very relaxing. Offer patients restricted to bed the opportunity to wash their face and hands. Tooth brushing and care of dentures also help to prepare the patient for sleep. Have patients void before going to bed so they are not kept awake by a full bladder. While a patient prepares for bed, help to position the patient off any potential pressure sites. Offering a back rub or massage helps relax the patient. Removal of irritating stimuli is another way to improve the patient's comfort for a restful sleep. Diaphoretic patients will benefit from a cool bath and dry clothes or linens. Perform nursing activities before the patient receives sleeping medications or begins to fall asleep. Long-term nighttime medication regimen can lead to abuse and dependence and is to be avoided. PTS:1DIF:Cognitive Level: Applying (Application) REF:864 | 865 OBJ escribe interventions appropriate to promoting sleep for patients with various sleep disorders.TOP:Nursing Process: Implementation MSC:Client Needs: Physiological Integrity

2.A nurse has been temporarily assigned to the night shift. A change in this circadian rhythm may cause which of the following? (Select all that apply.) a. Anxiety b. Weight gain c. Decreased appetite d. Increased periods of sleep e. Impaired judgment

ANS: A, C, E When the sleep-wake cycle becomes disrupted (e.g., by working rotating shifts), other physiological functions change as well. For example, a new nurse who starts working the night shift experiences a decreased appetite and loses weight, not weight gain. Anxiety, restlessness, irritability, and impaired judgment are other common symptoms of sleep cycle disturbances. Decreased, not increased, periods of sleep can occur. Failure to maintain an individual's usual sleep-wake cycle negatively influences the person's overall health. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:847 OBJ: Explain the effect the 24-hour sleep-wake cycle has on biological function. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

8.The nurse manager for a busy medical unit in an acute care hospital noticed a trend of complaints regarding the restful environment of the unit in the patient satisfaction reports. At the staff meeting, this issue was discussed with the staff, and they decide that the best thing to do is which of the following? a. Administer sleeping medications at 2200 hours. b. Cluster nursing activities at night. c. Turn off all alarms after 2200. d. Keep lights on in the main hallway for safety reasons.

ANS: B A challenge in the hospital is controlling noise. Because many patients spend only a short time in hospitals, it is easy to forget the importance of establishing good sleep conditions. In the hospital setting, plan nursing care activities to avoid awakening patients. Try to schedule assessments, treatments, procedures, and routines for times when patients are awake. Perform nursing activities before the patient receives sleeping medication or begins to fall asleep. For example, you have a patient who has had surgery. Before the patient gets ready for bed, change the surgical dressing, reposition the patient, administer pain medication, and check vital signs (clustering nursing activities). Turning alarms off is a violation of safety protocols in most hospitals because of patient safety concerns. Lights on in the hallway can cause distraction to sleep patterns. Regular use of any sleep medication leads to tolerance, and withdrawal causes rebound insomnia. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF: 852 OBJ: Identify factors that promote or disrupt sleep. TOP:Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment

16.A 45-year-old obese patient has been scheduled for cardiac bypass surgery. The nurse who is preparing the patient for surgery asks, "Do you have a history of sleep apnea?" This is important to know before surgery because patients with sleep apnea: a. are prone to snore after surgery and require a private room. b. who receive general anesthesia have a greater risk for airway obstruction. c. generally need additional pain medication. d. usually require sleep aids to provide more restful sleep.

ANS: B If a patient is scheduled for surgery, be sure to ask about a history of sleep apnea. Patients with sleep apnea who receive general anesthesia and pain medications after surgery have increased risk for developing airway obstruction during recovery. A private room is not necessary. Sleep apnea does not require a patient to need additional pain medication or sleep aids after surgery. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:857OBJ:Conduct a sleep history. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

4.A new mother has brought in her week-old infant to the health care provider for a 1-week well-baby checkup. She is breastfeeding and has only been sleeping a couple of hours at a time during the night between feedings. She asks the nurse, "When can I expect the baby to sleep through the night?" What is the nurse's best response? a. "Are you feeling tired, maybe you are experiencing depression." b. "Most children begin to sleep through the night around 3 months." c. "Most children begin to sleep through the night around 6 months." d. "Are you feeling tired? Maybe you are anemic?"

ANS: B Infants usually develop a nighttime pattern of sleep by 3 months of age. The neonate and infant up to the age of 3 months average about 16 hours of sleep a day. A symptom of anemia or depression is fatigue, but this does not focus on the question the new mother asked about the baby sleeping. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:849 OBJ: Compare and contrast the characteristics of sleep for different age groups. TOP:Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

1.A college student who is working in northern Alaska during the summer reports that he or she has an increase in difficulty sleeping since moving north. During a pre-employment physical, the patient asks the health care provider what could be causing this. The health care provider suspects the sleep disturbance is most likely because of which factor? a. Stress of the new job b. Increased daylight hours in Northern Alaska c. Physical demands of the new job d. Change in diet

ANS: B Northern Alaska has extended daylight hours. Light and temperature affect all circadian rhythms, including the sleep-wake cycle. The most familiar rhythm is the 24-hour, day-night cycle known as the diurnal or circadian rhythm. When the sleep-wake cycle becomes disrupted (e. g., by working rotating shifts), other physiological functions change as well. Stress of the new job, physical demands of the new job, and a change in diet are not the issues. The patient stated that the difficulty started when he or she moved north. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:847 OBJ: Explain the effect the 24-hour sleep-wake cycle has on biological function. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

7.A 73-year-old patient reports to the nurse about waking up early and not being able to return to sleep. The patient states, "I do not go to bed until after the evening news." What is the best advice for the nurse to give this patient to encourage a good night's sleep? a. Take a nap in the afternoon. b. Go to bed earlier. c. Go to bed later. d. Take a benzodiazepine.

ANS: B Older patients become sleepier in the early evening (going to bed when the body is naturally sleepy is beneficial) and wake earlier in the morning, but still require the necessary 7 to 8 hours of sleep a day. Going to bed later would not be beneficial. Research indicates that exercise is beneficial, particularly for older adults, to improve nighttime sleep. General recommendations include increasing daytime activity or exercise, not taking a nap. The use of benzodiazepines in the older adult population is potentially dangerous. Long-term use and high doses in this population have been associated with suicidal ideation. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:850 | 851 | 854 OBJ: Discuss differences in sleep interventions for patients of different age groups. TOP:Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

11.A primary health care provider has diagnosed the patient with having a parasomnia. The patient asks the nurse to explain what that means. What is the best explanation? a. A person is unable to breathe and sleep at the same time. b. It is a sleep disorder that produces abnormal sleep movements. c. It is a rare dysfunction of the mechanism that regulates sleep and wake states. d. It is a sudden muscle weakness occuring during intense emotions.

ANS: B The parasomnias are sleep disorders that can occur during arousal from REM or partial arousal from NREM sleep. They include sleep walking, night terrors, nightmares, teeth grinding, and bed-wetting. Narcolepsy is a rare central nervous system dysfunction of mechanisms that regulate sleep and wake states. Excessive daytime sleepiness is the most common complaint associated with narcolepsy. Cataplexy is a sudden muscle weakness during intense emotions such as anger or laughter that occurs at any time during the day. If the cataplectic attack is severe, the patient loses voluntary muscle control and falls to the floor. Sleep apnea is a disorder in which the individual is unable to breathe and sleep at the same time. PTS:1DIF:Cognitive Level: Applying (Application) REF: 854 OBJ: Discuss characteristics of common sleep disorders. TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

3.The nurse is triaging a patient for an annual check-up with the health care provider. When questioned about changes in sleep habits the patient replies, "Since my spouse passed away last month, I have not been sleeping well at all." What are the most appropriate interventions for the nurse to make? (Select all that apply.) a. Speaking to the health care provider for a benzodiazepine sleeping aid b. Contacting a pastoral care professional c. Consulting with a psychiatric clinical nurse specialist d. Consulting with a clinical psychologist e. Referring the patient for evaluation to the sleep clinic

ANS: B, C, D The nature of a sleep disturbance determines whether referrals to additional health care providers are necessary. For example, if a sleep problem is related to a situational crisis or emotional problem, refer the patient to a psychiatric clinical nurse specialist, pastoral care professional or clinical psychologist for counseling. When chronic insomnia is the problem, a medical referral or referral to a sleep center is beneficial. Benzodiazepine can lead to tolerance, abuse, and dependence. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:860 OBJ escribe interventions appropriate to promoting sleep for patients with various sleep disorders.TOP:Nursing Process: Implementation MSC:Client Needs: Psychosocial Integrity

5.A 6-year-old girl is being seen at the clinic for a well-child checkup. The guardian tells the nurse that the child is having difficulty getting to sleep at night and asks for suggestions. What is the nurse's best response? a. "You should play an active game with her like basketball to wear her out." b. "It would be a good idea to save homework until right before bedtime." c. "Quiet activities like reading sometimes help to settle down children her age." d. "Try to delay dinner time until later to help make her sleepy."

ANS: C A 6-year-old child averages 11 to 12 hours of sleep nightly. Encouraging quiet activities usually persuades the 6- or 7-year-old child to go to bed. Playing an active game, doing homework right before bed, and delaying dinner are not quiet activities. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:849 OBJ: Discuss differences in sleep interventions for patients of different age groups. TOP:Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

18.The long-term care facility nurse is assessing the patient's sleep environment for safety. Which finding will cause the nurse to intervene as it is an unsafe situation for the patient? a. A small night light left on in the bedroom b. All clutter removed between the bed and the bathroom c. Bed in high position with side rails up d. Call bell at the bedside for the patient to alert family members

ANS: C A bed in high position with side rails up is a safety hazard. Safety precautions are important for patients who awaken during the night to use the bathroom and for those with excessive daytime sleepiness. Set beds lower to the floor to lessen the chance of the patient falling when first standing. Remove clutter, and move equipment from the path a patient uses to walk from the bed to the bathroom. If patient needs assistance in ambulating from the bed to the bathroom, make sure the call light is within the patient's reach. The call light helps alert the nursing staff, not the family. A small night light is beneficial to help with vision PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:861 OBJ: Discuss differences in sleep interventions for patients of different age groups. TOP:Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment

22.A 2-year-old child in the pediatric unit resists going to sleep. To promote sleep, which is the best action for the nurse to take? a. Eliminate a daytime nap. b. Offer the child warm chocolate milk. c. Maintain the child's home bedtime routine. d. Allow the child to sleep longer in the morning.

ANS: C A bedtime routine (e.g., same hour for bedtime or quiet activity) used consistently helps toddlers and preschool children avoid delaying sleep. Parents need to reinforce patterns of preparing for bedtime. Reading stories, allowing children to sit in a parent's lap while listening to music or praying, and coloring are routines associated with preparing for bed. Toddlers still need naps. Sleeping longer will continue to disrupt the normal routine. Chocolate can cause a person to stay awake or wake up throughout the night. PTS:1DIF:Cognitive Level: Applying (Application) REF:861-862 OBJ: Discuss differences in sleep interventions for patients of different age groups. TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

2.The health care provider is seeing a 16-year-old boy at the local clinic. The guardian is concerned about the patient's lack of sleep. The guardian states that the patient "goes to school, works at a part-time job until 10 PM, and then stays up doing homework until after midnight. I am worried that he is not getting enough sleep." What is the best response for the health care provider to give the patient and his guardian? a. "I don't get enough sleep either; I spend most of my time studying." b. "You need to discuss this with the primary health care provider." c. "Sleep deprivation can cause a person to get sick or have excessive daytime sleepiness." d. "High school is a tough time in life, but I'm sure he will be fine."

ANS: C Adolescents need between 8 and 9 hours of sleep each night; however, the typical teenager gets about 7 hours of sleep per night. At a time when sleep needs actually increase, the typical adolescent is subject to a number of changes that often reduce the time spent sleeping, such as the time when school starts, after-school social events, part-time jobs, and extracurricular activities. The shortened sleep time in adolescents often results in excessive daytime sleepiness (EDS), which can reduce performance in school, increase risk of accidents, increase the use of alcohol, and lead to behavior and mood problems. Sleep deprivation affects immune functioning, metabolism, nitrogen balance, protein catabolism, and quality of life. Saying, "I don't get enough sleep either" or "You need to discuss this with the primary health care provider" is not focusing on the guardian's question. Saying the boy "will be fine" is false reassurance. PTS:1DIF:Cognitive Level: Applying (Application) REF:849 OBJ: Compare and contrast the characteristics of sleep for different age groups. TOP:Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

12.Which of the following data are most important to assess if a patient is receiving sufficient sleep? a. Hours of sleep each night b. Sleep-wake pattern c. Whether the patient feels rested d. Number of times the patient awakens during sleep

ANS: C Because sleep is a subjective experience, only the patient is able to report whether it is sufficient and restful. Patients are your best resource for describing a sleep problem and any change from their usual sleep and waking patterns. Number of hours of sleep, sleep-wake pattern, and number times awakes while sleeping are not the most important to assess to determine effectiveness of the patient's sleep, the subjective experience of the patient is the most important. PTS:1DIF:Cognitive Level: Applying (Application) REF:855OBJ:Conduct a sleep history. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

6.A 67-year-old farmer is at the clinic because he has been sleepy during the day. Which sleep change occurs with age? a. Older adults spend more time in stage 3. b. Older adults spend more time in REM sleep. c. Older adults spend more time in falling asleep. d. Older adults spend more time in deep sleep.

ANS: C Older adults awaken more often during the night, and it takes more time for them to fall asleep. To compensate they increase the number of naps taken during the day. Older adults spend more time in stage 1 and have less stages 3 and 4 NREM sleep; some older adults have almost no NREM stage 4 or deep sleep. Episodes of REM sleep tend to shorten, and there is less deep sleep and more lighter sleep. PTS:1DIF:Cognitive Level: Applying (Application) REF:850 OBJ: Compare and contrast the characteristics of sleep for different age groups. TOP:Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

17.A nurse is caring for an elderly patient with a sleeping disorder. When formulating a care plan for this patient it was determined that the goal will be that "the patient establishes a healthy sleep pattern." Which of the following is the best example of a measurable outcome to meet this goal? a. The patient will fall asleep more easily. b. The patient will sleep longer throughout the night. c. The patient will have less than two awakenings throughout the night. d. The patient will wake up more refreshed in the morning.

ANS: C Outcomes serve as measurable guidelines to determine goal achievement. "Less than two awakenings" is a measurable goal. The other responses are subjective (more easily, sleep longer, more refreshed) and do not have a measurable outcome. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF: 858 OBJ: Describe ways to evaluate the effectiveness of sleep therapies. TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

10.When visiting the clinic, a nurse takes the patient's sleep history and notes the appearance of a deviated septum. The nurse knows that this structural abnormality predisposes the patient to which condition? a. Narcolepsy b. Cataplexy c. Obstructive sleep apnea d. Insomnia

ANS: C Structural abnormalities such as a deviated septum, nasal polyps, narrow lower jaw, or enlarged tonsils sometimes predispose a patient to obstructive sleep apnea. Insomnia is a symptom rather than the name of a disease and is common among patients suffering from depression. It is experienced by patients who have chronic difficulty falling asleep, frequent awakenings from sleep, and/or a sleep or a nonrestorative sleep. Narcolepsy is a rare central nervous system dysfunction of mechanisms that regulate sleep and wake states; during the day a person suddenly feels an overwhelming wave of sleepiness and falls asleep. Cataplexy is a sudden muscle weakness during intense emotions such as anger or laughter that occurs at any time during the day. PTS:1DIF:Cognitive Level: Applying (Application) REF: 852-854 OBJ: Discuss characteristics of common sleep disorders. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

21.An older adult widow reports having problems sleeping at night and states, "I miss my spouse." The nurse also recognizes that older patients: a. are difficult to assess. b. take less time to fall asleep. c. may suffer from emotional stress or depressive mood problems. d. require less sleep than middle-age adults.

ANS: C The elderly frequently experience losses, such as retirement and death of a loved one, which may lead to emotional stress or depressive mood problems that affect sleep efficacy. Older adults have a harder time falling asleep and more trouble staying asleep than do young adults. Sleep studies on older adults show a decline in REM sleep and an increase in nighttime awakenings. It is a common misconception that sleep needs decrease with aging. Older adults still need 7 to 8 hours of sleep a day, just like middle-aged adults. Older adults are not more difficult to assess. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:857 OBJ: Compare and contrast the characteristics of sleep for different age groups. TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

28.A patient has returned from back surgery. The family has brought in the patient's continuous positive airway pressure (CPAP) machine. What is the best rationale for allowing the patient to use the CPAP machine at night? a. It will keep the patient in deep levels of REM, which will decrease the need for pain medication. b. It will help decrease hospital noise that will keep the patient awake. c. The patient needs ventilator support owing to the increased chance of postoperative respiratory complications. d. The patient needs to follow the same bedtime routine to promote a safe environment for sleep.

ANS: C These patients need ventilator support in the postoperative period because obstructive sleep apnea is linked to increased postoperative respiratory complications. After surgery the patient achieves very deep levels of REM sleep that lead to muscle relaxation and airway obstruction. In these patients the anesthesia in combination with pain medications used after surgery reduces the patient's defenses against airway obstruction. Make sure that patients use their home CPAP equipment. Use pain medication carefully in these patients. Promoting the home bedtime routine is beneficial, but that is not the primary reason for using the CPAP; it is to prevent complications from surgery. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:864 OBJ escribe interventions appropriate to promoting sleep for patients with various sleep disorders.TOP:Nursing Process: Evaluation MSC:Client Needs: Physiological Integrity

3.During a sleep study test, the patient states, "I never dreams anymore." The health care provider tells the patient that everyone dreams, but most people forget about them upon awakening. The health care provider tells the patient that the best way to remember dreams is to do which of the following? a. Eat spicy food before going to sleep. b. Avoid caffeine in the afternoon. c. Consciously think about the dreams upon awakening. d. Become more creative.

ANS: C To remember a dream, a person must consciously think about it on awakening. People who recall dreams vividly usually awaken just after a period of rapid eye movement (REM) sleep. Personality influences the quality of dreams; for example, a creative person may have very vivid, unusual dreams, whereas a depressed person may have dreams of helplessness. Eating a large, heavy, and/or spicy meal within 3 to 4 hours of bedtime sometimes results in indigestion that interferes with sleep. Alcohol consumed in the evening has insomnia-producing and diuretic effects. Coffee, tea, cola, and chocolate contain caffeine and xanthines that cause sleeplessness as a result of central nervous system stimulation. Avoiding caffeine and becoming more creative do not increase a person's memory for dreams. PTS:1DIF:Cognitive Level: Applying (Application) REF:849OBJ escribe the normal stages of sleep. TOP:Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

19.A patient has been hospitalized with pneumonia. The patient has had some difficulty sleeping while in the hospital. The patient would like to avoid taking medication for sleep because there have been problems with sleeping pills in the past. Which action by the nursing assistant personnel will cause the nurse to intervene? a. Encouraging the patient to void before bedtime b. Offering to give the patient a backrub c. Giving the patient an extra blanket when cold d. Providing a warm cup of hot cocoa before bedtime

ANS: D Coffee, tea, cola, and chocolate cause a person to stay awake or awaken throughout the night. Promote comfort by encouraging the patient to wear loose-fitting nightwear, void before bedtime, give a relaxing back rub, and offer an extra blanket to prevent chilling when trying to fall asleep. PTS:1DIF:Cognitive Level: Applying (Application) REF:861-863 OBJ escribe interventions appropriate to promoting sleep for patients with various sleep disorders.TOP:Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

20.While making night shift rounds, the nursing assistive personnel become concerned when a patient stops breathing from 1 to 2 minutes several times during the shift. The nurse informs the nursing assistive personnel that this condition is known as which of the following? a. Cataplexy b. Insomnia c. Narcolepsy d. Sleep apnea

ANS: D Sleep apnea is a disorder in which the individual is unable to breathe and sleep at the same time and has periods of apnea throughout the night. Cataplexy is a sudden muscle weakness during intense emotions such as anger or laughter that occurs at any time during the day. Insomnias are primary disorders related to difficulty falling asleep. Narcolepsy is a central nervous system dysfunction of mechanisms that regulate sleep and wake states. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF: 852-854 OBJ: Discuss characteristics of common sleep disorders. TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

25.A patient asks the nurse to explain how sleep occurs. The nurse explains to the patient that the physiology of sleep is a complex process. However, in simple terms, what is the nurse's best response? a. Circadian sleep rhythm controls sleep. b. Sleep occurs when a person's basal metabolic rate falls. c. Sleep is a dreaming process. d. Interrelated mechanisms of the brain control wake and sleep cycles.

ANS: D The major sleep center in the body is the hypothalamus. The suprachiasmatic nucleus (SCN) nerve cells in the hypothalamus control the rhythm of the sleep-wake cycle and coordinate this cycle with other circadian rhythms. Researchers believe that the ascending reticular activating system located in the upper brainstem contains special cells that maintain alertness and wakefulness. Circadian rhythms influence the 24-hour pattern of major biological and behavioral functions such as the predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood. Sleep causes the basal metabolic rate to fall; falling of the metabolic rate does not cause sleep. Normal sleep involves two phases: nonrapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:847 | 84 BJ iscuss mechanisms that regulate sleep. TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

13.A primary health care provider prescribes eszopiclone (Lunesta) for a patient. Which classification of drug will the nurse be administering to the patient? a. Benzodiazepine b. Melatonin agonist c. L-tryptophan antagonist d. Nonbenzodiazepine, benzodiazepine receptor agonist

ANS: D The nonbenzodiazepine, benzodiazepine receptor agonists are newer medications that appear to have better safety profiles and fewer adverse effects than the benzodiazepines. They are also associated with a lower risk of abuse and dependence than the benzodiazepines, although abuse and dependence do occur. Examples of medications in this class include zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). Benzodiazepines are a common classification of drug used to treat sleep problems when a change in sleep hygiene is not effective. Examples of benzodiazepines include temazepam (Restoril), flurazepam (Dalmane), estazolam (ProSom), and triazolam (Halcion). A new class of drugs called melatonin agonists promotes the onset of sleep by increasing levels of the natural hormone melatonin, which helps normalize circadian rhythm and sleep-wake cycles. Ramelteon (Rozerem) belongs to this drug class. There is no such classification as L-tryptophan antagonist. L-tryptophan is thought to promote sleep. PTS:1DIF:Cognitive Level: Applying (Application) REF:863 OBJ escribe interventions appropriate to promoting sleep for patients with various sleep disorders.TOP:Nursing Process: Implementation MSC:Client Needs: Physiological Integrity

23.A patient's vital signs are significantly lower than normal while sleeping. The nurse understands this to be a normal finding when the patient is in what stage of the sleep cycle? a. 1 b. 2 c. 3 d. 4

ANS: D Vital signs are significantly lower in stage 4 sleep than during waking hours. During stage 1, a gradual fall in vital signs and metabolism begins; during stage 2, body functions continue to slow; during stage 3, vital signs decline but remain regular. During stage 4, vital signs significantly lower. A healthy adult's normal heart rate throughout the day averages 70 to 80 beats per minute. However, during sleep the heart rate normally falls to 60 beats per minute or less, thus preserving cardiac function. Other biological functions decreased during sleep are respirations, blood pressure, and muscle tone. PTS:1DIF:Cognitive Level: Analyzing (Analysis) REF:84 BJ escribe the normal stages of sleep. TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity