Chapter 43 Sleep

Which physiological symptom is observed in the nurse who has a sleep disorder because of working rotating shifts? Select all that apply. One, some, or all responses may be correct. 1. Blurred vision 2. Increased reflexes 3. Decreased judgment 4. Slowed response time 5. Increased visual alertness

1, 3, 4 As a result of rotating shifts, the nurse has sleep deprivation, which can cause blurred vision, decreased judgment, and slowed response time. Sleep deprivation occurs in this nurse because the human biological clock becomes maladjusted. Sleep deprivation causes decreased (not increased) reflexes and decreased (not increased) visual alertness.

Which patient is at risk of developing central sleep apnea (CSA)? Select all that apply. One, some, or all responses may be correct. A patient with encephalitis A patient with nasal polyps A patient with enlarged tonsils A patient with muscular dystrophy A patient with a large neck circumference

1, 4 Patients prone to CSA are one with encephalitis and a patient with muscular dystrophy. CSA involves dysfunction in the respiratory control center of the brain. Patients with encephalitis and muscular dystrophy are at risk of developing CSA because of a fall in blood oxygen saturation levels. Obstructive sleep apnea (OSA) occurs when muscles or structures of the oral cavity or throat relax during sleep. Therefore patients with nasal polyps, enlarged tonsils, and a large neck circumference are at risk of developing OSA and not CSA.

How many hours of sleep are typically required to prevent fatigue in a 6-year-old child? A. 6 hours B. 8 hours C. 10 hours D. 12 hours

12 HOURS Twelve hours of sleep are required. A 6-year-old child typically requires 11 to 12 hours of sleep to be free of fatigue. An adult (not a 6-year-old child) requires about 6 to 9 hours of sleep for a fatigue-free day. An 11-year-old (not 6-year-old) child requires 9 to 10 hours of sleep to prevent fatigue.

Sedentary Lifestyle

a way of life that involves little physical activity; encourage patient to keep a exercise log

Which question would the nurse ask to assess the patient's insomnia? Select all that apply. One, some, or all responses may be correct. 1. "How frequently do you eat out?" 2. "How easily do you fall asleep?" 3. "What causes you to awaken early?" 4. "What do you think of when you try to fall asleep?" 5. "Do you ever feel paralyzed just before falling asleep?"

2, 3, 4 The nurse would ask the following questions: "How easily do you fall asleep," "What causes you to awaken early," and "What do you think of when you try to fall asleep?" Insomnia is a condition in which the patient has difficulty falling asleep. Information about the patient's problem falling asleep and reasons for waking up early helps determine the sleep pattern. If the patient is thinking about a specific issue when trying to sleep, it may be a source of stress. The questions about eating out does not contribute to determining the sleep pattern for insomnia. Asking about feeling paralyzed is for assessing narcolepsy, not insomnia.

Which measure would the nurse suggest to promote sleep in a patient? Select all that apply. One, some, or all responses may be correct. 1. Avoid taking a warm bath. 2. Eat a heavy meal at night. 3. Void before going to sleep. 4. Use extra blankets if necessary. 5. Wear soft, cotton nightclothes.

3, 4, 5 The nurse would suggest the following: void before going to sleep; use extra blankets if necessary; and wear soft, cotton nightclothes. The need to urinate may disturb the patient while sleeping. Voiding before going to sleep prevents sleep disturbances caused by a full bladder. Using extra blankets prevents the patient from feeling chilled. By wearing soft, cotton nightclothes the patient can feel comfortable and warm. A warm bath is also helpful for the patient to feel relaxed and to promote sleep; thus the patient would not avoid taking a warm bath. Consumption of a heavy meal at night should be avoided because it may cause indigestion and sleep disturbances. Consumption of a light meal improves sleep in the patient.

Which intervention is appropriate to include in the plan of care for a patient experiencing narcolepsy? A. Instruct the patient to increase carbohydrates in the diet. B. Have patient limit fluid intake 2 hours before bedtime. C. Preserve energy by limiting exercise to morning hours. D. Encourage patient to take one or two 20-minute naps during the day

Encourage patient to take one or two 20 minute naps during the day

Which action would the nurse take for a patient who is diagnosed with fatigue? A. Encourage short naps if possible. B. Instruct the patient to keep an exercise log. C. Have the patient keep a sleep log for a week. D. Suggest sleeping longer during weekends.

A. Encourage short naps if possible The nurse would instruct a patient who is diagnosed with fatigue to take short naps. A patient with a sedentary lifestyle (not fatigue) should keep an exercise log. A patient suffering from insomnia (not fatigue) should be asked to keep a sleep log for a week. The nurse would not suggest sleeping longer during weekends; sleeping long hours during weekends disturbs the normal sleep-wake cycle.

Which complaint is common in patients with obstructive sleep apnea? A. Fatigue B. Anxiety C. Increased sex drive D. Evening headaches

A. Fatigue Fatigue is a common complaint of patients with obstructive sleep apnea. Anxiety is not associated with obstructive sleep apnea. Decreased, not increased, sex drive is associated with obstructive sleep apnea. Morning (not evening) headaches are associated with sleep apnea.

Which patient finding is the nurse likely to observe while performing assessment? A. A school aged child who sleep 15 hours a day B. A teenage with an upcoming final who promptly goes to sleep at bedtime C. An infant taking several naps a day D. An adult falls asleep after vigous exercise before bedtime.

An infant taking several naps during the day

Which measure would the nurse suggest to a parent to promote sleep in a preschooler? A. Encourage co-sleeping on a soft mattress. B. Offer warm milk before sleeping. C. Make sure that the room is dark and quiet. D. Suggest a small piece of chocolate mint before bedtime.

B. To promote sleep in a preschooler, the nurse would suggest that the parent offer warm milk before sleeping. A dairy product such as warm milk contains L-tryptophan, which helps promote sleep. Co-sleeping should occur on a firm mattress; depending upon the parent's culture, co-sleeping may or may not be advised. Because preschoolers often have bedtime fears, the room should not be completely dark. Chocolate mint can act as a stimulant. Coffee, tea, soda, and chocolate can keep a person awake.

Which statement made by an older adult demonstrates understanding regarding taking a sleep medication? A. "I'll take the sleep medicine for 4 or 5 weeks, until my sleep problems disappear." B. "Sleep medicines won't cause any sleep problems once I stop taking them." C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." D. "Sleep medicines will make me feel extremely sleepy in the mornings."

C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." The older adult stating that he or she will consult a health care provider before using an over-the-counter sleep medication indicates an understanding of the risks of these medications. The other statements indicate a lack of understanding. The use of nonprescription sleep medications is not advisable. Sleep medications are taken short-term (no longer than 2 to 3 weeks), not 4 or 5 weeks. Sleep medicines can cause problems even after taking them, such as rebound insomnia. Sleep medicines should not make one feel extremely sleepy in the mornings.

Which patient can safely receive benzodiazepines for sleep? A. A 70-year-old patient with renal failure B. A nursing mother C. A 30-year-old patient D. A pregnant patient

C. A 30 year old patient; side effects are few

Which class of drug does the nurse suspect is responsible for the patient reporting daytime drowsiness and a lack of dreams? A. Antibiotics B. Antipyretics C. Opiates D. Diuretics

C. Opiates Opiates cause increased daytime drowsiness and suppress rapid eye movement (REM) sleep (a lack of dreams). Antibiotics generally do not cause a lack of dreams and daytime drowsiness. Antipyretics generally do not cause daytime drowsiness or suppress REM sleep. Diuretics are not associated with daytime drowsiness or a lack of dreams; however, diuretics can cause nighttime awakenings caused by nocturia.

Which intervention is priority for the nurse to suggest to the patient who reports fatigue? A. Revise the daily exercise plan. B. Drink a cup of warm milk before going to bed. C. Practice relaxation techniques before going to bed. D. Plan rest periods in between daily activities for better balance

D. The nurse would suggest that the patient plan rest periods in between daily activities for better balance to decrease fatigue. Revising or changing the daily exercise plan may improve sleep but not necessarily fatigue; thus it is not the priority. Although encouraging the patient to drink a cup of warm milk and to practice relaxation techniques before going to bed are appropriate, they are not the priority interventions for management of fatigue.