Class 4 Test Bank 345

An older patient asks a nurse, "I really have trouble sleeping, and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don't understand his response. Can you help me?" The best response by the nurse is: a. "Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep." b. "Prescription sleeping medications have many adverse effects in older people. Why don't you try using an over-the-counter medication?" c. "Sleeping medications do not provide any improvement in sleep for older people." d. "Sleep problems are common in older people. There really is nothing that you can do to help with that."

ANS: A Adverse effects of sleep medications, including over-the-counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep problems are common in older adults; however, many nonpharmacologic interventions can be used to improve sleep.

During the night, an older woman complains to the nurse that she has not slept more than 2 hours since admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman's sleep? a. Inquire about her sleep habits used at home. b. Suggest that she avoid napping during the day. c. Tell her that sleep is fragmented in older people. d. Offer a book to her or suggest watching a movie.

ANS: A Hospitalization often disrupts normal sleeping patterns; therefore, reestablishing these patterns is the best first step to improving the quality of sleep in the hospital. Avoiding napping during the day is a reasonable approach to complaints of sleeplessness, but it may not be this woman's problem. Sleep is increasingly fragmented in older adults; however, understanding that issue may or may not help this woman sleep for longer periods. A book or movie can help some people become drowsy, but becoming drowsy will not usually increase the quality or duration of sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep.

A 75-year-old woman asks a nurse, "I know I should be moving, but how much is the right amount of exercise for me?" The best response of the nurse is: a. "You need to engage in 30 minutes of moderate intensity exercise on at least 5 days a week." b. "You need to engage in at least 30 minutes of moderate-intensity exercise every day of the week." c. "Because you are 75 years old, the recommendation is for 30 minutes of moderate-intensity exercise three times a week." d. "There are no specific recommendations for someone of your age; just keep moving."

ANS: A Older adults need at least 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g., brisk walking, swimming, bicycling) every week and muscle-strengthening activities on 2 or more days that work all major muscle groups (legs, hips, abdomen, chest, shoulders, and arms).

Which of the following is a true statement about sleep in older adults? a. The time spent in bed increases, but the time spent asleep decreases. b. The amount of leg movement during sleep remains steady throughout life. c. Rapid eye movement (REM) sleep becomes more unevenly distributed with age. d. The amount of stage III sleep increases steadily throughout life.

ANS: A Older persons tend to spend less time asleep than younger persons, although they spend more time in bed. This statement is true because sleep takes longer to arrive and is more fragmented. Leg movements during sleep often tend to increase with age. REM sleep becomes more evenly distributed with age. Stage III sleep decreases with age and virtually disappears in older adults.

An older man has Alzheimer's disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the man's duration of sleep? a. Instruct the wife to increase his daily physical activity. b. Collaborate with the health care provider to administer a hypnotic medication. c. Teach the wife how to apply a vest restraint during sleep. d. Help the wife plan daily periods for napping and activity.

ANS: A Regular exercise can help increase the duration of sleep during the night. Adding a new medication to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Administering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of injury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hostility and combativeness. Excessive napping during the day may be contributing to the problem.

An older adult who has a balance disorder and has sustained repeated falls is recommended to start an exercise program. Which of the following exercises would be most beneficial in improving balance in this individual? (Select all that apply.) a. Yoga b. Tai Chi c. Swimming d. Pilates e. Weight lifting

ANS: A, B Yoga and Tai Chi are exercises that improve balance, as they use movements that improve the ability to maintain control of the body over the base of support to avoid falling. Swimming, Pilates, and weight lifting do not do this.

A nurse will be conducting an education session at the local senior citizen's center on the importance of physical activity. Which activities should the nurse include as an example of moderate-intensity aerobic activity? (Select all that apply.) a. Biking b. Range of motion (ROM) c. Weight lifting d. Dancing

ANS: A, D Biking and dancing incorporate large muscle groups and are classified as moderate-intensity aerobic activity. ROM exercises are classified as stretching activities. Weight lifting is considered an exercise that uses body weight and is a muscle-strengthening activity.

The nurse should encourage which of the following exercises to assist with balance for a patient who is at high risk for falls? (Select all that apply.) a. Tai Chi b. Use of resistance bands c. ROM activities d. Walking heel to toe

ANS: A, D Tai Chi and walking heel to toe are considered balance exercises. The use of resistance bands is considered muscle strengthening, and ROM activities are considered stretching exercises.

Which of the following is a true statement about sleeping in older adults? a. Older adults tend to fall asleep quickly but are awakened throughout the night. b. Sleep disturbances in older adults can be caused by chronic illness. c. Benzodiazepine agents are the medications of choice for sleep disorders. d. The times of day that medications are given has no effect on sleep disturbances.

ANS: B Chronic illness is an internal risk factor that can contribute to sleep disorders. It takes older adults more time to fall asleep, and older adults are awakened throughout the night more frequently than younger people. Benzodiazepines should not be used to induce sleep; these substances are highly addictive, and if their administration is suddenly withdrawn, then rebound insomnia can occur. In addition, older adults who take benzodiazepines for sleeping are more likely to experience a "hangover" after waking that can increase the risk of accidents and injuries. The times of day that medications are given can also contribute to sleep problems—for example, a diuretic given before bedtime or sedating medications given in the morning.

Exercises are prescribed for older adults as therapy to improve which one of the following qualities? a. Relative intensity b. Muscle strength c. Muscle retraining d. Body sculpting

ANS: B Exercises that improve muscle strength are important for balance, strong bones, and metabolic processes. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle definition is a quality valued by bodybuilders, but it is not a therapeutic concern.

The nurse completes an admission assessment on an older adult patient. The nurse identifies which factor that may contribute to sleep problems? a. Exposure to sunlight b. Polypharmacy c. Use of a sleep aid d. Decreased fluid intake

ANS: B Polypharmacy contributes to sleep problems as a result of medication side effects and drug interactions. Decreased exposure to sunlight contributes to sleep problems. Sleep aids may assist with sleep issues. Decreased fluid intake may lead to dehydration, which may result in lethargy.

The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY) tool to plan an exercise program for a female resident who is in good health except that her height has decreased inch. Which exercise safety tip from EASY calls for the nurse to assess the resident before planning care? a. Do not exercise a red, warm, or swollen joint. b. Avoid stretches that cause you to bend at the waist. c. Evaluate your surroundings for outdoor exercising. d. Begin by warming up with low- to moderate-intensity exercises.

ANS: B The nurse needs more information because the reason the resident's height has decreased is not known. Therefore, to obtain the information, the nurse decides to complete a resident assessment before planning an exercise program. The shrinkage can be due to atrophy of intervertebral disks, compression fractures, or changes in the curvature of the spine, any of which can be aggravated by incorrectly exercising. With a complete assessment, however, the nurse can plan a suitable exercise program for the resident. Red, warm, swollen joints are usually caused by gout or rheumatoid arthritis; fortunately, the resident does not have these health problems. However, this is a good recommendation for anyone who exercises. Evaluating an individual's surroundings when exercising does not alert the nurse who is considering an exercise plan for this resident; however, this is a good, general recommendation for anyone who exercises. Warming up with low- to moderate-intensity exercises is a good recommendation for anyone who exercises.

When an older adult patient is diagnosed with restless leg syndrome (RLS), the nurse is confident that patient education on the condition's contributing factors has been effective when the patient states: a. "A warm bath at night instead of in the morning is my new routine." b. "Eating a banana at breakfast assures me the potassium I need." c. "I've cut way back on my caffeinated coffee, teas, and sodas." d. "I elevate my legs on a pillow to improve circulation."

ANS: C Increased caffeine use can be a contributing factor to RLS. There is no research to confirm that a warm bath before sleep or elevating the legs will minimize or prevent RLS. Potassium deficiency has not been identified as a contributing factor to RLS.

An older woman maintains an active lifestyle playing various games with friends. She reports to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this woman's sleep? a. Recommend preparation for sleep. b. Suggest trying a cup of warm milk at bedtime. c. Inquire about her nightly sleep rituals. d. Propose volunteer work at a thrift shop.

ANS: C The nurse completes an assessment of the woman's sleeping habits and other pertinent information before planning care and implementing nursing interventions to individualize therapy. Preparing for sleep is a reasonable intervention to propose after completing an assessment. Sipping warm milk is also a reasonable intervention to suggest after completing an assessment. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment.

The nurse observes that a male patient is snoring every night. Which should the nurse assess in this patient to diagnose the potential for sleep apnea? (Select all that apply.) a. Change in appetite b. Rituals for sleeping c. Number of daytime naps d. Headaches in the morning e. Irritability during the day f. Awakening during the night

ANS: C, D, E, F The nurse asks the patient to evaluate how restorative or refreshing sleeping is for him; awakening unrefreshed is a risk factor for sleep apnea. In addition, morning headaches, daytime irritability and personality changes, and periods of nighttime wakefulness are all risk factors for sleep apnea. Changes in appetite and rituals for sleeping are rarely associated with an increased risk for sleep apnea.

During a routine physical examination, the patient reports, "I have problems falling asleep at night. I regularly engage in vigorous exercise to tire myself every evening." What response by the nurse is indicated? a. "Exercise is recommended and should be done immediately before bedtime to tire you out." b. "Exercise should only be done in the morning; otherwise, it can ruin your sleep." c. "A regular exercise regimen is helpful; it can deepen sleep, but it should not be done immediately before bedtime." d. "Exercise is helpful, but vigorous exercise can lead to restless leg syndrome, which can contribute to insomnia."

ANS: D A regular exercise regimen, for those who are able, can deepen sleep, increase daytime arousal, and decrease depression. It is important, however, to avoid exercise before bedtime. Vigorous exercise is not a contributor to restless leg syndrome.

A patient who reported "a problem sleeping" shows an understanding of good sleep hygiene when a. doing 10 pushups before bed to encourage a "pleasant tiredness." b. seldom eating a bedtime snack. c. engaging in computer games as a prebed activity. d. limiting the afternoon nap to just 30 minutes.

ANS: D Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while bedtime snack is acceptable if the food is light and so easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.

What is the difference between rest and sleep? a. Sleep occurs with rest. b. Rest is an extension of sleep. c. Rest occurs only in brief periods. d. Sleep is restorative and recuperative.

ANS: D Sleep provides an important survival tool to rest, restore, and rejuvenate the body. Rest occurs during sleep. Sleep is an extension of rest. Rest can occur in brief periods and in extended cycles during sleep.