Rest and Sleep PrepU (might have questions more than once)
Parents tell the nurse that their 5-year-old is only sleeping 10 hours now and is refusing to take an afternoon nap. The nurse should teach the parents:
"This is normal development for children in this age group."
Parents tell the nurse that their 5-year-old is only sleeping 10 hours now and is refusing to take an afternoon nap. The nurse should teach the parents:
"This is normal development for children in this age group." Rationale: Preschoolers typically sleep 10-16 hours, but become less dependent on napping as they approach school age. By 5 years, they usually do not need routine naps. Telling them to call their pediatrician is passing off responsibility. Sweets are not recommended before bedtime, and this child has normal sleep habits.
A nurse is caring for a client who has been diagnosed with a disturbed sleep pattern. What measures should the nurse implement to promote sleep?
- Providing a back massage - Assisting with progressive relaxation - Promoting daytime exercises
The nurse is promoting bedtime rituals with a family. Which of the following statements indicates the nurse may need to provide further instructions to the mother?
"My boys love to rough-house in their room right before bedtime."
The client has been in the intensive care unit for several days. The client appears to be sleeping throughout the night. The nurse records the data listed above. The nurse evaluates that rapid eye movement (REM) sleep is occurring at:
0100 Rationale: During REM sleep, the client's temperature, pulse, blood pressure, and respirations increase. The client may experience small muscle twitching, such as facial muscles twitching, and irregular pulse rate and respirations. During non-eye movement sleep, the client will exhibit a decrease in body temperature, pulse, blood pressure, and respirations.
A nurse is visiting the home of a first-time mother and her newborn. The nurse is teaching the mother about the newborn's sleep needs. The nurse would inform the mother that newborns sleep approximately how many hours per day?
14 to 20 hours Rationale: On average, infants require 14 to 20 hours of sleep each day.
A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep?
14 to 20 hours each day
A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep?
14 to 20 hours each day Rationale: The pediatric nurse informs the new parent that on average, infants require 14 to 20 hours of sleep each day.
A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep?
14-20 hours of sleep each day
REM sleep in a toddler is about:
30%
A nurse teaches the parents of a toddler about normal sleep patterns for this age group. How many hours of sleep per night is normal near the end of this stage?
8-10 hours
nightmare
A bad dream that occurs during REM sleep
Which of the following client conditions indicates the presence of a parasomnia?
A child who wets his bed every night
For which of the following clients would the nurse most likely administer a benzodiazepine-like drug?
A client who is being treated for short-term insomnia
Motivation
A desire to be wakeful and alert helps overcome sleepiness Ex: a student who is bored and uninterested in lecture will doze off in class
A nurse is reviewing the medication administration record. Which order does the nurse question?
A diuretic administered twice daily at 9am and 9pm
A nurse is reviewing the medication administration record. Which order does the nurse question?
A diuretic administered twice daily at 9am and 9pm. Rationale: A diuretic should not be administered after 6pm. This will promote sleep if a full bladder does not awaken the client. Once daily dosing and every other day dosing is not cause for question.
For which of the following patients would the nurse be most likely to administer a benzodiazepine-like drug?
A pt being treated for short-term insomnia
The nurse is instructing a parent on how to promote restful sleep for a child. The food that would serve as the best bedtime snack for the child is?
Apple slices
A nurse is caring for a client diagnosed with sleep apnea. What should the nurse do in order to promote sleep in the client?
Avoid sedatives for sleeping
Culture
Bed time rituals, sleeping position and place, pattern of sleep vary based on culture
A nurse on the night shift notices that a client is grinding his teeth while sleeping. How should the nurse document the diagnosis for the client?
Bruxism
Stage 2 NREM
Deeper sleep 10-20 minutes long Vital signs and metabolism continue slowing Requires more stimulation Increased relaxation
Factors Affecting Sleep Developmental Patterns Motivation Culture Lifestyle Habits
Environmental Factors Psychological Stress Illness Medications
A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage?
Hypothalamus
A nurse notes that a patient admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this patient's brain may have suffered damage?
Hypothalamus
The client is sleeping, and arousal is easy. Occasionally, the client exhibits involuntary muscle jerking, which appears to startle the client. Vital signs are unchanged from one hour ago. The nurse assesses the stage of non-rapid eye movement (NREM) sleep, which the client exhibits as Stage
I
The pediatric nurse teaches parents about normal sleep patterns in their children. Which of the following teaching points should the nurse include?
Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap.
The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborn's sleep patterns. Which statement is accurate about a newborn's sleep patters?
Newborns sleep 16 to 17 hours per day
The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborn's sleep patterns. Which statement is accurate about a newborn's sleep patters?
Newborns sleep 16-17 hours per day
The nurse has entered the room of a newly admitted client and observed a continuous positive airway pressure (CPAP) on the client's bedside table. The nurse would recognize that this client likely has a history of what condition?
Obstructive sleep apnea
Planning
Offer prescribed sleeping aids Rationale- Often used as a last resort to help clients to get the rest/sleep they need. • Teach about rest and sleep Rationale- well-informed persons are better able to cope with distressing situations like sleeplessness.
A nurse is providing community education about the importance of getting enough sleep. Which information about REM sleep is most accurate?
Plays a role in memory
Nursing Interventions to Promote Sleep
Prepare a restful environment. Promote bedtime rituals. Offer appropriate bedtime snacks and beverages. Promote relaxation and comfort. Respect normal sleep-wake patterns. Schedule nursing care to avoid disturbances. Use medications to produce sleep. Teach about rest and sleep.
A new patient in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is: Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis?
Provide an opportunity for the patient to talk about concerns.
Stage 3 NREM
Slow wave sleep or delta sleep Vital signs decreasing More difficult to awaken Psychological rest and restoration Reduced sympathetic activity
When the nurse attempts to wake a client who has just closed his eyes and appears asleep, the client states he is not asleep. What stage of sleep is this client in?
Stage 1
A client begins snoring and is sleeping lightly. The stage of sleep is:
Stage 2
Which guideline does the nurse apply to discussion of sleep patterns with older adult clients?
Total sleep time decreases as the clients age
When evaluating a client's sleep plan success, the nurse would expect the client to:
Verbalize feeling rested
Hyperinsomnia
disorders of excessive sleepiness or excessive sleep itself
Which activity for rest break should not be incorporated into care planning for clients to aid in healing and recovery?
drinking an 8 oz cup of a caffeinated beverage
In Stage 4 sleep, the:
pulse rate is slow
A nurse caring for a patient with hypersomnia investigates the cause of the sleep disorder. What are possible causes to consider? (Select all that apply.)
• Another sleep disorder, such as sleep apnea • Depression • Alcohol abuse • Some medications
Habits
What are you eating before you go to bed? Alcohol? Smoking?
Parents tell the nurse that their 5 year old is only sleeping 10 hours now and is refusing to take an afternoon nap.The nurse should teach the parents:
"This is a normal development for children in this age group"
Planning continued
Encourage bedtime ritual behaviors - Rationale- Promotes relaxation and sleep • Offer a carbohydrate (non-carbonated) snack Rationale- carbohydrates seem to promote sleep • Offer a backrub, warm bath or face washing Rationale- These activities offer a distraction and may promote relaxation.
A client reports periodic difficulty falling asleep. Which teaching will the nurse provide?
Adhere to a regular schedule for waking and going to sleep, Decrease caffeine intake, Go on a daily walk
The nurse should obtain a sleep history on which patients as a protocol?
All patients admitted to a health care agency
Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern?
Do you usually go to bed and wake up about the same time each day? Rationale: The best interview question for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern would be to ask if the client usually goes to bed and wakes up about the same time each day. The other questions are possible to ask the client, but are not related to recent changes in the client's sleep-wakefulness pattern.
Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening?
Eat some crackers with peanut butter at bedtime
An older adult client with mild hypothermia has been admitted to the health care facility. What should the nurse do to provide an appropriate environment to an older adult client?
Ensure that the environment is warmer
During the morning assessment the client reports to the nurse he is experiencing a hangover from his sleeping pill. The nurse reviews the Medication Administration Record. Which of the following medications is more likely to cause the client's complaint?
Flurazepam (Dalmane)
During the morning assessment, the client reports to the nurse that the client is experiencing a hangover from a sleeping pill. The nurse reviews the Medication Administration Record. Which medication is most likely to cause the client's complaint?
Flurazepam (Dalmane) Rationale: All of the listed medications are ones that promote sleep. Flurazepam is the drug most likely to cause the client's complaint of a morning hangover.
Which statement about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents?
Getting the child to sleep can be difficult. Rationale: Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.
A client reports periodic difficulty falling asleep. Which teaching will the nurse provide? (Select all that apply.)
Go on a daily walk. Adhere to a regular schedule for waking and going to sleep. Decrease caffeine intake. Rationale: The nurse will educate the client about sleep-promoting nursing measures, such as maintaining sleep rituals, reducing the intake of stimulating chemicals, promoting daytime exercise, and adhering to a regular schedule for retiring and awakening. Catching up on sleep and taking intermittent nap do not help in maintaining consistent sleep rituals.
When caring for a patient with insomnia, the nurse would appropriately institute which intervention?
Have the patient eliminate caffeine and alcohol in the evening because both are associated with disturbances in the normal sleep cycle.
Physiology of Sleep • Reticular activating system (RAS) - Facilitates reflex and voluntary movements - Controls cortical activities related to state of alertness • Hypothalamus—control center for sleeping and waking
I would go in the textbook and read the physiology of this, too long to type*
For the last 3 weeks, a nurse in a long-term care facility has administered a sedative-hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation?
Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration
For the last three weeks, a nurse in a long-term care facility has administered a sedative-hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now laying awake at night. Which of the following is the most likely explanation?
Most sedative-hypnotics lose their effect after one or two weeks of administration.
A patient diagnosed with hypothyroidism is suffering from fatigue, lethargy, depression, and difficulty executing the tasks of everyday living. What type of sleep deprivation would the nurse suspect is affecting this patient?
NREM deprivation
Developmental patterns
New borns- 16 hours Toddler- 12 hours Young adults- 8 Older- 7-9
A new client in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis?
Provide an opportunity for the client to talk about concerns
In Stage 4 sleep, the:
Pulse rate is slow
When a nurse notes that the patient appears to be sleeping, is demonstrating irregular respirations, and is showing eye movement, the nurse identifies the stage of sleep the patient is experiencing as
REM (Rapid Eye Movement)
A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client?
Sleep Deprivation
The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and complaints of severe lumbar and right leg pain. The nurse suspects a nursing diagnosis of:
Sleep Pattern Disturbance Due to Acute Pain
The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects a nursing diagnosis of:
Sleep Pattern Disturbance related to acute pain.
Illness
Sleep apnea, coughing, being congested, having pneumonia, injury/pain
A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which of the following nursing diagnoses is most appropriate for this client?
Sleep deprivation
A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client?
Sleep deprivation Rationale: Sleep deprivation is the most appropriate nursing diagnosis for this client because the symptoms of restless legs syndrome keep the person awake and prevent continuous sleep. Eventually, sleep deprivation affects the person's life, damaging work productivity and personal relationships. Relocation Stress Syndrome would not be an appropriate diagnosis because the symptoms are not due to relocation to a new place. Impaired Bed Mobility is an inappropriate diagnosis because the client is not confined to a bed. The client does not have a risk for injury; therefore, the diagnosis of Risk for Injury would be incorrect.
A nurse attempts to wake a patient who is scheduled for tests and is able to arouse him relatively easily. Which stage of sleep is this patient most likely experiencing?
Stage II
The nurse has a client who has been under stress due to a sick spouse. The client reports difficulty sleeping and a feeling of daytime sleepiness. Using nursing process, the nurse does the following in this order
States, "Tell me about your sleep problem" Makes the diagnosis Disturbed Sleep Pattern Plans with the client an outcome of reporting adequate sleep in one week Teaches the client relaxation techniques Evaluates the client in one week for outcome achievement
A nurse on the night shift checks on a patient and suspects that the patient is in REM sleep. Which patient cue is indicative of this stage of sleep?
The pt's eyes dart back and forth quickly
An elderly client is complaining of disturbed sleep during the night because of excessive urination. What information should the nurse address with the client as a possible cause related to the complaint?
Timing of diuretic medication
Environmental factors
Was just home, now in the ICU (noisey) Did they just move and now they live next to a airport or train tracks?
sleep apnea
a disorder in which the person stops breathing for brief periods while asleep
REM behavior disorder (RBD)
a sleep disorder in which a person physically acts out a dream
The nurse is providing client education for the parents of an obese child diagnosed with obstructive sleep apnea. What treatment measures would the nurse explain during the education session? Select all that apply.
a weight loss plan use of a continuous passive airway pressure (CPAP) machine use of a mandibular advancement device (MAD) Rationale: A weight loss plan, use of a continuous passive airway pressure (CPAP) machine, and the use of a mandibular advancement device (MAD) are treatment measures that the nurse would explain during the education session on obstructive sleep apnea. The use of antibiotics and sleeping pills would not be included. Counseling for depression is not necessary as the question is written.
The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to:
anticipate sleeping overnight at a health care center
The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to
anticipate sleeping overnight at a healthcare center.
enuresis
bed wetting
A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest?
decrease in awareness of environment
Which beverage does the nurse recommend to a client with insomnia that may promote the ability to sleep?
milk Rationale: Milk contains L-tryptophan, a chemical that is known to facilitate sleep. Hot chocolate and cola contain caffeine. The nurse should never recommend alcohol, which is a depressive drug.
The client being seen in the employee wellness clinic reports difficulty sleeping for the past several months. The most important assessment the nurse could make is:
reviewing the client's sleep diary for the past 2 weeks. A sleep diary kept for 2 weeks will provide a more detailed history of the client's sleep-wakefulness pattern than having the client identify foods that impact sleep, or having the client recall the number of hours of sleep each day for the past week. Client recall may be inaccurate. The client should describe the sleep problem, not the client's bed partner.
The nurse is caring for a client with narcolepsy. The client reports experiencing being unable to move upon awakening from sleep. The client's spouse states that the client makes sandwiches in the middle of the night, yet the client does not recall this behavior. How does the nurse document these concerns?
sleep paralysis and automatic behavior
somnambulism
sleepwalking
Medications
steroid shot, diuretics
A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because:
they may be disoriented on awakening. Rationale: The elderly sleep less soundly for less time, and have little or no Stage IV deep sleep. It is common for them to be confused upon awakening, which could lead to injury. Napping does not alter their safety. Somnabulism is commonly seen in children. Older adults commonly take prescribed or over-the-counter sleep aids.
A nursing student is changing the client's bed. Which action requires intervention from the nursing instructor?
tossing soiled linen on the floor
A nursing student is changing the client's bed. Which action requires intervention from the nursing instructor?
tossing soiled linen on the floor Rationale: Soiled linen should be placed directly into a pillow case or laundry hamper to prevent transferring microorganisms. Placing soiled linen on the floor requires intervention by the instructor, to prevent the unnecessary spread of microorganisms. Placing the bed in high position is appropriate as it reduces back strain. Anything attached to the linens should be removed prior to changing the bed and clean linen should be placed on a clean, dry surface, such as the bedside table or chair.
restless leg syndrome
uncomfortable sensations in legs causing movement and loss of sleep
An 82-year-old client is newly admitted to an assistive living facility. Which intervention promotes safety at night for the client?
using a night light in the bathroom
Lifestyle
working day shift or night shift?
A middle-aged client reports to the nurse that he has difficulty falling asleep at night. The nurse assessed the client as having poor sleep hygiene habits. The nurse provides the following instructions to the client:
• Avoid activities after 5 p.m that are stimulating. • Participate in a quiet activity, such as reading, prior to attempting to fall asleep.
The nurse is managing the environment for patients on a busy hospital ward. Which interventions would the nurse perform to facilitate a more restful environment? (Select all that apply.)
• Maintain a brighter room during daylight hours and dim lights in the evening. • Decrease the volume on alarms, pages, telephones, and staff conversations. • Medicate for pain if needed.
A nurse is caring for a client who has been diagnosed with a disturbed sleep pattern. What measures should the nurse implement to promote sleep? Select all that apply.
• Promoting daytime exercises • Providing a back massage • Assisting with progressive relaxation
A client describes difficulty falling asleep and difficulty maintaining sleep, and reports daytime fatigue and inability to concentrate. The nurse suggests which noninvasive techniques that may help promote restful sleep? Select all that apply.
• Waking at the same time every morning • Removing bedtime distractions such as watching television in bed • Practicing relaxation techniques
Sleep Eating Disorder
sufferers tend to be overweight and have episodes of recurrent sleep walking, during which time they binge on usually large quantities of food, often high in sugar or fat.
The nurse is completing a sleep history on a client who reports sleeping problems. Which of the client's regular behaviors will cause the client to have difficulty with sleep?
taking a diuretic at 9 a.m. and 5 p.m. daily
The nurse is caring for a client who is having difficulty sleeping. Which medication does the nurse anticipate will be prescribed by the healthcare provider?
temazepam (Restoril)
A client calls a sleep clinic "helpline" and describes her 46-year-old husband's sleep patterns: snoring loudly, then becoming startled and waking up 5 or 6 times a night. The wife is asking how to improve his sleep patterns. The nurse concludes:
the husband may be exhibiting signs of sleep apnea
A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because
they may be disoriented on awakening
A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because:
they may be disoriented on awakening.
The nurse knows that a client understands the purpose of a sleep diary when the client states:
"I will record the time I go to bed and how long it takes me to fall asleep."
The nurse knows that a client understands the purpose of a sleep diary when the client states:
"I will record the time I go to bed and how long it takes me to fall asleep." Rationale: Keeping notes of times of sleep and waking are important details to record in a sleep diary. The notes are usually maintained for 14 days and include specifics such as all wakeful activities and sleep patterns in strange environments.
A client reports to the nurse, "Sleep really isn't necessary." Which teaching by the nurse is appropriate? (Select all that apply.)
"Sleep helps your blood flow to the brain." "Sleep helps you to learn easier and remember more." "Sleep helps your immune system to fight off infections." Rationale: In addition to promoting emotional well-being, sleep enhances various physiologic processes. Sleep is believed to play a role in the following: reducing fatigue, stabilizing mood, improving blood flow to the brain, increasing protein synthesis, maintaining the disease-fighting mechanisms of the immune system, promoting cellular growth and repair, and improving the capacity for learning and memory storage. It is not appropriate, nor accurate, to teach the client that sleep can be stressful or that sleep can cause mood fluctuations.
Narcolepsy
A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times.
A nurse is talking with a client about ways to help sleep and rest. Which of the following recommendations should the nurse give to the client to promote sleep and rest? (Select all that apply) A. Practice muscle relaxation techniques B. Exercise each morning C. Take an afternoon nap D. Alter the sleep environment for comfort E. Limit fluid intake at least 2 hours before bed
A. Practice muscle relaxation techniques B. Exercise each morning D. Alter the sleep environment for comfort E. Limit fluid intake at least 2 hours before bed
A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning the client reports overwhelming fatigue and has told the nurse, "I just can't manage to get any sleep around here." How should the nurse first respond to this client's statement?
Assess the factors that the client believes contribute to the problem
A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning the client complains of overwhelming fatigue and has told the nurse, "I just can't manage to get any sleep around here." How should the nurse first respond to this client's statement?
Assess the factors that the client believes contribute to the problem.
A nurse is preparing a presentation at a local community center about sleep hygeine. When explaining (REM) sleep, which of the following characteristics should the nurse include? (Select all that apply) A. REM sleeps provides cognitive restoration B. Rem last about 90 minutes C. It is difficult to awaken a person in REM sleep D. Sleepwalking occurs during REM sleep E. Vivid dreams are common during REM
E. Vivid dreams are common during REM C. It is difficult to awaken a person in REM sleep A. REM sleeps provides cognitive restoration
Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening?
Eat some crackers with peanut butter at bedtime.
A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage?
Hypothalamus Rationale: The hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleeping and waking. Injury to the hypothalamus may cause a person to sleep for abnormally long periods. The medulla and midbrain are part of the reticular activating system (RAS), which plays a part in the cyclic nature of sleep. The cerebral cortex does not have any role in the sleep process.
A nurse is caring for a client diagnosed with sleep apnea. Which nursing diagnosis should the nurse include in her nursing care plan?
Impaired Gas Exchange
A nurse is caring for a client diagnosed with sleep apnea. Which of the following nursing diagnoses should the nurse include in her nursing care plan?
Impaired gas exchange
The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include?
Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap
When the newly admitted client with chronic obstructive pulmonary disease informs the nurse that she frequently awakens during the night, the nurse may notify the physician for which intervention?
Low-flow oxygen
A new client in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis?
Provide an opportunity for the client to talk about concerns. Rationale: Stress and anxiety interfere with a person's ability to relax, rest, and sleep. The client is scheduled for a surgical procedure in the morning. The nursing diagnosis addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other options are incorrect because the options do not address the situation at hand, or the nursing diagnosis that is noted.
Which factor necessitates the need for more sleep in the adolescent population?
Rapid growth Rationale: The growth spurt that occurs during adolescence may necessitate the need for more sleep. However, the stresses of school, activities, and part-time employment may cause adolescents to have restless sleep, and many adolescents do not get enough sleep.
A maternity nurse is instructing new parents on the proper sleeping position for their newborn child. In what position does the nurse instruct the parents to place the infant?
Supine position
A client taking a diuretic twice daily for treatment of hypertension reports being awakened often by a full bladder. What teaching regarding the diuretic will the nurse provide?
Take before 6:00 PM at night. Rationale: The client taking a diuretic may awaken at night with a full bladder. The nurse will teach the client to take the second dose of the medication before 6:00 PM at night so that urination is accomplished before going to sleep. The other options are not appropriate for the nurse to teach the client.
Which factor has the most influence on an individual's sleep-wake patterns?
The inner biologic clock
Stage 1 NREM
Very light sleep Only a few minutes long Muscle relaxation Loss of awareness os surroundings Vital signs and metabolism begin to decrease Awakens easily Feels relaxed and drowsy
REM
Vivid dreaming About 90 minutes after falling alseep Longer with each sleep cycle Average length is 20 minutes Varying vital signs Very difficult to awake Cognitive restoration
Bruxism
grinding teeth
When a client tells the clinic nurse that he has irresistible sleep attacks throughout the day lasting from 10 to 15 minutes, the nurse suspects that the client may be experiencing what?
Narcolepsy
Which factor necessitates the need for more sleep in the adolescent population?
Rapid growth
The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects a nursing diagnosis of:
Sleep Pattern Disturbance related to acute pain. Rationale: The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain he is experiencing. Anxiety may be present but that is a symptom of his problem rather than the nursing diagnosis. He may have impaired mobility, but it is not due to RLS. Also, his role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.
A 62-year-old woman informs the nurse that her mother has been anxious and disoriented in the morning, and that she sleeps 4 hours per night, while getting up from sleep to use the bathroom. What factor in the client's health regimen could interfere with healthy sleep?
Taking diuretic medicine at 1000 and 2200.
A client is worried and states, "I just know I won't be able to sleep before my surgery." What sleeping pattern would the nurse anticipate?
The client will likely not be able to sleep
A nurse on the night shift checks on a client and suspects that the client is in REM sleep. Which client cue is indicative of this stage of sleep?
The client's eyes dart back and forth quickly Rationale: The nurse would find the client's eyes dart back and forth quickly during REM sleep. The client would have a rapid or irregular pulse. The client's metabolism and body temperature would increase. The client's blood pressure would increase.
Planning
Darken the room and allow for quiet privacy Rationale- unusual surroundings and noise contribute to sleep disturbances. • Adjust the room temperature to suit the client's comfort Rationale- too hot or too cool of an environment may hamper sleep.
The nurse is preparing a care plan for a client recently diagnosed with obstructive sleep apnea. The client complains of daytime sleepiness, fatigue and excessive snoring that "wakes me up". What nursing diagnosis would be appropriate for this client?
Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring
A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which condition is a manifestation of depression in an older client?
Insomnia
Insomnia
inability to sleep
sleep terrors
A sleep disturbance characterized by an episode of increased physiological arousal, intense fear and panic, frightening hallucinations, and no recall of the episode the next morning; typically occurs during stage 3 or stage 4 NREM sleep; also called night terrors.
A nurse in a providers office is caring for a client who states that, for the past week, "I have felt tired during the day and cannot sleep at night." Which of the following responses should the night nurse ask when collecting data about the clients difficulty sleeping? (Select all that apply) A. Have your working hours changed recently? B. Do you feel confused in the late afternoon? C. Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day? D. Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep? E. Tell me about the personal stress you are experiencing.
A. Have your working hours changed recently? C. Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day? D. Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep? E. Tell me about the personal stress you are experiencing.
A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning the client reports overwhelming fatigue and has told the nurse, "I just can't manage to get any sleep around here." How should the nurse first respond to this client's statement?
Assess the factors that the client believes contribute to the problem. Rationale: Assessment is the first step in the nursing process. Consequently, the nurse should determine the factors contributing to the client's problem before performing interventions.
A nurse is instructing a client who has narcolepsy about measures that might help with self-management. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. Ill add plenty of carbohydrates to my meals. B. Ill take a short nap whenever I feel a little sleepy C. Ill make sure to stay warm when I am at my desk at work D. Its okay to drink alcohol as long as I limit it to one drink per day
B. Ill take a short nap whenever I feel a little sleepy
A nurse is caring for a client who has been following the facilities routine and bathing in the morning. However, at home, the client always take a warm bathe before bedtime. Now the client is having difficulty falling alseep at night. Which of the following actions should the nurse take first? A. Rub the clients back for 15 minutes before bed B. Offer the client warm milk and crackers at 2100. C. Allow the client to take a bathe in the evening D. Ask the provider for a sleeping medication
C. Allow the client to take a bathe in the evening
What factor has been hypothesized by researchers regarding current thoughts on sleep?
Chronic sleep deprivation is present
What factor has been hypothesized by researchers regarding current thoughts on sleep?
Chronic sleep deprivation is present.
What factor has been hypothesized by researchers regarding current thoughts on sleep?
Chronic sleep deprivation is present. Rationale: Most recently, researchers have hypothesized that much of the population in industrialized nations may be chronically sleep deprived.
•Offer prescribed pain medications Pain is one of the major deterrents to rest and sleep Respect normal sleep and wake patterns This allows for the best fit for individual needs and the least amount of interference with sleeping.
Cluster nursing activities Most common complaint from patients isthat their rest and sleep is interrupted for non-critical nursing activities.
Which activity for rest break should not be incorporated into care planning for clients to aid in healing and recovery?
drinking an 8 oz cup of a caffeinated beverage Rationale: Drinking a caffeinated beverage is not as energizing as a short 15- to 30-minute nap, stretching exercises, or taking a short walk.
Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening?
Eat some crackers with peanut butter at bedtime. Rationale: Carbohydrates make tryptophan more available to the brain, thereby promoting sleep. Therefore, a small protein- and carbohydrate-containing snack such as peanut butter on toast or cheese and crackers are effective. Nicotine contained in cigarettes has a stimulating effect, and smokers usually have a more difficult time falling asleep. The client must be encouraged to quit smoking or to eliminate cigarette smoking after the evening meal. Exercise that occurs within a 3-hour interval before normal bedtime can hinder sleep. Caffeinated products, such as chocolate, coffee, and tea are considered stimulants and can interfere with sleep.
A nurse is caring for a client diagnosed with sleep apnea. Which nursing diagnosis should the nurse include in her nursing care plan?
Impaired Gas Exchange Rationale: The nurse should include the nursing diagnosis of Impaired Gas Exchange in her nursing care plan. During the apneic or hypopneic periods, ventilation decreases, and blood oxygenation drops. The accumulation of carbon dioxide and the fall in oxygen cause brief periods of awakening throughout the night. Relocation Stress Syndrome, Impaired Bed Mobility, and Risk For Injury are not appropriate diagnoses because the client's loss of sleep is not due to a new place; there is also no immobility or injury risk involved with sleep apnea.
The nurse would recognize that an obese, male client who has been diagnosed with obstructive sleep apnea (OSA) faces an increased risk of
heart disease
The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include?
Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. Rationale: The nurse would include the education point that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. It is normal for infants to have eye movements, groaning, or grimacing during sleep periods. School-age children become aware of the concept of death, not preschool children. Waking from nightmares or night terrors is common during the preschooler stage.
A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which of the following conditions is a manifestation of depression in an older client?
Insomnia
The nurse should obtain a sleep history on which clients as a protocol?
all clients admitted to a health care agency Rationale: Interview questions help identify the client's sleep-wakefulness patterns, the effect of these patterns on everyday functioning, the client's use of sleep aids, and the presence of sleep disturbances and contributing factors. If the client's sleep is adequate and poses no problems, the sleep history may be brief but should still be conducted. As issues or concerns are identified in the general assessment, more detailed questions can be asked to gather more information.
The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to:
anticipate sleeping overnight at a health care center. Rationale: Polysomnography is a sleep study. The client will be scheduled for the study at a health care center and sleep overnight as part of the study. The client should avoid sedatives as this will aggravate OSA. Interventions for OSA include inserting an oral appliance or applying a facial mask for continuous positive airway pressure.
A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest?
decrease in awareness of environment Rationale: There is a decrease in the awareness of the environment in sleep; this does not happen during rest. Motor and cognitive response to stimuli may be decreased in both sleep and rest. Sleep is a whole body phenomenon; whereas, rest may involve the whole body system or only a part.
The nurse is performing an intake assessment of a 60-year-old client who admits to having a "nightcap" of 4 to 6 ounces of scotch whisky each night. What effect might this alcohol be having on the client's sleep?
decreased REM sleep Rationale: Alcohol is known to decrease the amount of REM and delta sleep an individual experiences. Alcohol does not typically shorten sleep cycles or increase the total amount of sleep.
A factory worker has a work schedule involving rotating work hours between days, evenings, and nights. The client tells the nurse he is a "morning" person, and is not sleeping well when he has to work nights. The nurse recommends:
modifying the sleep environment to simulate quiet and darkness.
A factory worker has a work schedule involving rotating work hours between days, evenings, and nights. The client tells the nurse he is a "morning" person, and is not sleeping well when he has to work nights. The nurse recommends:
modifying the sleep environment to simulate quiet and darkness. Rationale: The factory worker needs interventions that will promote natural, restful sleep. Caffeine and stimulant medications will exacerbate the problem. Applying for a different job may be possible, but is more of a long-term solution.
The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is:
observe client's hours of sleep and review client's sleep diary. Rationale: Observing the sleeping patterns and checking the client's sleep diary can lead the nurse to clues about the quality of the client's sleep. Neck circumference can be a factor in obstructive sleep apnea, but it is not routinely measured during assessment. Being overweight is a common finding in sleep disorder clients, but visual acuity issues are not. Auscultation of the lungs and abdomen are not pertinent to the potential disorder.
The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is:
observe their hours of sleep and review their sleep diary.
The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is:
observe client's hours of sleep and review client's sleep diary
In Stage 4 sleep, the:
pulse rate is slow Rationale: During slow-wave sleep, the muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle all decrease.
Which factor necessitates the need for more sleep in the adolescent population?
rapid growth
A nurse is caring for a client with insomnia. The nurse is explaining the importance of sleep to the client. Which of the following roles is sleep supposed to play?
reduce fatigue
A nurse is caring for a client with insomnia. The nurse is explaining the importance of sleep to the client. Which role is sleep supposed to play?
reduce fatigue Rationale: Sleep is believed to play an important role in reducing fatigue, stabilizing mood, and improving blood flow to the brain, among other things. Sleep increases, not reduces, protein synthesis. Sleep does not eliminate accumulation of fat in a person's body. Regular exercise or physical activity reduces fat accumulation. Sleep increases pain tolerance in a person, whereas sleep deprivation decreases pain tolerance.
The client being seen in the employee wellness clinic reports difficulty sleeping for the past several months. The most important assessment the nurse could make is:
reviewing the client's sleep diary for the past 2 weeks
The nurse is caring for a client with narcolepsy. The client reports experiencing being unable to move upon awakening from sleep. The client's spouse states that the client makes sandwiches in the middle of the night, yet the client does not recall this behavior. How does the nurse document these concerns?
sleep paralysis and automatic behavior Rationale: Sleep paralysis occurs when the person cannot move for a few minutes just before falling asleep or awakening. Cataplexy occurs with a sudden loss of muscle tone triggered by an emotional change such as laughing or anger. Hypnogogic hallucinations are dream-like auditory or visual experiences while dozing or falling asleep. Automatic behavior is the performance of routine tasks without full awareness, or later memory, of having done them. This client experiences sleep paralysis and automatic behavior.
A client has voiced concerns about her inability to fall asleep. When reviewing her history, what information would the nurse expect to find?
smokes 1 pack of cigarettes daily drinks coffee with all meals history of hyperthroidism
The nurse makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep are unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to:
use caution when driving an automobile
An 82-year-old client is newly admitted to an assistive living facility. Which intervention promotes safety at night for the client?
using a night light in the bathroom Rationale: Using night lights rather than bright room lights is preferred if an older adult arises during the night. Bright lights stimulate the brain and interfere with efforts to resume sleep. Administering a diuretic at night will cause nocturnal diuresis causing the client to be up more at night. Leaving the door open to the nursing hallway does not promote safety.
When evaluating a client's sleep plan success, the nurse would expect the client to
verbalize feeling rested
The mother reports her 4-year-old child wakes frequently at night screaming. She also reports this occurs shortly after her son has fallen asleep. The nurse assesses the child takes a tub bath and the mother reads a story to her son prior to bedtime at 8 PM. The nurse intervenes by stating to the mother
• "You may find a night light in his room is helpful." • "It is common for this to occur in this age group." • "Comforting your child when this occurs may help."
A nurse explains cognitive behavioral therapy (CBT) to a patient who is experiencing chronic insomnia. Which statements by the nurse best describe this therapy? (Select all that apply.)
• "You will meet with a therapist to work through any maladaptive sleep beliefs." • "Used with other complementary therapies, CBT is very successful." • "CBT may include progressive muscle relaxation measures, stimulus control, and sleep restriction therapy."
The nurse recognizes that sleep deprivation related to environmental concerns will apply to which of the following clients? Select all that apply.
• A 84-year-old male hospitalized for prostate surgery • A 67-year-old male who has two beers during the late night newscast • A 32-year-old male machinist, two pack a day smoker
