Sleep-Rest Disorders Concepts

The nurse is conducting a clinic visit with a mother and an adolescent client. Both the mother and the adolescent report that the adolescent is not able to sleep until late at night and then wakes up too late in the morning. This has caused the adolescent to be late for school several times. The mother states, "I don't know what to do." Which response by the nurse is the most appropriate? A) Inform her that several techniques can potentially help correct this problem. B) Recommend a polysomnography (PSG). C) Indicate that this is simply a normal change of the body's internal clock associated with puberty, and it will work itself out. D) Ask about other medical conditions because the adolescent's sleep patterns indicate the onset of a chronic illness.

A Explanation: A) Adolescents experience changes in the body's internal clock associated with puberty that in some adolescents cause a delay in melatonin release each night; the result is delayed sleep phase syndrome. Signs of delayed sleep phase syndrome include an inability to fall asleep and wake up at the desired time. The use of sleep hygiene, sleep restriction therapy, and relaxation techniques can be beneficial in the treatment of this syndrome. A sleep study would only be indicated if the adolescent were experiencing other sleep disturbance symptoms. This isn't a sign of another illness but shouldn't be ignored either. B) Adolescents experience changes in the body's internal clock associated with puberty that in some adolescents cause a delay in melatonin release each night; the result is delayed sleep phase syndrome. Signs of delayed sleep phase syndrome include an inability to fall asleep and wake up at the desired time. The use of sleep hygiene, sleep restriction therapy, and relaxation techniques can be beneficial in the treatment of this syndrome. A sleep study would only be indicated if the adolescent were experiencing other sleep disturbance symptoms. This isn't a sign of another illness but shouldn't be ignored either. C) Adolescents experience changes in the body's internal clock associated with puberty that in some adolescents cause a delay in melatonin release each night; the result is delayed sleep phase syndrome. Signs of delayed sleep phase syndrome include an inability to fall asleep and wake up at the desired time. The use of sleep hygiene, sleep restriction therapy, and relaxation techniques can be beneficial in the treatment of this syndrome. A sleep study would only be indicated if the adolescent were experiencing other sleep disturbance symptoms. This isn't a sign of another illness but shouldn't be ignored either. D) Adolescents experience changes in the body's internal clock associated with puberty that in some adolescents cause a delay in melatonin release each night; the result is delayed sleep phase syndrome. Signs of delayed sleep phase syndrome include an inability to fall asleep and wake up at the desired time. The use of sleep hygiene, sleep restriction therapy, and relaxation techniques can be beneficial in the treatment of this syndrome. A sleep study would only be indicated if the adolescent were experiencing other sleep disturbance symptoms. This isn't a sign of another illness but shouldn't be ignored either.

Sleep disorders mainly do what with respect to the activities of daily living? A) Interfere B) Decrease C) Change D) Increase

A Explanation: A) Sleep disorders can lead to disrupted activities of daily living, and so primarily interfere with such activities. They do not necessarily decrease these activities, change them, or increase them, but they do make them more difficult to accomplish. B) Sleep disorders can lead to disrupted activities of daily living, and so primarily interfere with such activities. They do not necessarily decrease these activities, change them, or increase them, but they do make them more difficult to accomplish. C) Sleep disorders can lead to disrupted activities of daily living, and so primarily interfere with such activities. They do not necessarily decrease these activities, change them, or increase them, but they do make them more difficult to accomplish. D) Sleep disorders can lead to disrupted activities of daily living, and so primarily interfere with such activities. They do not necessarily decrease these activities, change them, or increase them, but they do make them more difficult to accomplish.

An older adult client recovering from prostate surgery is waking up frequently during the night. Which client statement supports the nursing diagnosis Disturbed Sleep Pattern? A) "The pain in my hips is unbearable at times." B) "I walk for half an hour after I eat breakfast." C) "I take my Zoloft as soon as I get up in the morning." D) "I have one cup of regular coffee in the morning."

Answer: A Explanation: A) Physical discomfort or pain, especially from osteoarthritis and focused in the hips, often disrupts the sleep of older persons. The client is taking his prescribed antidepressant medication Zoloft (sertraline hydrochloride) appropriately because it has a stimulant effect and should be taken in the morning. A short walk in the morning is an appropriate type and timed exercise. Caffeine intake of one morning cup of coffee should have little interference with sleeping during the night. B) Physical discomfort or pain, especially from osteoarthritis and focused in the hips, often disrupts the sleep of older persons. The client is taking his prescribed antidepressant medication Zoloft (sertraline hydrochloride) appropriately because it has a stimulant effect and should be taken in the morning. A short walk in the morning is an appropriate type and timed exercise. Caffeine intake of one morning cup of coffee should have little interference with sleeping during the night. C) Physical discomfort or pain, especially from osteoarthritis and focused in the hips, often disrupts the sleep of older persons. The client is taking his prescribed antidepressant medication Zoloft (sertraline hydrochloride) appropriately because it has a stimulant effect and should be taken in the morning. A short walk in the morning is an appropriate type and timed exercise. Caffeine intake of one morning cup of coffee should have little interference with sleeping during the night. D) Physical discomfort or pain, especially from osteoarthritis and focused in the hips, often disrupts the sleep of older persons. The client is taking his prescribed antidepressant medication Zoloft (sertraline hydrochloride) appropriately because it has a stimulant effect and should be taken in the morning. A short walk in the morning is an appropriate type and timed exercise. Caffeine intake of one morning cup of coffee should have little interference with sleeping during the night.

Which client is exhibiting hypersomnia? A) The client only gets about 5 or 6 hours of sleep each night. B) The client gets roughly 8 hours of sleep each night but can't stay awake during the day. C) The client consistently has trouble getting to sleep and often lies awake for hours after bedtime. D) The client experiences repetitive involuntary leg movements that interfere with sleep.

B Explanation: A) Hypersomnia is a condition of getting enough sleep at night but still exhibiting daytime drowsiness. A client getting 5 or 6 hours of sleep each night is experiencing sleep loss. Difficulty falling asleep is insomnia. Repetitive involuntary leg movements is restless leg syndrome. B) Hypersomnia is a condition of getting enough sleep at night but still exhibiting daytime drowsiness. A client getting 5 or 6 hours of sleep each night is experiencing sleep loss. Difficulty falling asleep is insomnia. Repetitive involuntary leg movements is restless leg syndrome. C) Hypersomnia is a condition of getting enough sleep at night but still exhibiting daytime drowsiness. A client getting 5 or 6 hours of sleep each night is experiencing sleep loss. Difficulty falling asleep is insomnia. Repetitive involuntary leg movements is restless leg syndrome. D) Hypersomnia is a condition of getting enough sleep at night but still exhibiting daytime drowsiness. A client getting 5 or 6 hours of sleep each night is experiencing sleep loss. Difficulty falling asleep is insomnia. Repetitive involuntary leg movements is restless leg syndrome.

The nurse is assessing a client for a sleep-rest disorder. Which client behavior is most indicative of such a disorder? A) The client answers history questions in detail. B) The client expresses impatience after two or three questions and insists that the nurse hurry up and finish. C) The client expresses a concern about the privacy of the information he reveals. D) The client cannot answer definitely whether he sleeps in strange positions.

B Explanation: A) Observation can indicate the presence of fatigue, decreased cognitive functioning and coordination, dark circles under the eyes, and irritability. Expressing impatience after just two or three questions is indicative of irritability, which could be a sign of sleep deprivation from a sleep-rest disorder. Answering history questions in detail does not demonstrate decreased cognitive functioning, a concern about privacy is a normal concern, and the client may not be able to answer about strange sleep positions because he may simply not know. B) Observation can indicate the presence of fatigue, decreased cognitive functioning and coordination, dark circles under the eyes, and irritability. Expressing impatience after just two or three questions is indicative of irritability, which could be a sign of sleep deprivation from a sleep-rest disorder. Answering history questions in detail does not demonstrate decreased cognitive functioning, a concern about privacy is a normal concern, and the client may not be able to answer about strange sleep positions because he may simply not know. C) Observation can indicate the presence of fatigue, decreased cognitive functioning and coordination, dark circles under the eyes, and irritability. Expressing impatience after just two or three questions is indicative of irritability, which could be a sign of sleep deprivation from a sleep-rest disorder. Answering history questions in detail does not demonstrate decreased cognitive functioning, a concern about privacy is a normal concern, and the client may not be able to answer about strange sleep positions because he may simply not know. D) Observation can indicate the presence of fatigue, decreased cognitive functioning and coordination, dark circles under the eyes, and irritability. Expressing impatience after just two or three questions is indicative of irritability, which could be a sign of sleep deprivation from a sleep-rest disorder. Answering history questions in detail does not demonstrate decreased cognitive functioning, a concern about privacy is a normal concern, and the client may not be able to answer about strange sleep positions because he may simply not know.

Which of the following is most characteristic of the clinical manifestations of sleep apnea? A) Difficulty thinking B) Difficulty breathing C) Difficulty waking up D) Difficulty controlling motor functions

B Explanation: A) Sleep apnea can manifest as snoring or gasping during sleep, and treatment may involve devices to assist with ventilations during sleep. Frequent awakenings typically accompany sleep apnea, not difficulty waking up. Cognitive deficits are more typical of insomnia. Difficulty controlling the body is more typical of restless leg syndrome. B) Sleep apnea can manifest as snoring or gasping during sleep, and treatment may involve devices to assist with ventilations during sleep. Frequent awakenings typically accompany sleep apnea, not difficulty waking up. Cognitive deficits are more typical of insomnia. Difficulty controlling the body is more typical of restless leg syndrome. C) Sleep apnea can manifest as snoring or gasping during sleep, and treatment may involve devices to assist with ventilations during sleep. Frequent awakenings typically accompany sleep apnea, not difficulty waking up. Cognitive deficits are more typical of insomnia. Difficulty controlling the body is more typical of restless leg syndrome. D) Sleep apnea can manifest as snoring or gasping during sleep, and treatment may involve devices to assist with ventilations during sleep. Frequent awakenings typically accompany sleep apnea, not difficulty waking up. Cognitive deficits are more typical of insomnia. Difficulty controlling the body is more typical of restless leg syndrome.

An adult client diagnosed with sleep apnea has been prescribed a continuous positive airway pressure (CPAP) machine as treatment. The nurse is instructing the client on how to use the machine. Which instruction least relates to ensuring the patient's comfort with the device? A) Use a properly sized mask with the straps tight. B) Instruct the client to wear the mask with air pressure while sleeping. C) Show how to adjust the pressure to reduce difficulty exhaling. D) Demonstrate relaxation techniques to reduce a claustrophobic feeling when wearing the mask.

B Explanation: A) Wearing the right size mask and keeping the straps tight, doing relaxation exercises to reduce the claustrophobic feelings caused by wearing the mask, reducing the difficulty of exhalation by properly adjusting pressure may all help safeguard the patient's comfort with the CPAP device, but wearing the mask with air pressure while sleeping is simply the general way the device should be used and doesn't make any special allowances for the comfort of the patient. B) Wearing the right size mask and keeping the straps tight, doing relaxation exercises to reduce the claustrophobic feelings caused by wearing the mask, reducing the difficulty of exhalation by properly adjusting pressure may all help safeguard the patient's comfort with the CPAP device, but wearing the mask with air pressure while sleeping is simply the general way the device should be used and doesn't make any special allowances for the comfort of the patient. C) Wearing the right size mask and keeping the straps tight, doing relaxation exercises to reduce the claustrophobic feelings caused by wearing the mask, reducing the difficulty of exhalation by properly adjusting pressure may all help safeguard the patient's comfort with the CPAP device, but wearing the mask with air pressure while sleeping is simply the general way the device should be used and doesn't make any special allowances for the comfort of the patient. D) Wearing the right size mask and keeping the straps tight, doing relaxation exercises to reduce the claustrophobic feelings caused by wearing the mask, reducing the difficulty of exhalation by properly adjusting pressure may all help safeguard the patient's comfort with the CPAP device, but wearing the mask with air pressure while sleeping is simply the general way the device should be used and doesn't make any special allowances for the comfort of the patient.

A client with a history of insomnia is scheduled for a polysomnogram that requires an overnight stay in a sleep laboratory. The test will not include audio and video equipment. It will monitor the client's blood oxygen levels, heart rate, breathing, and eye and leg movements, and it will use an electroencephalogram to monitor brain waves. What disorder is least likely to be identified in this test? A) Periodic limb movement disorder B) Sleep apnea C) Sleep talking D) Restless leg syndrome

C Explanation: A) Heart rate, breathing, and blood oxygen levels as well as audio monitoring can detect snoring and breathing changes that suggest sleep apnea. The monitoring of leg movements detects periodic limb movement disorder and restless leg syndrome. Audio and video equipment can also detect parasomnias such as sleep talking, but because such equipment is not being used in this case, the study is least likely to identify this disorder. B) Heart rate, breathing, and blood oxygen levels as well as audio monitoring can detect snoring and breathing changes that suggest sleep apnea. The monitoring of leg movements detects periodic limb movement disorder and restless leg syndrome. Audio and video equipment can also detect parasomnias such as sleep talking, but because such equipment is not being used in this case, the study is least likely to identify this disorder. C) Heart rate, breathing, and blood oxygen levels as well as audio monitoring can detect snoring and breathing changes that suggest sleep apnea. The monitoring of leg movements detects periodic limb movement disorder and restless leg syndrome. Audio and video equipment can also detect parasomnias such as sleep talking, but because such equipment is not being used in this case, the study is least likely to identify this disorder. D) Heart rate, breathing, and blood oxygen levels as well as audio monitoring can detect snoring and breathing changes that suggest sleep apnea. The monitoring of leg movements detects periodic limb movement disorder and restless leg syndrome. Audio and video equipment can also detect parasomnias such as sleep talking, but because such equipment is not being used in this case, the study is least likely to identify this disorder.

A client with clinical depression asks the nurse for suggestions on how to improve the quality of sleep. The client often drinks a glass of wine before bedtime to help sleep. The client falls asleep quickly but then wakes up an hour or so later and often feels anxious. A period of wakefulness follows, often lasting several hours. Which of the following planning goals would be least appropriate for this client? A) Avoid the use of alcohol late in the evening. B) Reduce or remove environmental distractions from the bedroom. C) Maintain a consistent bedtime. D) Report decreased snoring.

D Explanation: A) For this client, avoiding the use of alcohol late in the evening would definitely be a worthwhile goal, as well as ensuring an environment and a routine conducive to sleep. However, the client's history does not indicate that snoring or apnea is a problem, so a goal related to decreasing snoring is probably least appropriate for this client unless there is reason to suspect this as a problem. B) For this client, avoiding the use of alcohol late in the evening would definitely be a worthwhile goal, as well as ensuring an environment and a routine conducive to sleep. However, the client's history does not indicate that snoring or apnea is a problem, so a goal related to decreasing snoring is probably least appropriate for this client unless there is reason to suspect this as a problem. C) For this client, avoiding the use of alcohol late in the evening would definitely be a worthwhile goal, as well as ensuring an environment and a routine conducive to sleep. However, the client's history does not indicate that snoring or apnea is a problem, so a goal related to decreasing snoring is probably least appropriate for this client unless there is reason to suspect this as a problem. D) For this client, avoiding the use of alcohol late in the evening would definitely be a worthwhile goal, as well as ensuring an environment and a routine conducive to sleep. However, the client's history does not indicate that snoring or apnea is a problem, so a goal related to decreasing snoring is probably least appropriate for this client unless there is reason to suspect this as a problem.

A resident in an assisted-living facility is restless most nights and sits in the lounge area reading. When questioned, the resident reports suffering from insomnia. What should the nurse expect as a likely outcome if the resident continues with this pattern of sleep? A) Sleep paralysis B) Onset of cardiac dysfunction C) Onset of new underdiagnosed health problems D) The client's activities during the day may be hindered by these episodes.

D Explanation: A) Insomnia is defined as an inability to fall asleep or stay asleep on most nights for over a month. The individual experiencing insomnia is at risk for daytime drowsiness and may experience cognitive deficits, fatigue, and irritability, all of which can hinder the client's activities during the day. Sleep paralysis is a clinical manifestation of narcolepsy, not insomnia. There is no evidence that insomnia leads to cardiac problems. There is no evidence that the resident client is demonstrating underlying problems. B) Insomnia is defined as an inability to fall asleep or stay asleep on most nights for over a month. The individual experiencing insomnia is at risk for daytime drowsiness and may experience cognitive deficits, fatigue, and irritability, all of which can hinder the client's activities during the day. Sleep paralysis is a clinical manifestation of narcolepsy, not insomnia. There is no evidence that insomnia leads to cardiac problems. There is no evidence that the resident client is demonstrating underlying problems. C) Insomnia is defined as an inability to fall asleep or stay asleep on most nights for over a month. The individual experiencing insomnia is at risk for daytime drowsiness and may experience cognitive deficits, fatigue, and irritability, all of which can hinder the client's activities during the day. Sleep paralysis is a clinical manifestation of narcolepsy, not insomnia. There is no evidence that insomnia leads to cardiac problems. There is no evidence that the resident client is demonstrating underlying problems. D) Insomnia is defined as an inability to fall asleep or stay asleep on most nights for over a month. The individual experiencing insomnia is at risk for daytime drowsiness and may experience cognitive deficits, fatigue, and irritability, all of which can hinder the client's activities during the day. Sleep paralysis is a clinical manifestation of narcolepsy, not insomnia. There is no evidence that insomnia leads to cardiac problems. There is no evidence that the resident client is demonstrating underlying problems.

An older adult client is talking with the nurse about sleep problems. Which fact regarding sleep should the nurse teach this client? A) All elderly individuals experience disrupted sleep and depression. B) The need for sleep decreases with age. C) Sleep problems signal the onset of other developing medical conditions. D) The elderly do not experience as much deep sleep as a younger person.

D Explanation: A) Starting at age 20, there is a reduction in stages 3 and 4 NREM sleep and in REM sleep, which is the deepest sleep. This reduction in deep sleep progresses with aging. Sleep problems may be from a sleep disorder as the primary condition and not another developing medical condition. Generally, the amount of sleep needed is about the same for the youth, middle-aged, and older adult. Not all elderly people experience depression and sleep disturbances. B) Starting at age 20, there is a reduction in stages 3 and 4 NREM sleep and in REM sleep, which is the deepest sleep. This reduction in deep sleep progresses with aging. Sleep problems may be from a sleep disorder as the primary condition and not another developing medical condition. Generally, the amount of sleep needed is about the same for the youth, middle-aged, and older adult. Not all elderly people experience depression and sleep disturbances. C) Starting at age 20, there is a reduction in stages 3 and 4 NREM sleep and in REM sleep, which is the deepest sleep. This reduction in deep sleep progresses with aging. Sleep problems may be from a sleep disorder as the primary condition and not another developing medical condition. Generally, the amount of sleep needed is about the same for the youth, middle-aged, and older adult. Not all elderly people experience depression and sleep disturbances. D) Starting at age 20, there is a reduction in stages 3 and 4 NREM sleep and in REM sleep, which is the deepest sleep. This reduction in deep sleep progresses with aging. Sleep problems may be from a sleep disorder as the primary condition and not another developing medical condition . Generally, the amount of sleep needed is about the same for the youth, middle-aged, and older adult. Not all elderly people experience depression and sleep disturbances.

What primarily differentiates lack of sleep due to a sleep disorder from lack of sleep due to another developing condition? A) The length of sleep B) The quality of sleep C) The symptoms of lack of sleep D) The cause for the lack of sleep

D Explanation: A) The etiology, or cause, of the lack of sleep will differ depending on whether the condition is because of a sleep disorder or another developing condition. However, the length of sleep, quality of sleep, and symptoms related to the lack of sleep may not differ. B) The etiology, or cause, of the lack of sleep will differ depending on whether the condition is because of a sleep disorder or another developing condition. However, the length of sleep, quality of sleep, and symptoms related to the lack of sleep may not differ. C) The etiology, or cause, of the lack of sleep will differ depending on whether the condition is because of a sleep disorder or another developing condition. However, the length of sleep, quality of sleep, and symptoms related to the lack of sleep may not differ. D) The etiology, or cause, of the lack of sleep will differ depending on whether the condition is because of a sleep disorder or another developing condition. However, the length of sleep, quality of sleep, and symptoms related to the lack of sleep may not differ.