Chapter 34: Rest and Sleep Part 1

Which of the following factors has the greatest positive effect on sleep quality? a)Sleeping hours in synchrony with one's circadian rhythm b)Sleeping in a quiet environment c)Spending additional time in stage III of the sleep cycle d)Napping frequently during the day hours

A A circadian rhythm is a biorhythm based on the day-night pattern in a 24-hour cycle. Sleep quality is best when the time at which the person goes to sleep and awakens is in synchrony with his circadian rhythm. Not all people require a quiet environment for sleep. Time spent in stage III of the sleep cycle is affected by the total time spent asleep. Napping on and off throughout the day might disrupt the natural circadian rhythm with uninterrupted periods of sleep that cycle through the various stages of the sleep cycle.

The nurse is caring for a patient newly diagnosed with narcolepsy. What is the priority teaching point the nurse would share with the patient? a)Do not drive or operate heavy equipment. b)Men are more likely to be diagnosed than women. c)There is no treatment; symptoms must be managed. d)Getting more sleep will correct narcolepsy.

A For safety reasons, it is important to advise patients with a sleep disorder to avoid driving or operating heavy equipment until their condition is stabilized. Men and women are equally likely to be diagnosed with narcolepsy. Narcolepsy is treated with central nervous system stimulants that control the symptoms. Although pseudo-narcolepsy may result from inadequate sleep, more sleep will not correct narcolepsy.

What are patterns of waking behavior that appear during sleep known as? a)Parasomnias b)Dyssomnias c)Insomnia d)Hypersomnia

A Parasomnias are patterns of waking behavior that appear during sleep. Sleepwalking, sleep talking, and bruxism are parasomnias.

The primary focus of your interventions for a 6-year-old child who sleepwalks would be to: a)Maintain patient safety during episodes of somnambulation b)Administer and teach about medications to suppress stage III sleep c)Encourage the child to verbalize feelings regarding sleep pattern d)Provide a quiet environment for nighttime sleep

A Sleepwalking places the patient at Risk for Injury because of his lack of awareness of the surroundings. The nurse's primary intervention would be to protect the patient from injury (e.g., falls) while sleepwalking, also called somnambulation. Because the child is only 6 years old, administering and teaching about medications and having him verbalize feelings would not be useful. Providing a quiet environment would likely be ineffective and certainly not the focus of interventions.

The nurse is developing a plan of care for a patient admitted following a motor vehicle accident (MVA) who reports regularly sleeping only 2 to 3 hours per night. The patient says this is the third MVA he's been involved in this year. The patient thinks he might have been asleep when he got into the accident. What is the most appropriate nursing diagnosis for this patient? a)Insomnia b)Sleep Deprivation c)Disturbed Sleep Pattern d)Risk for Injury

A The most appropriate nursing diagnosis for this patient is Insomnia. The duration of quality sleep is inadequate and it is impairing the patient's daily functioning (e.g., multiple MVAs caused by sleep while driving). Sleep Deprivation would not be appropriate because the patient is not describing symptoms associated with lack of sleep. Disturbed Sleep Patterns would not be indicated because this patient's lack of sleep is a regular occurrence and not time limited. Although this patient may be at risk for self-injury due to lack of sleep, this diagnosis does not address the cause of the problem; therefore, it would not be the best choice.

During which of the following developmental stages does a person tend to need the most hours of sleep? a)Toddler b)Adolescence c)Middle adulthood d)Older adulthood

A Toddlers (ages 1 to 3 years) require 12 to 14 hours of sleep in a 24-hour period. Adolescents (ages 12 to 18 years) usually need 8 to 9 hours in a 24-hour period. Middle-aged adults (ages 40 to 65 years) typically require 7 hours in a 24-hour period. Older adults (age 65 years and older) often need 5 to 7 hours of sleep in a 24-hour period.

A client in his 40s has asked the nurse how much sleep he should be getting in order to maximize his health and well-being. How should the nurse respond? A) "Most adults need between seven and nine hours, but everyone is different." B) "It's important to get a minimum of eight hours sleep each night." C) "More sleep equals better health, so the more sleep you can fit into your schedule, the better." D) "Sleep needs depend a lot on age, and at your age, six to seven hours usually suffice.

A) "Most adults need between seven and nine hours, but everyone is different." Sleep needs and routines are highly individual, but most adults require between seven and nine hours of sleep.

Which of the following clients likely faces a risk for the nursing diagnosis of Disturbed Sleep Pattern: Difficulty Remaining Asleep? A) A client who receives IV antibiotics every three hours B) A client whose opioid analgesics result in central nervous system depression C) A client who is receiving corticosteroids that make her feel restless and agitated D) A client whose physical therapy has been scheduled in the late evening

A) A client who receives IV antibiotics every three hours A client who requires medications throughout the night is likely to experience the frequent awakenings associated with Disturbed Sleep Pattern: Difficulty Remaining Asleep. Drowsiness or agitation as a result of medications may affect sleep, but are less likely to result in mid-sleep awakenings. A client who performs physical activity prior to bedtime may have difficulty falling asleep.

A nurse working the night shift assesses a client's vital signs at 4 a.m. (0340). What would be the expected findings, based on knowledge of NREM sleep? A) Decreased TPR and BP B) Increased TPR and BP C) No change from daytime readings D) Highly individualized, cannot predict

A) Decreased TPR and BP Throughout the stages of NREM sleep, the parasympathetic nervous system dominates; decreases in temperature, pulse, respirations, and blood pressure occur.

A client reports that her naps after lunch often stretch to three hours in length and that she has great difficulty rousing herself after a nap. This condition is best termed as which of the following? A) Hypersomnia B) Insomnia C) Parasomnia D) Sleep apnea

A) Hypersomnia Hypersomnia is a condition characterized by excessive sleep, particularly during the day. Insomnia is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep. Parasomnias are patterns of waking behavior that appear during sleep. Sleep apnea is a condition in which a person experiences the absence of breathing, or diminished breathing efforts, during sleep (between snoring intervals).

A nurse is caring for a client who has been diagnosed with insomnia. What nursing intervention would help the nurse relieve the client's condition? A) Maintain a calm and quiet environment free from noise. B) Administer sedatives as prescribed by the physician. C) Motivate the client to sleep because it may affect his health. D) Engage the client in some diversional activities.

A) Maintain a calm and quiet environment free from noise. Maintaining a calm and quiet environment is the most appropriate nursing activity to relieve insomnia. Motivating the client to sleep by telling him that it may affect his health may cause anxiety in the client. Engaging the client in diversional activities at bedtime may increase sleeplessness. Sedatives can be administered as prescribed, but they should be used as last resort. These activities may not relieve insomnia in the client.

Which natural chemical does the body produce at night to decrease wakefulness and promote sleep? A) Melatonin B) Serotonin C) Endorphins D) Dopamine

A) Melatonin Melatonin is a natural chemical produced at night that decreases wakefulness and promotes sleep.

What condition have studies confirmed occurs when adults and children do not get recommended hours of sleep at night? A) Obesity B) Anxiety C) Diabetes D) Hypertension

A) Obesity The fact that children and adults are getting less sleep has been implicated as a contributing factor to the obesity epidemic in the United States (CDC, 2008, Goldsmith, 2007). Various studies confirm that adults and children who slept less than their recommended hours per night were more likely to be overweight. This sleep-weight link is possibly related to two hormones: leptin and ghrelin. Leptin signals the brain to stop eating, whereas ghrelin promotes continued eating. Research suggests that sleep deprivation lowers leptin levels and elevates ghrelin levels, thus increasing one's appetite.

What is the rationale for using CPAP to treat sleep apnea? A) Positive air pressure holds the airway open. B) Negative air pressure holds the airway closed. C) Delivery of oxygen facilitates respiratory effort. D) Alternating waves of air stimulate breathing.

A) Positive air pressure holds the airway open. Continuous positive airway pressure (CPAP) is used to treat sleep apnea. The device, worn at night, delivers positive air pressure through a facemask to hold the airway open.

The nurse manager in an acute care facility has received client evaluations in which the clients have complained about excessive noise that interfered with their rest. The nurse manager and nursing staff plan to do the following. Which activity will most assist clients in obtaining rest? A) Post signs for quiet and turn down hall lights during formal quiet times. B) Ensure clients are offered prescribed sleeping medications at bedtime. C) Provide a small carbohydrate snack or juice prior to hours of sleep. D) Adjust the temperature of the room to 74 degrees and provide a blanket.

A) Post signs for quiet and turn down hall lights during formal quiet times. All of the options may be helpful in promoting rest. However, the client complaints are about excessive noise, and posting signs for quiet and turning down hall lights during formal quiet times is the only option that directly addresses noise. Also, some clients cannot rest if the room temperature is not to their liking. The room temperature needs to be adjusted to client preference.

A nurse educates a young couple on putting their newborn on his back to sleep. What is the rationale for this information? A) Prone position increases the risk for sudden infant death syndrome. B) Prone position decreases the risk for sudden infant death syndrome. C) Supine position may alter the size and shape of the infant's head. D) Supine position makes changing diapers and feeding difficult.

A) Prone position increases the risk for sudden infant death syndrome. Newborns sleep an average of 16 out of every 24 hours. It is important to teach parents to position an infant on the back. Sleeping in the prone position increases the risk for sudden infant death syndrome (SIDS).

An individual awakens from a sound sleep in the middle of the night because of abdominal pain. Why does this happen? A) Stimuli from peripheral organs to the RAS B) Stimuli to the wake center in the cerebral cortex C) Messages from chemoreceptors to the brain D) Messages from baroreceptors to the spinal cord

A) Stimuli from peripheral organs to the RAS The reticular activating system (RAS) facilitates reflex and voluntary movements as well as cortical activities related to a state of alertness. Wakefulness occurs when the RAS experiences stimuli (including pain) from peripheral organs and cells.

A client who has a sleep disorder is trying stimulus control to improve amount and quality of sleep. What is recommended in this type of therapy? A) Use the bedroom for sleep and sex only. B) Use the bedroom for reading and eating. C) Go to bed at the same time every night. D) Sleep alone with minimal coverings

A) Use the bedroom for sleep and sex only. Stimulus control involves using the bedroom for sleep and sex only. If not asleep within 15 to 20 minutes, the person should leave the room and return only when he or she feels sleepy. Getting up at the same time every day is also recommended.

Select the factors known to affect sleep. Select all that apply. a)Age b)Environment c)Lifestyle d)State of health e)Ethnicity

A, B, C, D Age, environment, lifestyle, and state of health are factors affecting sleep. Many older adults sleep less but require more rest. Alcohol, caffeine, and nicotine use and diet are examples of a lifestyle factor that affects sleep. When a person is ill, she may sleep more or find that she cannot sleep because of pain or other factors associated with illness. Changes in environment also affect sleep.

The nurse is caring for a patient admitted to the hospital's hospice unit with terminal cancer and acute cancer pain. What factors does this patient have that will interrupt circadian rhythms? Select all that apply. a)Pain b)Fear c)Frequent vital signs d)Noise e)Lights

A, B, D Pain can disrupt circadian rhythms and make sleep difficult. Fear of the unknown, such as fear of death, can disrupt circadian rhythms and make sleep difficult. Noise in the facility can disrupt circadian rhythms and make sleep difficult. Vital signs would not be taken at night for a patient who is terminal, as changes in vital signs will not require interventions or alter outcome. Lights in the patient's room in a hospice unit should be turned out to avoid alterations in circadian rhythm and the door to the room can be closed to block out light from the hallway.

A nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? (Select all that apply.) A. pt who has uncontrolled hypothyroidism B. pt with coronary artery disease C. pt with GERD D. pt who is HIV positive E. pt who is taking corticosteroids for arthritis F. pt with a UTI

A, B, and C RATIONALE: A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has GERD may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.

A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? (Select all that apply.) A. daily mental activities B. daily physical activities C. morning and evening body temp D. daily measurement of fluid intake and output E. presence of anxiety or worries affecting sleep F. morning and evening BP readings

A, B, and E RATIONALE: A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is not usually kept in a sleep diary.

A nurse caring for patients in a long-term care facility is implementing interventions to help promote sleep in older adults. Which action is recommended for these patients? A. increase in physical activities during the day B. encourage short periods of napping during the day C. increase fluids during the evening D. dispense diuretics during the afternoon hours

A. Rationale: Napping should be discouraged during the day, fluids should not be increased at night, and diuretics if needed should be given during the day and not the night so the patient won't have to continually get up and void

A nurse is discussing sleep problems with a client. What type of foods should the nurse recommend to promote sleep? A. cheese and crackers B. one cup of peanuts C. 3 glasses of red wine D. one cup of hot chocolate

A. cheese and crackers

To promote sleep in a patient, a nurse suggests what intervention? A. follow the usual bedtime routine if possible B. drink two or three glasses of water at bedtime C. have a large snack at bedtime D. take a sedative hypnotic every night at bedtime

A. follow the usual bedtime routine if possible RATIONALE: Keeping the same bedtime schedule helps promote sleep. Drinking two or three glasses of water at bedtime will probably cause the patient to awaken during the night to void. A large snack may be uncomfortable right before bedtime; instead, a small protein and carbohydrate snack is recommended. Taking a sedative-hypnotic every night disturbs REM and NREM sleep, and sedatives also lose their effectiveness quickly.

What is the purpose of using a sleep diary? a)Identify sleep-rest patterns over a 1-year period. b)Note the trend in sleep-wakefulness patterns over a 2-week period. c)Note typical sleep habits and most common daily routines. d)Examine the patterns of sleep during the night and naps during the day.

B A sleep diary provides specific information about the patient's sleep-wakefulness patterns over a certain period of time. It allows identification of trends in sleep-wakefulness patterns and associates specific behaviors interfering with sleep. The diary is typically kept for 14 days.

The nurse teaches a class for new parents promoting safe sleep for infants. The nurse determines a participant understood the important safety points when a parent makes which statement? "I will a)"Gently lay my son down on his back with a soft pillow to support his head" b)"Put my son on a firm crib mattress on his back and remove all padding" c)"Position my son to sleep on his back and place soft pads around the crib to prevent injury" d)"Have my son sleep in my bed so I can be sure he is safe at night."

B According to the American Academy of Pediatrics, it is safest for infants to sleep positioned on their back on a firm surface with no soft padding (e.g., stuffed animals, blankets, or pillows). Supine position is especially discouraged before 3 months or at the point that the infant develops strength of his head, neck, and upper body. Pillows should never be used for infants because they can lead to poor airway alignment, which increases the risk for apnea and even sudden infant death syndrome. The safest place for an infant to sleep is in the same room as the caregiver, but not in the same bed. Sleeping with the newborn is associated with smothering or rolling on top of the baby and should be discouraged.

A patient tells you that she has trouble falling asleep at night, even though she is very tired. A review of symptoms reveals no physical problems and she takes no medication. She has recently quit smoking, is trying to eat healthier foods, and has started a moderate-intensity exercise program. Her sleep history reveals no changes in bedtime routine, stress level, or environment. Based on this information, the most appropriate nursing diagnosis would be Disturbed Sleep Pattern related to: a)Increased exercise b)Nicotine withdrawal c)Caffeine intake d)Environmental changes

B Based on the information given, the patient is not experiencing significant stress, or change in sleep routine or environment, which commonly leads to insomnia. People who use nicotine tend to have more difficulty falling asleep and are more easily aroused than those who are nicotine free. People who stop smoking often experience temporary sleep disturbances during the withdrawal period.

The nurse is performing a sleep assessment for a newly admitted patient. He says his sleep habits are satisfactory and that he normally feels well rested. What would the nurse ask next? a)"Would you be willing to complete a sleep diary for the next 2 weeks?" b)"What time do you usually go to bed and awaken?" c)"How many times do you usually awaken?" d)"Do you have trouble falling asleep at night?"

B If the patient is happy with his sleep habits and feels rested, the nurse need only support normal sleep habits and bedtime rituals; therefore, learning when the patient goes to bed would be important to ask in order to meet his needs. If the patient is satisfied with his sleep habits and feels rested, then there is no need for a sleep diary. If the patient is satisfied with his sleep habits, then there is no need to inquire about sleep problems such as awakening at night. If the patient is satisfied with his sleep habits, then there is no need to inquire about sleep problems such as having trouble falling asleep.

The nurse working on the postpartum unit is preparing a first-time mother for discharge to home. What information should be included in the teaching plan? a)Try to reduce work-related stress to promote sleep. b)Nap frequently during the day when you can. c)Avoid fluids in the evening to reduce nocturia. d)Avoid vigorous-intensity exercise to reduce fatigue.

B The mother should be taught to nap when the baby naps as frequently as possible to meet her sleep needs. The postpartum patient who is employed would be most likely on leave from work for the first weeks after discharge, so this would not be a component of patient teaching. The older adult is more likely to experience frequent nocturia, and reducing hydration status is not an effective or safe sleeping strategy. It is unlikely the new mother will lose sleep because of late night television watching, but her sleep deprivation is more likely due to the interruptions related to the infant feedings and other nighttime awakenings. Physical activity improves strength, circulation, and feelings of well-being.

The nurse is teaching the patient about foods that promote sleep versus those that may disrupt sleep. What diet chosen by the patient demonstrates understanding of foods that promote sleep? a)A hamburger, potato fries, and a milkshake b)Turkey fettuccini, whole wheat bread, and a glass of milk c)Chicken salad sandwich, pineapple salad, and a diet cola d)Fish, broccoli, applesauce, and a cup of tea

B Turkey, pasta, whole wheat bread, and milk (presuming the patient is not lactose intolerant or gluten sensitive) contain L-tryptophan and carbohydrates that may help to promote sleep. Carbohydrates found in fruit also promote relaxation. This meal is high in saturated fat, which is slow to digest, and can interfere with sleep. Diet cola contains caffeine than can interfere with sleep patterns. While some tea is caffeine free, many teas are high in caffeine that interferes with sleep. However, keep in mind, this meal is not as effective at promoting sleep as other options.

A client has sought care because of insomnia that has been increasing in severity and frequency in recent months. What questions should the nurse include in an assessment of this client's health problem? Select all that apply. A) "Do you have a family history of sleep disturbances?" B) "Do you smoke?" C) "What medications are you currently taking?" D) "Do you have a consistent routine around getting ready for bed and going to bed?" E) "How would you characterize your mood lately?"

B) "Do you smoke?" C) "What medications are you currently taking?" D) "Do you have a consistent routine around getting ready for bed and going to bed?" E) "How would you characterize your mood lately?" Sleep is a multifaceted phenomenon that is affected by many variables. Among these are cigarette smoking, medications, sleep routines, and mood; the nurse should assess each of these areas. Sleep problems do not normally have a genetic basis.

The client is a male who states his wife complains that his snoring awakens her at night. The spouse is present. To obtain further data, the nurse asks the spouse what? A) "How loud is his snoring?" B) "Is there silence after snoring which then is followed with a snort?" C) "How long does he snore each night?" D) "How often are you awakened at night due to his loud snoring?"

B) "Is there silence after snoring which then is followed with a snort?" Snoring that is followed by silence and then a snort may be a sign of obstructive apnea. Snoring is not considered a sleeping disorder and is often more disturbing to the sleep partner.

Which group of terms best describes sleep? A) Decreased state of activity, refreshed B) Altered consciousness, relative inactivity C) Comatose, immobility D) Alert, responsive

B) Altered consciousness, relative inactivity Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Rest is a condition in which the body is in a decreased state of activity.

A nurse is caring for a client diagnosed with sleep apnea. What should the nurse do in order to promote sleep in the client? A) Encourage the client to lose weight. B) Avoid sedatives for sleeping. C) Encourage deep breathing exercises. D) Provide good ventilation in the room.

B) Avoid sedatives for sleeping. The nurse should avoid sedatives in the client because sedatives may depress respiration. The client with sleep apnea already has decreased ventilation and low blood oxygenation; the condition may become worse if the respiration is further depressed by sedatives. Losing weight is a long-term measure and is not applicable in this case. Encouraging deep breathing exercises and providing good ventilation may help the client, but they are secondary measures.

A middle-age adult man has just started an exercise program. What would the nurse teach him about timing of exercise and sleep? A) Exercising immediately before bedtime enhances ability to sleep B) Exercising within two hours of bedtime can hinder ability to sleep C) The time of day does not matter; exercise facilitates sleep D) The fatigue from exercise may be a hindrance to sleep

B) Exercising within two hours of bedtime can hinder ability to sleep Moderate exercise is a healthy way to promote sleep, but exercise that occurs within a two-hour interval before normal bedtime can hinder sleep.

A client with a sleep disorder experiences cataplexy. Which is a feature of this condition? A) Irresistible urge to sleep, regardless of the type of activity in which the client ais engaged B) Sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion C) Nightmare or vivid hallucinations experienced during sleep time D) Skeletal paralysis that occurs during the transition from wakefulness to sleep

B) Sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion Cataplexy is the sudden loss of motor tone that may cause the person to fall asleep; this is usually experienced during a period of strong emotion. Sleep attacks are irresistible urges to sleep, regardless of the type of activity in which the client is engaged. Hypnagogic hallucinations involve nightmares or vivid hallucinations. In sleep-onset REM periods, during a sleep attack, the person moves directly into REM sleep. Sleep paralysis is skeletal paralysis that occurs during the transition from wakefulness to sleep.

What is the most common method for ordering sleep medications? A) Stat B) p.r.n C) Single order D) Daily dose

B) p.r.n Sleep medications are often ordered on a p.r.n. (as needed) basis. These medications should be administered only when indicated, and always with the full knowledge of their limitations.

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? A) 7 8 hours B) 8 10 hours C) 10 12 hours D) 12 15 hours

B) 8 10 hours -this includes one nap that lasts about 1-3 hours and sleep about 10+ hours a night-After 18 months, naps are reduced from 2 to 1

A patient has been instructed to increase fluid intake but as a result has lost sleep to get up to void several times a night. What can the nurse recommend to decrease the interruption of sleep? A) Drink most of the liquids during the night. B) Drink most of the liquids before 5 p.m. C) Try drinking coffee instead of water. D) Drink the total amount of liquids before noon.

B) Drink most of the liquids before 5 p.m.

The patient tells the nurse, "I've always been able to maintain a steady weight by exercising and watching what I eat, but lately I seem to be steadily gaining weight." The nurse then collects a thorough sleep history. Why will the nurse ask the patient about her sleep habits? Select all that apply. Lack of sleep: a)Causes increased insulin production b)Reduces activity levels c)Increases appetite d)Leads to poor glucose tolerance e)Reduces total energy output

B, C, D Lack of sleep may increase the body's energy output to maintain the body's function, but exhaustion leads to less activity. Leptin and ghrelin hormone levels (hormones that regulate appetite) are altered with lack of sleep; this leads to an increase in appetite. Lack of sleep increases insulin resistance, not insulin production. Lack of sleep makes the body less able to tolerate glucose and causes greater insulin resistance, leading to weight gain. Sleep deprivation leads to fatigue with reduced opportunity for restoration, repair, healing, and growth.

A mother expresses concern that her 7-year-old has episodes of nocturnal enuresis approximately 3 to 4 times per week. The nurse's best response would be which of the following? Select all that apply. a)"Your daughter's bladder is still developing at this point in her life." b)"Be patient; most children outgrow enuresis." c)"Wake your daughter every 4 hours to use the bathroom." d)"You might consider purchasing protective pads for the bed." e)"Try a bed alarm to wake her when she starts wetting the bed at night."

B, D Enuresis is nighttime incontinence past the stage at which toilet training has been well established. Most incidents occur during NREM sleep when the child is difficult to arouse. As the great majority of children outgrow enuresis, the best strategy is patience. In the meantime, protecting the mattress from moisture and odor will help reduce frustration and embarrassment. A bed alarm can be used for older children (typically older than age 10 or 12) who are resistant to other behavioral strategies.

The nurse learns during assessment of a client that they have difficulty falling asleep, wake up early, and doesn't feel refreshed in the morning. What is the client most likely experiencing? A. ineffective coping B. disturbed sleep pattern C. increased sleep D. activity intolerance

B. disturbed sleep pattern

A nurse caring for patients in a busy hospital environment should implement which recommendation to promote sleep? A. keep the room light dimmed during the day B. keep the room cool C. keep the door of the room open D. offer a sleep aid medication to patients on a regular basis

B. keep the room cool Rationale: the nurse should keep the room cool, provide ear plugs, and provide eye masks for patients who are having trouble sleeping because of the hospital environment

A nurse is performing a sleep assessment on a patient being treated for a sleep disorder. During the assessment, the patient falls asleep in the middle of a conversation. The nurse would suspect which disorder? A. circadian rhythm sleep-wake disorder B. narcolepsy C. enuresis D. sleep apnea

B. narcolepsy Narcolepsy is an uncontrollable desire to sleep; the person may fall asleep in the middle of a conversation. Circadian rhythm sleep-wake disorders are characterized by a chronic or recurrent pattern of sleep-wake rhythm disruption primarily caused by an alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep-wake schedule desired or required; a sleep-wake disturbance (e.g., insomnia or excessive sleepiness); and associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder) (Sateia, 2014). Enuresis is urinating during sleep or bedwetting. Sleep apnea is a condition in which breathing ceases for a period of time between snoring.

The nurse has entered the room of a newly admitted client and observed a CPAP on the bedside table. The nurse would recognize this client has a history of what condition? A. narcolepsy B. sleep apnea C. insomnia D. somnambulism

B. sleep apnea

When the nurse attempts to wake a client who has just closed his eyes and appears to be asleep, the client says he's not asleep. What stage of sleep is he in? A. stage III B. stage I C. stage II D. stage IV

B. stage I stage 1= the transitional stage between drowsiness and sleep-indicated by a shift form alpha waves to low-voltage, fast theta on the EEG-usually only lasts a few minutes and it awakened, the person may say he was not asleep

Which of the following snacks is an appropriate snack to promote sleep in a patient? A. candy B. toast C. lunchmeat D. cheese

B. toast Rationale: carbohydrates promote sleep, avoid things high in sugar

A hospitalized client informs the nurse he has a routine before bed time. The client inquires about his ability to perform his routine. How does the nurse respond? A. we will need to talk to a physician and maintain an order B. we will include this in your evening plan of care C. you will have to talk to the UAP who helps you prepare for sleep D. it is difficult for clients to perform a bedtime routing during a hospital stay

B. we will include this in your evening plan of care

A person who is deprived of REM sleep for several nights in succession will usually experience: a)Extended NREM sleep b)Paradoxical sleep c)REM rebound d)Insomnia

C A person who is deprived of REM sleep for several nights will usually experience REM rebound. The person will spend a greater amount of time in REM sleep on successive nights, generally keeping the total amount of REM sleep constant over time.

Which of the following is the main difference between sleep and rest? a)In sleep, the body may respond to external stimuli. b)Short periods of sleep do not restore the body as much as do short periods of rest. c)Sleep is characterized by an altered level of consciousness. d)The metabolism slows less during sleep than during rest.

C During rest, the mind remains active and conscious; sleep is characterized by altered consciousness. Sleep is a cyclical state of decreased motor activity and perception. A sleeping person is unaware of the environment and does respond selectively to certain external stimuli. However, at rest, the body is disturbed by all external stimuli; sleep restores the body more than does rest. The metabolism decreases more during sleep than during rest.

What intervention might the nurse suggest to the patient to promote rest? a)Take benzodiazepine as prescribed. b)Avoid caffeine for several hours pc (after meals). c)Meditate for 30 to 60 minutes in the evening. d)Avoid watching television in the bedroom.

C Meditation helps to calm and relax the patient, reducing anxiety and stress, promoting rest. Medications are used to promote sleep, not rest. Caffeine before bedtime can disturb sleep, so this would not be the best advice to promote rest. Although watching television in the bedroom can interfere with falling asleep (generally it is best that the bedroom be an area used only for sleeping), television viewing is a passive activity and can be restful for some (depending on the program).

A patient states that many of his friends told him to ask for Valium or Ativan to help him sleep while hospitalized. The nurse knows that nonbenzodiazepines (such as Ambien) are often preferred over benzodiazepines (Ativan or Valium). Why is this? a)Benzodiazepines are eliminated from the body faster than are nonbenzodiazepines, so they do not provide a full night of sleep. b)Nonbenzodiazepines cause daytime sleepiness, allowing people to rest throughout the day. c)Benzodiazepines produce daytime sleepiness and alter the sleep cycle. d)Nonbenzodiazepines remain in the body longer than do benzodiazepines.

C Nonbenzodiazepines (such as Ambien) have a short half-life, which means that they are eliminated from the body quickly and do not cause daytime sleepiness. Ativan is a long-acting benzodiazepine and remains in the body longer than Ambien, often causing daytime sleepiness.

The nurse is performing a sleep assessment and suspects a patient is experiencing sleep apnea. What will be implemented next to confirm the diagnosis? a)Sleep diary b)Sleep history c)Polysomnography d)CPAP

C Polysomnography is the sleep study often implemented to confirm sleep apnea and determine the significance and cause of the problem. A sleep history is more comprehensive than is a sleep diary, although both would contribute to assessing the nature and extent of the patient's sleep issue. If the nurse performed a sleep assessment, then a sleep history would have been part of the process. CPAP (continuous positive airway pressure) is an intervention (not an assessment tool). This is a device that delivers oxygen using forced air pressure to keep the airways open when apnea occurs.

From what stage of sleep are people typically most difficult to arouse? a)NREM, alpha waves b)NREM, sleep spindles c)NREM, delta waves d)REM

C Stage III NREM (delta wave) is the deepest stage of sleep—not REM. It is difficult to awaken someone in stage III slow wave NREM sleep, and if she is awakened, the person may appear confused and react slowly. Stage I NREM is a light sleep from which the sleeper can easily be awakened. Stage II (sleep spindles) is also light sleep; the sleeper in this stage is easily roused. REM sleep is the stage at which most dream activity occurs, as well as more spontaneous awakenings.

When making rounds on the night shift, the nurse observes her patient to be in deep sleep. His muscles are very relaxed. When he arouses as the nurse changes the IV tubing, he is confused. What stage of sleep was the patient most likely experiencing? a)NREM I b)NREM II c)NREM III d)REM

C Stage III NREM is the deepest sleep. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage III sleep; if awakened, the person may appear confused and react slowly. During this stage, the body releases human growth hormone, which is essential for repair and renewal of brain and other cells.

A new mother is discussing her 6-month-old infant's sleep habits and expresses concern about the infant obtaining too much sleep. The mother reports the infant's circadian cycle as: Time period Activity 0600-0900 awake 0900-1100 sleep 1100-1300 awake 1300-1600 sleep 1600-1900 awake 1900-2200 sleep 2200-2400 awake 2400-0600 sleep The best statement by the nurse is: A) "Your infant requires more time asleep during the day hours." B) "You need to awaken your infant during the 2400 to 0600 time period." C) "Your infant is obtaining the average hours of sleep per day for an infant." D) "Your infant is actually obtaining too little sleep for one day.

C) "Your infant is obtaining the average hours of sleep per day for an infant." Infants usually require 14 to 20 hours of sleep per day. This infant is obtaining 14 hours of sleep each day.

What name is given to the rhythmic biologic clock that exists in humans? A) Sleep-wake cycle B) Alert-unaware process C) Circadian rhythm D) Yo-yo theory

C) Circadian rhythm Rhythmic biologic clocks are known to exist in plants, animals, and humans. Circadian rhythms complete a full cycle every 24 hours and in humans affect heart rate, blood pressure, body temperature, hormone secretions, and metabolism, as well as performance and mood.

A nurse is caring for a client who is sleeping for abnormally long periods of time. This condition may be caused by injury to which of the following body structures? A) Spinal cord B) Pancreas C) Hypothalamus D) Thyroid

C) Hypothalamus 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.

Which expected outcome demonstrates the effectiveness of a plan of care to promote rest and sleep? A) Verbalizes inability to sleep without medications B) Continues to read in bed for hours each night C) Identifies factors that interfere with normal sleep pattern D) Reports minimal improvement in quality of rest and sleep

C) Identifies factors that interfere with normal sleep pattern The nurse evaluates the effectiveness of the plan of care to promote rest and sleep by evaluating if the client has met the expected outcomes of the plan. If the client is able to identify factors that interfere with normal sleep patterns, this illustrates achievement of one expected outcome.

Which of the following is the most common sleep disorder? A) Hypersomnia B) Parasomnia C) Insomnia D) Dyssomnia

C) Insomnia Insomnia is characterized by difficulty falling asleep, intermittent sleep, or early awakening from sleep. It is the most common of all sleep disorders.

A sedative-hypnotic has been prescribed to help a client sleep. What should the nurse teach the client about this medication? A) It should be taken every night for several months B) It is useful for sleep but is better taken with alcohol C) It loses its effectiveness after one or two weeks D) It should be taken in the morning for long-term effects

C) It loses its effectiveness after one or two weeks Although most sedative-hypnotics provide several nights of excellent sleep, the medication often loses its effect after one or two weeks. Caution the client not to increase the dose or take the drug with alcohol to try to increase effect.

Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing which chemical? A) Neonephrine B) Seratonin C) Melatonin D) Dopamine

C) Melatonin Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing melatonin (a natural chemical produced at night that decreases wakefulness and promotes sleep).

Which of the following guidelines does the nurse apply to discussion of sleep patterns with older adult clients? A) Circadian rhythms become more prominent as clients age. B) The amount of stage 4 sleep increases as clients age. C) Total sleep time decreases as the clients age. D) Older clients fall asleep more quickly than younger ones.

C) Total sleep time decreases as the clients age. As people age, the amount of stage 4 sleep decreases significantly. Sleeping patterns may become polyphasic, with a shorter nocturnal period plus daytime naps.

A client is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder? A) Waking during sleep B) Restless leg syndrome C) Uncontrollable desire to sleep D) Decrease in the amount or quality of sleep

C) Uncontrollable desire to sleep Narcolepsy is a condition characterized by an uncontrollable desire to sleep. Narcolepsy is considered a neurologic disorder.

A client's bed partner reports the client often has irregular snoring and silence followed by a snort. Does this warrant further assessment? A) No, snoring has varied patterns B) No, this is a description of normal snoring C) Yes, this is an indicator of obstructive apnea D) Yes, the bed partner is unable to sleep at night

C) Yes, this is an indicator of obstructive apnea Snoring is caused by an obstruction to airflow through the nose and mouth. When snoring changes from the characteristic sawing wood sound to a more irregular silence followed by a snort, this indicates obstructive apnea.

A nurse is explaining the use of sleep hygiene to a patient experiencing insomnia. Which of the following statements accurately describe recommended guidelines for the use of this technique? Select all that apply. A) drink an alcoholic drink before bedtime B) take frequent naps during the day C) eat a light meal before bedtime D) sleep in a warm, dark room E) take a warm bath before bedtime F) eliminate the use of a clock in the bedroom

C) eat a light meal before bedtime E) take a warm bath before bedtime F) eliminate the use of a clock in the bedroom Explanation:Sleep hygiene involves the following: restricting the intake of caffeine, nicotine, and alcohol, especially later in the day; avoiding activities after 5 p.m. that are stimulating; avoiding naps; eating a light meal before bedtime; sleeping in a cool, dark room; eliminating use of a bedroom clock; taking a warm bath before bedtime; and trying to keep the sleep environment as quiet as possible (Gevirtz, 2007).

The patient is diagnosed with obstructive sleep apnea. Identify the symptoms you would expect the client to exhibit. Select all that apply. a)Bruxism b)Enuresis c)Daytime fatigue d)Snoring e)Drooling

C, D Obstructive sleep apnea is caused by partial airway occlusion (usually by the tongue or palate) during sleep. The patient experiences interrupted sleep as he arouses frequently to clear the airway. As a result, the patient has episodes of snoring and daytime fatigue

A nurse working the night shift in a pediatric unit observes a 10-year-old patient who is snoring and appears to have labored breathing during sleep. Upon reporting the findings to the primary care provider, what nursing action might the nurse expect to perform? A. prepare the family for a diagnosis of insomnia and related treatments B. prepare the family for a diagnosis of narcolepsy and related treatments C. anticipating the scheduling of polysomnography to confirm OSA D. no action would be taken, this is a normal finding for hospitalized children

C. RATIONALE: OSA (pediatric) is defined by the presence of one of these findings: snoring, labored/obstructed breathing, enuresis, or daytime consequences (hyperactivity or other neurobehavioral problems, sleepiness, fatigue). According to the American Academy of Pediatrics children and adolescents with symptoms of OSA, including snoring, should have polysomnography to confirm the diagnosis. Although OSA may cause insomnia, this is not the primary diagnosis in this case. Narcolepsy is a condition characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. This scenario is not usually a normal finding in hospitalized children during sleep.

When caring for a client with insomnia, the nurse would appropriately institute which intervention? A. encouraging them to nap frequently during the day to make up for lost sleep B. avoid food high in carbs before bedtime C. have them eliminate caffeine and alcohol in the evening because both are associated with sleep disturbances D. advise them to exercise vigorously before bedtime to promote drowsiness

C. have them eliminate caffeine and alcohol in the evening because both are associated with sleep disturbances -Caffeine= CNS stimulant= decrease ability to sleep in most ppl.-napping through the day interferes with the normal sleep cycle-exercise before bed does not promote drowsiness

A nurse is discussing with an older adult patient measures to take to induce sleep. What teaching point might the nurse include? A. drinking a cup of regular tea at night induces sleep B. using alcohol moderately promotes a deep sleep C. having a small bedtime snack high in tryptophan and carbohydrates can improve sleep D. exercising right before bedtime can hinder sleep

C. having a small bedtime snack high in tryptophan and carbohydrates can improve sleep RATIONALE: The nurse would teach the patient that having a small bedtime snack high in tryptophan and carbohydrates improves sleep. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity within a 3-hour interval before normal bedtime can hinder sleep.

The nurse is providing discharge instructions for a new mom about sleep practices for her newborn. The mother will be breast feeding. Which pertinent information will the nurse provide? A. position the baby on its side when preparing for sleep B. its okay to use a pillow to position the baby C. your newborn will probably sleep an avg of 16 hours a day D. it will be easier to breast feed if the infant sleeps in your bed

C. your newborn will probably sleep an avg of 16 hours a day

The patient tells the nurse, "After a couple of glasses of wine I sleep very soundly." After assessing further about the patient's alcohol history, what response by the nurse is most accurate? a)"Although alcohol helps you fall asleep, you will be more likely to awaken during the night and have trouble falling back to sleep." b)"If you quit drinking, you will find falling asleep more difficult, but you'll feel more rested when you awaken." c)"I know alcohol helps you to sleep but you could take a sleeping pill instead to help you fall asleep." d)"What else do you do on a regular basis that helps you to fall asleep and stay asleep?"

D Collecting a complete sleep history is the first step in caring for a patient with sleep difficulty. Alcohol (even wine), especially consumed in excess, hastens the onset of sleep but also disrupts REM and slow-wave sleep; it may cause spontaneous awakenings with difficulty returning to sleep. There is no evidence to support the benefit of alcohol in helping people to feel more rested upon awakening after heavy consumption, so this would be an inaccurate statement. Taking a sleeping pill instead of drinking alcohol is not an ideal trade-off because the goal is to promote natural sleep.

Which patient teaching would be most therapeutic for someone with sleep disturbance? a)Give yourself at least 60 minutes to fall asleep. b)Avoid eating carbohydrates before going to sleep. c)Catch up on sleep by napping or sleeping in when possible. d)Do not go to bed feeling upset about a conflict.

D Intense emotion before bedtime can interfere with rest and sleep. Lying awake longer than 30 minutes is counterproductive. Eating a small amount of a complex carbohydrate can aid in falling asleep. Avoid simple sugars because sucrose can lead to a short-term energy boost instead of relaxation. Taking naps during the day and sleeping late on some mornings can actually exacerbate a sleep disturbance. It's better to establish a consistent routine for wake and sleep. The extra sleep during the day can interfere with the body's readiness for sleep at night.

A 6-year-old boy is admitted to the hospital for a surgical procedure associated with a hospital stay. When the nurse asks his mother about the boy's sleep patterns, she says, "Sometimes he will get out of bed, walk into the kitchen, and get the cereal out of the cabinet. Then he just turns around and goes back to bed." The nurse explains that he is sleepwalking. The best nursing diagnosis for the boy would be: a)Risk for Insomnia related to sleepwalking b)Risk for Fatigue related to sleepwalking c)Disturbed Sleep Pattern related to dyssomnia d)Risk for Injury related to sleepwalking

D Sleepwalking occurs during stage III NREM sleep. The sleeper leaves the bed and walks about with little awareness of surroundings. He may perform what appear to be conscious motor activities but does not wake up and has no memory of the event on awakening. The boy is at high risk for injury when sleepwalking because of his lack of awareness of his surroundings. Insomnia is a medical diagnosis rather than a nursing diagnosis. Certainly his sleep pattern is disturbed; however, there is little in the way of independent actions that the nurse could take for either the problem or etiology of this diagnosis, so it would not be useful. The boy does not awaken while sleepwalking and is not likely to experience fatigue from the event.

Which is a major factor regulating sleep? a)Electrical impulses transmitted to the cerebellum b)Level of sympathetic nervous system stimulation c)Amount of sleep to which a person has become accustomed d)Amount of light received through the eyes

D The circadian rhythm is a biorhythm based on the day-night pattern in a 24-hour cycle. A person's circadian rhythm is regulated by a cluster of cells in the hypothalamus of the brainstem that respond to changing levels of light. A major factor in regulating sleep is the amount of light received through the eyes—not the typical amount of sleep the person has within a 24-hour period. The autonomic nervous system (rather than central nervous system) controls the involuntary processes of the body, such as sleep, digestion, immune function, and so on.

The patient tells the nurse, "I have terrible insomnia. It seems as though I am exhausted all the time." What question is most appropriate for the nurse to ask this patient? a)"What time do you go to bed at night?" b)"Are you experiencing much stress right now?" c)"Have you tried meditation to help you relax?" d)"Do you have trouble falling asleep or staying asleep?"

D The first question the nurse should ask the patient with an alteration in sleep is whether she has trouble falling asleep, staying asleep, or returning to sleep after she has awakened. Before recommending interventions to promote sleep, it is important for the nurse to gather data related to what the patient means by insomnia. The time the patient goes to sleep is not as important as how long she sleeps or whether there has been a significant change in sleep patterns. While assessing stress is an important factor in various alterations in sleep, the nurse would first gather information about the sleep quantity and quality before assessing specific factors contributing to insomnia.

Which of the following patients with inadequate or poor quality of sleep would be the best choice for a nursing diagnosis of Disturbed Sleep Patterns? a)Adolescent diagnosed with somnambulism b)Patient with obstructive sleep apnea c)Attorney who says she has no time for sleep d)New mother of twins

D The new mother of twins would experience disturbed sleep until the babies are mature enough to sleep through the night; therefore, this is a time-limited sleep problem and fits the diagnosis of Disturbed Sleep Patterns. The patient who is reported to walk in her sleep (somnambulism) would not fit the diagnosis of Disturbed Sleep Patterns because sleepwalking would not be time limited. In this case, the patient may not know she sleepwalks and may report no sleep problems. The patient diagnosed with obstructive sleep apnea would not fit the diagnosis because the irregular breathing pattern during sleep is not time limited. This patient does not have a time-limited change in sleep patterns and would not fit the diagnosis.

The expected outcome (goal) for a patient with Disturbed Sleep Pattern is that she will: a)Limit exercise to 1 hour per day early in the day b)Consume only one caffeinated beverage per day c)Demonstrate effective guided imagery to aid relaxation d)Verbalize that she is sleeping better and feels less fatigued

D The patient would verbalize that she is sleeping better and feels less fatigued. The expected outcome (goal) is based on the nursing diagnosis, and its achievement should reflect resolution of the problem. The other options are outcomes that demonstrate only that the patient took certain actions. They would not, if achieved, demonstrate that the problem of Disturbed Sleep Pattern had been resolved.

The spouse of a patient recently diagnosed with cancer reports feeling anxious and is having trouble sleeping at night despite feeling tired. The spouse says sleep was never previously a problem. What type of interventions would be first priority for the spouse? a)Promote physical comfort. b)Support bedtime routines. c)Create a restful environment. d)Promote relaxation.

D The stress of having a loved one diagnosed with cancer appears to be causing anxiety; therefore, interventions aimed at helping the spouse to relax would be most helpful in resolving the problem. The spouse is not experiencing pain, so interventions aimed at promoting comfort would not help this person to sleep. The spouse is physically tired; therefore, supporting bedtime rituals and routines would not resolve the underlying issue that is keeping the spouse from achieving restful sleep. The spouse reports feeling tired, so restful environment interventions would not resolve the anxiety causing the spouse to experience insomnia.

The pediatric nurse caring for a 3-year-old recognizes the most likely cause of sleep disturbances would be what? a)Concerns about friends b)Staying up to watch television c)Side effect of medication d)Fear of monsters

D Toddlers and preschoolers are likely to fear monsters or imaginary figures. Social concerns (worries about friends) are more likely to be seen in an older child. Staying up to watch television is more of a concern for older children. Use of medication that interferes with sleep is more common in adolescents and young adults.

Which medication is least likely to affect sleep quality? A) Diuretic B) Steroid C) Antidepressant D) Ambien

D) Ambien Sleep quality is influenced by drugs. Drugs that decrease sleep include diuretics, steroids, and antidepressants. Ambien and chloral hydrate appear to influence the quality of sleep least and promote normal sleep.

A nurse is caring for a client who complains about sleep apnea. Which of the following delivery devices should the nurse use to administer oxygen to this client? A) Nasal catheter B) Oxygen tent C) Transtracheal oxygen D) CPAP mask

D) CPAP mask The nurse should use a CPAP mask for a client with complaints of sleep apnea. A CPAP mask maintains positive pressure within the airway throughout the respiratory cycle. Clients generally wear this type of mask at night to maintain oxygenation when they experience sleep apnea. A nasal catheter is a tube for delivering oxygen that is inserted through the nose into the posterior nasal pharynx. It is used for clients who tend to breathe through the mouth or experience claustrophobia when a mask covers their face. An oxygen tent is a clear plastic enclosure that provides cooled, humidified oxygen, which is used for active toddlers. Transtracheal oxygen is a hollow tube inserted within the trachea to deliver oxygen to clients who require long-term oxygen therapy.

What independent nursing action can be used to facilitate sleep in hospitalized clients who are on bedrest? A) Administering prescribed sleep medications B) Changing the bed with fresh linens C) Encouraging naps during the daytime D) Giving a back massage

D) Giving a back massage Simple interventions, such as offering a back massage, can promote comfort and sleep in hospitalized clients on bedrest.

Which drug normalizes sleep cycles by enabling the body's supply of melatonin to naturally promote sleep? A) Flurazepam (Dalmane) B) Temazepam (Restoril) C) Eszopiclone (Lunesta) D) Ramelteon (Rozerem)

D) Ramelteon (Rozerem) The most recently approved sleep medication is Ramelteon (Rozerem). This drug is classified as a melatonin receptor agonist and it normalizes sleep cycles by enabling the body's supply of melatonin to naturally promote sleep (Goldsmith, 2007).

The parents of a boy 10 years of age are worried about his sleepwalking (somnambulism). What topic should the nurse discuss with the parents? A) Sleep deprivation B) Privacy C) Schoolwork D) Safety

D) Safety Somnambulism (sleepwalking) is a parasomnia, a pattern of waking behaviour that appears during sleep. It is more commonly seen in children and is commonly outgrown before adulthood. Safety and prevention of injury are paramount concerns.

Which individual is likely to require more hours of sleep? A) a person 75 years of age B) a person 43 years of age C) a person 25 years of age D) a person 15 years of age

D) a person 15 years of age Despite individual variations, growing children, especially adolescents who are in a tremendous growth period, require from 10 to 14 hours of sleep per night. This is in comparison with the accepted standard for adults, which is 8 hours. Older adults often require less sleep.

A nurse is discussing sleep problems with a patient. What type of foods would she recommend to promote sleep? A) one cup of hot chocolate B) three glasses of red wine C) a high-protein snack D) a carbohydrate snack

D) a carbohydrate snack

A nurse working in a sleep lab observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply. A. REM sleep constitutes much of the sleep cycle of a preschool child B. by the age of 8, most children no longer take naps C. sleep needs usually decrease when physical growth peaks D. many adolescents do not get enough sleep E. total sleep decreases in a adults with a decrease in stage IV of sleep F. sleep is less sound in older adults and stage IV sleep may be absent

D, E, F RATIONALE: Many adolescents do not get enough sleep due to the stresses of school, activities, and part-time employment causing restless sleep. Total sleep time decreases during adult years, with a decrease in stage IV sleep. Sleep is less sound in older adults, and stage IV sleep is absent or considerably decreased. REM sleep constitutes much of the sleep cycle of a young infant, and by the age of 5 years, most children no longer nap. Sleep needs usually increase when physical growth peaks.

When a nurse notes that the client appears to be sleeping, is demonstrating irregular aspirations, and is showing eye movement, the nurse identifies what stage of sleep? A. light sleep B. transitional C. slow wave D. REM

D. REM (rapid eye movement) REM is a deep stage of normal sleep. The body and brain go through several changes, including rapid movement of the eyes, fast and irregular breathing, increased heart rate (to near waking levels), changes in body temperature, increased blood pressure, and brain activity similar to that seen while awake. Muscular jerking, regular respiration, and transitioning to wakefulness are not indicative of REM sleep.

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'tmanage to get any sleep around here." How should the nurse first respond to this client's statement? A. obtain a PRN oder for a sedative from the physician B. facilitate a change in the patients diet C. educate the patient on relaxation techniques and reduce noise level on the unit D. assess the factors that the client believes contribute to the problem

D. 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.

When a client tells the nurse he has irresistible sleep attacks throughout the day lasting from 10-15 minuets, the nurse suspects the client may be experiencing? A. prolonged latency B. insomnia C. cataplexy D. narcolepsy

D. narcolepsy

A client calls a sleep clinic helpline and describes the spouse's sleep patterns of snoring loudly then becoming startled and waking up five or six times a night. The client is asking how to improve the spouse's sleep patterns. Which Information will the nurse include in teaching about healthy sleep patterns? Discuss the sleep pattern with the health care provider. Sleep in another room to limit your disruption of the spouse's sleep. Limit food intake before bed. The spouse's sleeping pattern seems normal.

Discuss the sleep pattern with the health care provider. The description of the client's snoring is suggestive of sleep apnea. The treatment plan should be to attempt detection of this disorder rather than disguising it by lowering the spouse's sensitivity to it. The client's spouse should discuss the symptoms with the health care provider. Advising the spouse that partners often sleep in separate rooms is not therapeutic and is masking potential sleep apnea. Snacks do not affect sleep apnea.

The nurse is caring for a client who reports insomnia. The client has recently moved from an area near a fire station in the inner city to the country. Which recommendation will the nurse make to facilitate sleep? Enjoy the peace and quiet of the country. Find a phone app that plays sounds of the city. Avoid eating right before bedtime. Ingest 1 ounce of liquor before going to sleep.

Find a phone app that plays sounds of the city. Clients tend to adapt to the unique sounds where they live, such as traffic, trains, and the hum of appliance motors or furnaces. Unfamiliar sounds tend to interfere with the ability to fall or stay asleep. The nurse will recommend that the client find an app that plays sounds of the city, which mimics the sounds with which the client is most familiar. Ignoring the problem by telling the client to adapt to the new environment does not address the problem. Avoiding eating before bedtime could cause the client to wake up hungry in the middle of the night. The nurse does not recommend alcohol, a depressive drug, to clients.

A 62-year-old client informs the nurse that the parent has been anxious and disoriented in the morning. The client also informs the nurse that the parent gets up frequently to use the bathroom. Which nursing intervention can decrease the disruption of sleep? Have your parent take diuretic medicine in the morning. Offer your parent iced tea before bed. Suggest your parent sleep without socks. Encourage your parent to take frequent naps during the day.

Have your parent take diuretic medicine in the morning. Taking a diuretic will promote the need for voiding within a few hours, interrupting the sleep cycle if taken at night. Taking the diuretic during the morning can lessen voiding effects later in the day. Tea is a weak stimulant but should be avoided close to bedtime. Older adults can have difficulty sleeping if they feel cold, so wearing socks to bed can promote restful sleep. Taking naps during the day can interfere with sufficient sleep at night.

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 patterns? Newborns have shorter periods of REM sleep. Newborns are inactive when awake. Newborns will nap two times per day. Newborns sleep 16 to 17 hours per day.

Newborns sleep 16 to 17 hours per day. Newborns sleep an average of 16 to 17 hours per 24 hours a day, divided into about seven sleep periods distributed fairly evenly throughout the day and night.

The student nurse is providing an education program for preschool parents. The nursing student should include which intervention to improve the child's sleep? The child should limit fluids after supper. The child should drink milk at bedtime. The parents should keep the child up until 10 PM. The child should sleep with the parents.

The child should limit fluids after supper. Parents and other caregivers can assist children in establishing the habit of voiding as part of preparing for bedtime. Drinking milk at bedtime, keeping the child up until 10 PM and sleeping with the parents will not improve the child's 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 The client has a slow, regular pulse. The client's metabolism and body temperature have decreased. The client's blood pressure decreases.

The client's eyes dart back and forth quickly 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.

A newly admitted client states to the nurse, "I average about 5.5 hours of sleep per night." What determination of this client's sleep patterns does the nurse discuss with the client? They are in need of medication to aid sleep. They are sleep deprived to some degree. They are an efficient sleeper. They are in need of a sleep clinic visit.

They are sleep deprived to some degree. Optimum daytime performance with minimal sleepiness and no accumulation of sleep debt in adults is related to obtaining 8 hours of sleep each night. Sleeping less than 6 hours has been linked to an increase in morbidity and early mortality.

A nurse is reviewing the medication administration record. Which order does the nurse question? a diuretic administered twice daily at 9 a.m. and 9 p.m. a diuretic administered once daily at 9 a.m. a diuretic administered twice daily at 9 a.m. and 5 p.m. a diuretic administered every other day at noon

a diuretic administered twice daily at 9 a.m. and 9 p.m. A diuretic should not be administered after 6 p.m. 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.