Chapter 35: Rest and Sleep

How long can apnea episodes last during OSA?

10 to 20 second, possibly as long as 2 minutes

What is stage 3 and 4 of NREM?

10% of sleep, deep sleep states (delta sleep)

What is REM sleep?

20% to 25% of a persons nightly sleep time

How many adults complain of insomnia?

30 to 35%

What is obstructive sleep apnea?

5 or more predominantly obstructive respiratory events during sleep, accompanied by sleepiness, fatigue, insomnia, snoring, subjective nocturnal respiratory disturbance, or observed apnea

What is stage 1 and 2 of NREM?

5 to 50% of sleep, light sleep

Adults with OSA may also present with:

o Hypertension o Coronary artery disease o Atrial fibrillation o Congestive heart failure o Stroke o Diabetes o Cognitive dysfunction o Mood disorder

How can environmental factors affect sleep?

o People tend to sleep best in their usual home environments o Sleeping in a strange or new environment tends to influence both REM and NREM sleep o People who are used to sleeping in noisy areas may find it hard to sleep in quiet areas, and vice versa

How many times during the night do we go through stage 1 of NREM?

only once

During long periods of apnea what happens?

oxygen levels drop, pulse become irregular, blood pressure increases

How does the sleep cycle occur?

the person passes through the 4 stages of NREM, then the pattern is reversed (4, 3, 2) instead of entering stage 1, REM sleep is entered, the person re-enters NREM sleep at stage 2 and moves on to 3 and 4

A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because: · they are the age group least likely to use prescribed sleep medications. · they are typically prone to sleep walking. · they may be disoriented on awakening. · they nap in the afternoon, which lessens their hours of sleep at night.

they may be disoriented on awakening.

What information is recorded in a sleep diary?

time patient retires; time patient tries to fall asleep; approximate time patient falls asleep; time of any awakening during the night and resumption of sleep; time of awakening in the morning; presence of any stressor affecting sleep; record food, drink, or medication affecting sleep; record of physical activities performed 2 to 3 hours before bedtime; presence of worries or anxieties affecting sleep

Which of the following snacks is an appropriate bedtime snack to promote sleep in a patient? a. candy b. toast c. lunchmeat d. cheese

toast

Which of the following snacks is an appropriate snack to promote sleep in a patient?

toast

T/F: somnabulism is a parasomnia in which the person walks in their sleep

true

What are orexin receptor antagonists?

used for insomnia

What are benzodiazepines?

used for patients experiencing difficulty with sleep onset and maintenance, difficulty returning to sleep after awakening during the night

What illnesses are associated with sleep disturbances?

§ GERD § Coronary artery disease § Epilepsy § Liver failure and encephalitis § Hypothyroidism § End-stage renal failure

The nurse awakens a client while the client is experiencing rapid eye movement sleep. What statement made by the client indicates they were awakened during REM sleep? · "I feel really cold." · "I heard you immediately when you came in my room." · "I was having a great dream and I remember all of it." · "It feels like I just went to sleep."

· "I was having a great dream and I remember all of it."

The nurse is educating a client about restless leg syndrome. What statement made by the client indicates that further education regarding restless leg syndrome is required? · "My heating pad will decrease the tingling in my legs." · "I won't drink any wine with dinner or in the evening." · "I will try to lose weight so I can sleep better at night." · "I will eliminate the use of tobacco products and caffeine."

· "I will try to lose weight so I can sleep better at night."

A hospitalized client informs the evening shift nurse about not being able to sleep without a shot of whiskey each night before bed and asks if the spouse can bring in a bottle. Which is the best response by the nurse? · "It will be difficult for you to continue that routine in the hospital." · "Let's discuss that with your health care provider." · "Do you really think that is a good habit?" · "Go ahead and ask your spouse to bring a bottle."

· "Let's discuss that with your health care provider."

A client comes to the clinic and states to the nurse, "I am traveling overseas for a project frequently and am having a difficult time adjusting because of jet lag. What is the best response by the nurse? · "If you have jet lag once, you shouldn't have any further problems on your next trip overseas." · "You should take sleeping pills when you board so that you will sleep until you arrive at your destination. · "Try to stay awake for the duration of the flight and sleep when you arrive." · "Light therapy can be beneficial and help ease the transition to a new time schedule or zone."

· "Light therapy can be beneficial and help ease the transition to a new time schedule or zone."

A client reports to the nurse, "Sleep really isn't necessary." Which teaching by the nurse is appropriate? Select all that apply. · "Sleep helps your immune system to fight off infections." · "Sleep helps your blood flow to the brain." · "Sleep takes time, which can be stressful for some people." · "Sleep can make your moods fluctuate over time." · "Sleep helps you to learn easier and remember more."

· "Sleep helps your immune system to fight off infections." · "Sleep helps your blood flow to the brain." · "Sleep helps you to learn easier and remember more."

The nurse is educating a client and spouse about sudden jerking that occurs during sleep. What is the most appropriate nursing response? · "When oxygen levels drop during sleep, muscles will jerk suddenly." · "Sudden twitches that occur during the early phases of sleep are common." · "Those are hypnogogic twitches that happen during REM sleep." · "Sudden jerking movements can indicate vivid dreaming."

· "Sudden twitches that occur during the early phases of sleep are common."

A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage? · Medulla · Hypothalamus · Cerebral cortex · Midbrain

· Hypothalamus

The nurse should obtain a sleep history on which clients as a protocol? · only clients who have been suffering from a sleep disorder · clients who suffer from a sleep disorder or who are spending time in the CCU · all clients admitted to a health care agency · only clients who suffer from a sleep disorder or have been unconscious

· all clients admitted to a health care agency

Which assessment finding(s) confirms or indicates that the client is experiencing rapid-eye movement (REM) sleep? Select all that apply. · Muscles are relaxed, but muscle tone is maintained. · Blood pressure and pulse rate show wide variations and fluctuate rapidly. · The client has wet the bed. · Deep tendon reflexes are depressed. · The client is unable to move.

Muscles are relaxed, but muscle tone is maintained. · Blood pressure and pulse rate show wide variations and fluctuate rapidly. · Deep tendon reflexes are depressed. · The client is unable to move.

· A nurse has been assigned to sit overnight with a client who has been demonstrating unsafe actions. The charge nurse asks the the nurse to monitor the client closely to help identify any deficits in sleep quality. For each characteristic, click to specify if it is consistent with the Rapid Eye Movement (REM) and/or the Non-Rapid Eye Movement (NREM) Reduction in metabolism

NREM

What are the stages of sleep?

NREM 1-4, REM

· A nurse has been assigned to sit overnight with a client who has been demonstrating unsafe actions. The charge nurse asks the the nurse to monitor the client closely to help identify any deficits in sleep quality. For each characteristic, click to specify if it is consistent with the Rapid Eye Movement (REM) and/or the Non-Rapid Eye Movement (NREM) Changes in BP

NREM and REM

The nurse is admitting a client that has obesity and is diagnosed with obstructive sleep apnea (OSA). The client states, "I just wake up a lot and don't feel rested but it's not a big deal." What education should the nurse provide about the complications related to OSA? OSA can cause a condition called respiratory alkalosis OSA can cause you to have seizures. OSA contributes to hypertension and heart disease. OSA is the cause of depression.

OSA contributes to hypertension and heart disease.

What can negatively affect sleep?

developmental considerations, motivation, culture, lifestyle and habits, environmental factors, psychological stress, illness, and medications

What is insomnia?

difficulty in falling asleep, intermittent sleep, or early awakening from sleep

What information is collected while obtaining a sleep history?

nature of the problem; cause of the problem; related S/S; when the problem began and how often it occurs; how the problem affects everyday living; severity of the problem and how it can be treated; how the patient is coping with the problem and success of treatments attempted

How can motivation affect sleep?

o A desire to be wakeful and alert helps overcome sleepiness and sleep o When there is minimal motivation to be awake, sleep generally follows

How can lifestyle and habits affect sleep?

o Activity and exercise increase fatigue and can promote relaxation followed by sleep o Increases REM and NREM sleep o Contributes to more restful sleep Dietary habits

What medications are associated with sleep disturbances?

o Benzodiazepines o Amphetamines o Antidepressants o Diuretics o Antiparkinsonian drugs o Antihypertensives o Steroids o Decongestants o Caffeine o Asthma medications

How can culture affect sleep?

o Children's bedtime rituals, sleeping position and place, and patterns of sleep may vary based on culture o Methods to enhance or foster sleep may be culturally influenced o A cultural orientation toward privacy and quiet makes sleep difficulty in a busy special care unit o Sensitivity to a patient's culture must be included in the plan of care for preparing a patient for evening sleep

A parent reports their 4-year-old child wakes up at night screaming and this occurs shortly after the child has fallen asleep. The nurse determines that the child takes a tub bath and the parent reads a story prior to bedtime at 8 p.m. What is the best response to the parent? Select all that apply. "It is common for this to occur in this age group." "Comforting your child when this occurs may help." "You will need to change your child's bedtime routine." "You may find a nightlight in his room is helpful." "Put the child in your bed to sleep when this occurs."

"It is common for this to occur in this age group." "Comforting your child when this occurs may help." "You may find a nightlight in his room is helpful."

A client asks the nurse if hot chocolate at bedtime will improve the client's sleep. Which is the best response by the nurse? "Milk is a better option to help you sleep." "Hot chocolate relaxes you and can help you sleep." "You should try cola to promote sleep." "Tea is the best option for promoting sleep."

"Milk is a better option to help you sleep."

What are the nonpharmacological treatments for lack of sleep?

cognitive behavioral therapy: progressive muscle relaxation techniques, stimulus control, sleep restriction, sleep hygiene measures, biofeedback and relaxation therapy

What is hypersomnia?

condition characterized by excessive sleeping, especially daytime sleeping

In which stage of NREM sleep does the person fall into a stage of sleep but can be aroused with relative ease?

stage 2

· A nurse has been assigned to sit overnight with a client who has been demonstrating unsafe actions. The charge nurse asks the the nurse to monitor the client closely to help identify any deficits in sleep quality. For each characteristic, click to specify if it is consistent with the Rapid Eye Movement (REM) and/or the Non-Rapid Eye Movement (NREM) Decrease in muscle motility

REM

· A nurse has been assigned to sit overnight with a client who has been demonstrating unsafe actions. The charge nurse asks the the nurse to monitor the client closely to help identify any deficits in sleep quality. For each characteristic, click to specify if it is consistent with the Rapid Eye Movement (REM) and/or the Non-Rapid Eye Movement (NREM) Increase in body temperature

REM

· A nurse has been assigned to sit overnight with a client who has been demonstrating unsafe actions. The charge nurse asks the the nurse to monitor the client closely to help identify any deficits in sleep quality. For each characteristic, click to specify if it is consistent with the Rapid Eye Movement (REM) and/or the Non-Rapid Eye Movement (NREM) Increase in heart rate

REM

A client has voiced concerns about their ongoing inability to fall asleep. What aspectss of the client's health history will the nurse identify as potential causative factors? Select all that apply. · Smokes 1 pack of cigarettes daily · History of hyperthyroidism · Exercises 30 to 60 minutes daily · Works 30 hours per week · Drinks black tea with all meals

Smokes 1 pack of cigarettes daily · History of hyperthyroidism · Drinks black tea with all meals

What is restless leg syndrome?

a condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling or tingling sensation in the legs

What are nonpharmacologic interventions for a patient with insomnia?

a small protein snack before bed, stopping misuse of coffee and alcohol, cognitive behavioral therapy

What is sleep?

a state of rest accompanied by altered consciousness and relative inactivity

How can OSA be diagnosed?

based on frequency of obstructive respiratory events that occur at a rate of >15 events per hour, even in the absence of associated symptoms or health disorders

What are pharmacologic sleep aids?

benzodiazipines, selective melatonin receptor agonist, orexin receptor antagonists, selective histamine receptor antagonists

How does caffeine affect sleep?

blocks the ability of adenosine to cause drowsiness

How can psychological stress affect sleep?

caused by illness or life situations that disturb sleep by making it difficult to obtain the amount of sleep needed and REM sleep decreases leading to anxiety and stress

In which stages of sleep does the depth of sleep increases and arousal becomes increasingly difficult?

stage 3 and 4

What are selective melatonin receptor agonists?

facilitates the onset of sleep but is not intended for sleep maintenance

T/F: Barbiturates, amphetamines, and antidepressants increase REM sleep

false; they decrease

Enuresis

involuntary urination; most often used to refer to a child who involuntarily urinates during the night

What do large quantities of alcohol do to sleep?

limit REM and delta sleep

In which of the following sleep disorders does the patient have uncontrollable desire to sleep?

narcolepsy

What are selective histamine receptor antagonists?

patients experiencing difficulty with sleep maintenance

What is parasomnia?

patterns of waking behavior that occur during sleep (sleep walking, sleep talking, nocturnal erections)

What occur during REM sleep?

pulse, respiratory rate, blood pressure, metabolic rate, and body temperature increase; skeletal muscle tone and deep tendon reflexes are depressed

What is rest?

refers to a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed

What are the pharmacological treatments for lack of sleep?

sedatives or hypnotics

What are the screening tools to assess sleep disturbances?

sleep diary; the Epworth sleepiness scale; the Pittsburgh sleep quality index; STOP-Bang questionnaire; stanford sleepiness scale

What is somnabulism?

sleep walking

In which stage of NREM sleep is the person in a transitional stage between wakefulness and sleep?

stage 1

A nurse is caring for a client newly diagnosed with sleep apnea. Which should the nurse teach the client about the most important reason why the continuous positive air pressure (CPAP) device should be used during sleep? · "The CPAP prevents you from snoring so your spouse can sleep." · "The CPAP assures you get enough oxygen throughout the night." · "By maintaining the oxygen in your body during sleep other health problems can be avoided." · "Using the CPAP will increase your energy during the day by allowing you to sleep at night."

· "The CPAP assures you get enough oxygen throughout the night."

Which client could be diagnosed with insomnia? · A 20-year-old man who is reporting excessive drowsiness at work to the point that he falls asleep while at his computer. He goes to bed at 11 p.m. and wakes up at 7 a.m. without difficulty. Twice in the last year he passed out after getting extremely angry. · A 40-year-old obese man who is reporting fatigue. He states that he goes to bed around 9 p.m. every night and wakes up between 5 and 6 in the morning. He feels like he gets a good night's sleep, but his wife says that she constantly has to poke him throughout the night because he "stops breathing." · A 45-year-old woman who has been reporting fatigue for the last year. When asked about her sleep schedule, she states that she usually goes to bed around 1 a.m. and gets up at 7 a.m. when her 5-year-old daughter gets up. She describes herself as a night owl. · A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m.

· A 50-year-old woman who is reporting increased irritability for the past 2 months. She states that she goes to bed at 10 p.m. every night and tries to sleep in but, no matter what she does, she always wakes up around 4 a.m.

An older adult client tells the home care nurse that he doesn't seem to sleep as well as he used to. The nurse will teach the client about what age-related change to sleep patterns in older adults? · An increase in stage II of the sleep cycle. · A decrease in the deep sleep stage of the sleep cycle. · A change in the normal progression of the sleep cycle. · A decrease in stage I of the sleep cycle.

· A decrease in the deep sleep stage of the sleep cycle.

Which client should the nurse monitor most closely for frequent nocturia? · A client being treated for a respiratory infection · A middle-aged woman experiencing menopause · A client with obesity · An older adult with an enlarged prostate

· An older adult with an enlarged prostate

The nurse observes the sleep pattern of an obese client with cardiac disease and notes occasional periods of apnea. Which initial action should the nurse take? · Assess the client's vital signs and pulse oximetry. · Ask a colleague to come and observe the sleep pattern. · Administer bronchodilators · Review the client's health record for factors contributing to sleep disturbances.

· Assess the client's vital signs and pulse oximetry.

Which is not a lifespan consideration for sleep cycles? · In adolescents, there is a shift to later evening bedtime. · Getting the toddler and preschooler to fall asleep is a common problem. · By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases. · Newborns can sleep up to 16 to 18 hours per day.

· By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases.

The nurse is caring for a client with a diagnosis of insomnia who is returning to share the success of their sleep plan. Which statement by the client indicates that the plan was successful? · Client can explain the direct actions of the hypnotic prescribed. · Client verbalizes feeling rested. · Client identifies how many NREM cycles progressed through nightly. · Client describes the dreams experienced.

· Client verbalizes feeling rested.

A client is experiencing slow-wave sleep. What assessment finding will the nurse identify as being consistent with this sleep stage? · Decreased temperature · Increased heart rate · Irregular respirations · Increased blood pressure

· Decreased temperature

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? · 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.

· Discuss the sleep pattern with the health care provider.

Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern? · Do you usually go to bed and wake up about the same time each day? · In what way does the sleep you get each day affect your everyday living? · What do you usually do to help yourself fall asleep? · How much sleep do you think you need to feel rested?

· Do you usually go to bed and wake up about the same time each day?

The nurse is caring for a client who reports an inability to sleep. Which education provided by the nurse promotes sleep hygiene? · Eat two oranges at bedtime, as vitamin C promotes sleep. · Drink a warm beverage at bedtime such as hot tea or coffee. · Take a tepid bath at bedtime to lower body temperature. · Ensure adequate exposure to natural sunlight during the day.

· Ensure adequate exposure to natural sunlight during the day.

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? · Find a phone app that plays sounds of the city. · Enjoy the peace and quiet of the country. · Avoid eating right before bedtime. · Ingest 1 ounce of liquor before going to sleep.

· Find a phone app that plays sounds of the city.

The nurse is assessing an older adult client that reports feeling fatigued and tired throughout the day. What is the nurse's best action? · Have the client further evaluated for depression · Encourage the client to increase the amount of fluids during the evening hours · Encourage the client to drink or eat more foods with caffeine during the day · Inform the client that taking frequent naps during the day will help

· Have the client further evaluated for depression

The pediatric nurse teaches parents about normal sleep patterns in their children. Which education point should the nurse include? · Teach parents of infants to report any eye movements, groaning, or grimacing by their infant during sleep periods. · Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap. · Inform parents about the preschool child's awareness of the concept of death possibly occurring and encourage parents to help alleviate the child's fears. · Advise parents that waking from nightmares or night terrors is common during the adolescent stage.

· Inform parents that daytime napping decreases during the preschool period, and, by the age of 5 years, most children no longer nap.

A nurse is explaining to an insomniac client the effect of a prescribed medication and the different phases of sleep. Which statement is true for nonrapid eye movement (NREM) sleep? · It is called slow wave sleep. · It is called active sleep. · It is the deepest stage of sleep. · It is called paradoxical sleep.

· It is called slow wave sleep.

A newly admitted client with chronic obstructive pulmonary disease informs the nurse that they frequently awakens during the night. The nurse should acvocate for what intervention? · Hypnotic medication · Opioid analgesic · Portable room heater · Low-flow oxygen

· Low-flow oxygen

The client reports to the sleep clinic for a study following reports of sleepwalking and enuresis. Which sleep stage of non-rapid eye movement (NREM) sleep is affected based on the client's reports? · NREM theta · NREM delta · NREM alpha · NREM kappa

· NREM delta

What are interventions to promote sleep?

· Prepare a restful environment · Promote bedtime rituals · Offer appropriate bedtime snacks and beverages · Promote relaxation and comfort · Respect normal sleep-wake patterns · Schedule nursing care to avoid disturbances · Use medications to promote sleep · Teach about rest and sleep

A new client in the medical-surgical unit reports difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nurse identifies the nursing concern of altered sleep pattern with insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this this client's nursing concern? · Use tactile relaxation techniques, such as a back massage. · Provide an opportunity for the client to talk about concerns. · Bring the client a warm glass of milk at bedtime. · Help the client maintain normal bedtime routine and time for sleep.

· Provide an opportunity for the client to talk about concerns.

The nurse is planning health education sessions for adults which will focus on the role of sleep and strategies for enhancing sleep. What principle will the nurse integrate into the education plan? · Previously established norms for the quantity of sleep for adults have been proven excessive · Sleep sufficiency is essential for overall health and wellness · Older adults normally have unrealistic expectations for sleep quality and quantity · Napping should be avoided in order to ensure adequate nighttime sleep

· Sleep sufficiency is essential for overall health and wellness

The nurse is providing health promotion education regarding sleep. What topic should the nurse prioritize? · Reducing sleep latency for adult clients · Preventing nightmares in children · Helping new parents to have their infants sleep through the night · Strategies for ensuring adolescents receive adequate sleep

· Strategies for ensuring adolescents receive adequate sleep

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 drink milk at bedtime · The parents should shift the child's bedtime one to two hours later · The child should sleep in the same room as the parents · The child should limit fluids after supper

· The child should limit fluids after supper

The nurse is creating a plan of care for a client that is reporting an inability to sleep and rest. What outcome criterion will the nurse address for a goal that the client will demonstrate physical signs of being rested? · The client reports a decrease in sleep latency to 10-15 minutes. · The client reports less anxiety regarding falling asleep. · The client has decreases both in under-eye circles and in excessive yawning by 1 week. · The client reports drinking only one cup of coffee a day.

· The client has decreases both in under-eye circles and in excessive yawning by 1 week.

A client is worried and states, "I just know I won't be able to sleep before my surgery." What sleeping pattern would the nurse anticipate? · The client will likely sleep all night. · The client will probably not be able to stay asleep. · The client will likely not be able to sleep. · The worry will make the client fall asleep quickly.

· The client will likely not be able to sleep.

A nurse is working with an older adult client who has been diagnosed with onset insomnia and informs the nurse about waking at least once during the night. What actions by the nurse can help promote adequate sleep? Select all that apply. · The nurse teaches the client that shorter, unbroken sleep periods are not normal. · The nurse encourages the client to remove the television from the bedroom. · The nurse advises the client to exercise no closer than 6 hours to bedtime. · The nurse helps the client come up with a bedtime routine that can be implemented each night. · The nurse encourages the client to minimize caffeine intake several hours prior to bedtime.

· The nurse encourages the client to remove the television from the bedroom. · The nurse advises the client to exercise no closer than 6 hours to bedtime. · The nurse helps the client come up with a bedtime routine that can be implemented each night. · The nurse encourages the client to minimize caffeine intake several hours prior to bedtime.

The nurse is assessing a client and determines that they are in rapid eye movement (REM) sleep. What finding indicates to the nurse that the client is in this stage? · There is muscle jerking that may awaken the individual. · There is rapid eye movement under the eyelids. · Respirations are regular. · The individual is transitioning from wakefulness to sleep.

· There is rapid eye movement under the eyelids.

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

The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects which primary nursing concern? · altered role performance related to inability to work at occupation · altered sleep pattern related to acute pain · anxiety related to hospitalization · altered physical mobility related to restless leg syndrome

· altered sleep pattern related to acute pain

The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to: · take a prescribed sedative before trying to sleep. · insert an oral appliance prior to attempting sleep. · apply a facial mask that will deliver positive air pressure. · anticipate sleeping overnight at a health care center.

· anticipate sleeping overnight at a health care center.

The nurse is instructing a parent on how to promote restful sleep for a child. What food would be the best bedtime snack for the child? · grapes with honey · cheese and crackers · chocolate bar · tuna salad

· cheese and crackers

A nursing instructor is describing the difference between sleep and rest. Which characteristic would the instructor identify as distinguishing sleep from rest? · decrease in awareness of environment · involves all the body systems · decrease in cognitive response to stimuli · decrease in motor response to stimuli

· decrease in awareness of environment

The nurse is performing an intake assessment of a 60-year-old client who admits to having a nightcap of 4 to 6 ounces of scotch whisky each night. What effect might this alcohol be having on the client's sleep? · shorter sleep cycles · increased amount of total sleep · decreased REM sleep

· decreased REM sleep

The nurse is discussing sleep interventions with a client. What statement made by the client indicates an understanding of sleep restriction? · taking prescribed stimulant medication to counteract narcolepsy · limiting time in bed to actual sleep time · purposefully shortening sleep time over several nights to reach a point when lengthy sleep is necessary · never allowing sleep in a new environment

· limiting time in bed to actual sleep time

A nurse working in a health clinic assesses sleep patterns during each health assessment. Based upon the nurse's knowledge regarding sleep needs, the nurse recognizes which age group as generally needing the least amount of sleep? · adolescents · infants · older adults · young adults

· older adults

The client being seen in the employee wellness clinic reports difficulty sleeping for the past several months. The most important assessment the nurse could make is: · identifying specific foods that negatively impact sleep. · having the client recall the number of sleep hours each night for the past week. · asking the client's bed partner to describe the sleep problem. · reviewing the client's sleep diary for the past 2 weeks.

· reviewing the client's sleep diary for the past 2 weeks.

The nurse is caring for a client with narcolepsy. The client reports experiencing being unable to move upon awakening from sleep. The client's spouse states that the client makes sandwiches in the middle of the night, yet the client does not recall this behavior. How does the nurse document these concerns? · cataplexy and hypnogogic hallucinations · hypnogogic hallucinations and sleep paralysis · sleep paralysis and automatic behavior · sleep paralysis and hypnogogic hallucinations

· sleep paralysis and automatic behavior

A client begins snoring and is sleeping lightly. The stage of sleep is: · stage 3. · stage 4. · stage 2. · stage 1.

· stage 2.

The nurse is completing a sleep history on a client who reports sleeping problems. Which of the client's regular behaviors will cause the client to have difficulty with sleep? · drinking 2 cups of coffee every morning · taking a diuretic at 9 a.m. and 5 p.m. daily · using a white noise machine to mask outside noise · exercising immediately after getting off work at 5 p.m.

· taking a diuretic at 9 a.m. and 5 p.m. daily

Which factor has the most influence on an individual's sleep-wake patterns? · the inner biologic clock · daylight and darkness · the body's need for 8 hours of sleep · bedtime rituals

· the inner biologic clock