Chapter 43

The nurse is teaching a patient about the use of herbal medicines. Which statements by the patient indicate effective learning? Select all that apply. "Herbal medicines cause insomnia." "Herbal medicines cause sleep apnea." "Herbal medicines always cause allergic reactions." "Herbal medicines may interact with prescribed medication." "Herbal medicines are not regulated by the U.S. Food and Drug Administration."

"Herbal medicines may interact with prescribed medication." "Herbal medicines are not regulated by the U.S. Food and Drug Administration."

Which statement made by the patient indicates a need for further teaching on sleep hygiene? "I'm going to do my exercises before I eat dinner." "I'll have a glass of wine at bedtime to relax." "I set my alarm to get up at the same time every morning." "I moved my computer to the den to do my work."

"I'll have a glass of wine at bedtime to relax."

Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching? "I won't put the baby to bed with a bottle." "For the first few weeks we're putting the cradle in our room." "My grandmother told me that babies sleep better on their stomachs." "I know I'll have to get up during the night to feed the baby when he wakes up."

"My grandmother told me that babies sleep better on their stomachs."

A patient questions the nurse about narcolepsy. Which response by the nurse is accurate? 1 "Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states." 2 "Narcolepsy is a disorder characterized by the lack of airflow through the nose and mouth." 3 "Narcolepsy is a symptom that patients experience when they have chronic difficulty falling asleep." 4 "Narcolepsy involves sudden muscle weakness during intense emotions such as anger, sadness, or laughter."

1 "Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states."

A patient reports difficulty falling asleep. Further assessment shows that the patient consumes alcohol. What are the effects of alcohol on sleep? Select all that apply. 1 Alcohol promotes sleep. 2 Alcohol prevents the patient from falling asleep. 3 Alcohol causes the patient to remain awake. 4 Alcohol awakens the patient early and causes difficulty in returning to sleep. 5 Alcohol reduces rapid eye movement (REM) sleep.

1 Alcohol promotes sleep. 4 Alcohol awakens the patient early and causes difficulty in returning to sleep. 5 Alcohol reduces rapid eye movement (REM) sleep.

What nursing intervention should the nurse provide to a patient who is diagnosed with fatigue? A. Encourage short naps if possible B. Instruct the patient to keep an exercise log C. Have the patient keep a sleep log for a week D. Use active listening when talking to patient

A. Encourage short naps if possible Rationale: P. 1120

Which question would the nurse ask during the assessment of a patient who is suspected of having insomnia? A. "Do you snore loudly?" B. "How easily do you fall asleep?" C. "Do you have vivid, lifelike dreams?" D. "Have you ever had episodes of falling to the floor?"

B. "How easily do you fall asleep?" Rationale: P. 1115

A head nurse is teaching nursing students about the different phases of sleep. What information should the nurse include? Select all that apply. 1 Children experience more stage 4 nonrapid eye movement (NREM) sleep. 2 Dreams occur during rapid eye movement (REM) sleep only. 3 Personality has an influence on dreams. 4 Dreams occur during both NREM and REM sleep. 5 There is a decreased epinephrine release during REM sleep

1 Children experience more stage 4 nonrapid eye movement (NREM) sleep. 3 Personality has an influence on dreams. 4 Dreams occur during both NREM and REM sleep.

The nurse is gathering a sleep history from a patient who is being evaluated for obstructive sleep apnea. Which common symptoms does the patient most likely report? Select all that apply. 1 Headache 2 Early wakening 3 Excessive daytime sleepiness 4 Difficulty falling asleep 5 Snoring

1 Headache 3 Excessive daytime sleepiness 5 Snoring

The nurse is developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? 1. Instruct the patient to sleep in a supine position. 2. Have patient limit fluid intake 2 hours before bedtime. 3. Elevate head of bed and assume a side or prone position. 4. Encourage the patient to take an over-the-counter sleep aid.

3. Elevate head of bed and assume a side or prone position.

How many hours of sleep are typically required to prevent fatigue in a 6-year-old child? 6 hours 8 hours 10 hours 12 hours

12 hours Rationale: A 6-year-old child typically requires 11 to 12 hours of sleep to be free of fatigue. An adult requires about 6 to 9 hours of sleep for a fatigue-free day. An 11-year-old child requires 9 to 10 hours of sleep to prevent fatigue. P. 1111

How long before bedtime should a patient take melatonin? blank hours

2 Rationale: P. 1123

Which priority nursing intervention does the nurse incorporate into a plan of care to promote sleep for a hospitalized patient? 1 Have patient follow hospital routines. 2 Cluster nursing activities. 3 Give prescribed sleeping medications at dinner. 4 Turn television on low to late-night programming

2 Cluster nursing activities. Rationale: P. 1124

Which sleep assessment tool asks the patient to separately rate the quality and quantity of sleep? 1 Visual analog scale (VAS) 2 Numeric rating scale 3 Epworth Sleepiness Scale 4 Pittsburgh Sleep Quality Index

2 Numeric rating scale Rationale: P. 1114

A 72-year-old patient asks the nurse about using an over-the-counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse's best response? 1. "Antihistamines are better than prescription medications because these can cause a lot of problems.: 2. "Antihistamines should not be used because they can cause confusion and increase your risk of falls." 3. "Antihistamines are effective sleep aids because they do not have many side effects." 4. "Over-the-counter medications when combined with sleep hygiene measures are a good plan for sleep.

2. "Antihistamines should not be used because they can cause confusion and increase your risk of falls."

In which order would a nurse perform the steps of a sleep assessment of a patient using the visual analogue scale? 1. Use the scale repeatedly to show change over time. 2. Draw a straight horizontal line 100 mm (4 inches) long. 3. Measure the distances of the mark along the line in millimeters or inches. 4. Mark one end of the line as "best night's sleep" and one end as "worst night's sleep." 5. Make the patient mark a point according to the patient's sleep perception about the previous night.

2. Draw a straight horizontal line 100 mm (4 inches) long. 4. Mark one end of the line as "best night's sleep" and one end as "worst night's sleep." 5. Make the patient mark a point according to the patient's sleep perception about the previous night. 3. Measure the distances of the mark along the line in millimeters or inches. 1. Use the scale repeatedly to show change over time. Rationale: P. 1114

The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? (Select all that apply.) 1. Can cause urinary retention 2. Should not be used indefinitely 3. May have toxic effects on the liver 4. May cause diarrhea and anxiety 5. Are not regulated by the U.S. Food and Drug Administration (FDA)

2. Should not be used indefinitely 3. May have toxic effects on the liver 5. Are not regulated by the U.S. Food and Drug Administration (FDA)

A patient who has alcoholism complains of disturbed sleep and fatigue. Which statements should the nurse include when teaching the patient? Select all that apply. 1 "Alcohol causes nightmares." 2 "Alcohol prevents the onset of sleep." 3 "Alcohol causes awakening from sleep." 4 "Alcohol causes difficulty returning to sleep." 5 "Alcohol reduces rapid eye movement (REM) sleep."

3 "Alcohol causes awakening from sleep." 4 "Alcohol causes difficulty returning to sleep." 5 "Alcohol reduces rapid eye movement (REM) sleep."

The nurse works on a medical-surgical unit. Which patients require further assessment to determine the risk of developing obstructive sleep apnea? Select all that apply. 1 The patient with arthritis 2 The patient with anemia 3 The patient with hypertension 4 The patient who is a chronic smoker 5 The patient who has type II diabetes

3 The patient with hypertension 4 The patient who is a chronic smoker 5 The patient who has type II diabetes

What are the potential adverse effects of sleep medications? 1 Vomiting 2 Dehydration 3 Sleep driving 4 Allergic reactions 5 Severe facial swelling

3 Sleep driving 4 Allergic reactions 5 Severe facial swelling Rationale: P. 1125

Which patient is at risk of developing central sleep apnea (CSA)? Select all that apply. A patient with encephalitis A patient with nasal polyps A patient with enlarged tonsils A patient with muscular dystrophy A patient with a large neck circumference

A patient with encephalitis A patient with muscular dystrophy Rationale: CSA involves dysfunction in the respiratory control center of the brain. Patients with encephalitis and muscular dystrophy are at risk of developing CSA because of a fall in blood oxygen saturation levels. Obstructive sleep apnea (OSA) occurs when muscles or structures of the oral cavity or throat relax during sleep. Therefore patients with nasal polyps, enlarged tonsils, and a large neck circumference are at risk of developing OSA and not CSA. P. 1109

Which question asked by the nurse would help assess predisposing factors for a sleep disturbance? Select all that apply. A. "Do you smoke?" B. "When did you notice the problem?" C. "Do you consume alcohol?" D. "Do you have a family history of osteoporosis?" E. "How is your mood?"

A. "Do you smoke?" C. "Do you consume alcohol?" E. "How is your mood?" Rationale: P. 1115

The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? A. "I always feel tired when I wake up in the morning." B. "I go to bed at the same time each night." C. "It takes me about 15 minutes to fall asleep." D. "Sometimes, I have to get up during the night to urinate."

A. "I always feel tired when I wake up in the morning." Rationale: P. 1119

Which physiologic symptom is observed in the nurse who has a sleep disorder because of working rotating shifts? Select all that apply. A. Blurred vision B. Increased reflexes C. Decreased judgment D. Slowed response time E. Increased visual alertness

A. Blurred vision C. Decreased judgment D. Slowed response time Rationale: Sleep deprivation occurs due to rotating shifts because the human biological clock becomes maladjusted. This can cause neurological slowness, blurred vision, decreased judgment, and slowed response time. Sleep deprivation causes decreased reflexes and decreased visual alertness. P. 1110

Which point would be included in a teaching session for a group of high school students about health-promoting behaviors that improve sleep? Select all that apply A. Do not study in bed B. Go to sleep each night when tired C. Turn off cell phones at bedtime D. Avoid drinking coffee or soda before bedtime E. Watch television in bed to help fall asleep

A. Do not study in bed C. Turn off cell phones at bedtime D. Avoid drinking coffee or soda before Rationale: P. 1121

Which question would the nurse ask during the assessment of a patient with suspected sleep apnea? Select all that apply. A. Do you snore loudly B. How easily do you fall asleep C. What do you do to prepare for sleep D. Do you fall asleep at inappropriate times E. Do you experience headaches after awakening

A. Do you snore loudly E. Do you experience headaches after awakening Rationale: P. 1115

Which activity is done during the implementation phase for a patient with sleep disturbances? A. Instructing the patient to keep an exercise log B. Determining the current sleep patterns of the patient C. Asking the patient if expectations of care are being met D. Reviewing the factors that promote sleep with the patient

A. Instructing the patient to keep an exercise log Rationale: P. 1120

Which information would the nurse likely obtain from parents while performing a sleep assessment of a 3-month-old infant? A. The infant's eating pattern B. The frequency of benzodiazepine use C. The sleep log of the infant's sleep behavior only at night D. The specific routines of the infant

A. The infant's eating pattern Rationale: P. 1113

Which action would the nurse take as part of the evaluation phase of the nursing process? Encourage the patient to begin walking routinely during the day Question the patient about any physical signs of sleep problems and disturbances Ensure that the patient will achieve a better sleep pattern within 4 weeks Ask the patient to describe sleeping quality after using relaxation techniques

Ask the patient to describe sleeping quality after using relaxation techniques

Which advice would the nurse give to a patient who falls asleep uncontrollably at inappropriate times and has vivid dreams during such times? Select all that apply. Avoid alcohol. Avoid smoking. Avoid chewing gum. Avoid heavy meals. Avoid long-distance driving.

Avoid alcohol. Avoid heavy meals. Avoid long-distance driving. Rationale: Alcohol, heavy meals, and long-distance driving tend to induce drowsiness and should be avoided, because the patient's symptoms indicate narcolepsy. Smoking is not related to narcolepsy. The patient should not avoid chewing gum; in fact, chewing gum is recommended for patient with narcolepsy. PP. 1109-1110

Which question would the nurse ask to assess the patient's insomnia? Select all that apply. A. "How frequently do you eat out?" B. "How easily do you fall asleep?" C. "What causes you to awaken early?" D. "What do you think of when you try to fall asleep?" E. "Do you stay with your parents?"

B. "How easily do you fall asleep?" C. "What causes you to awaken early?" D. "What do you think of when you try to fall asleep?" Rationale: P. 1115

The nurse is providing health teaching to a patient using herbal compounds such as melatonin for sleep. Which points need to be included? Select all that apply. A. It can cause urinary retention. B. It should not be used indefinitely. C. It may cause diarrhea and anxiety. D. It may interfere with prescribed medications. E. It can lead to further sleep problems when taken long term. F. It is not regulated by the U.S. Food and Drug Administration (FDA).

B. It should not be used indefinitely. D. It may interfere with prescribed medications. E. It can lead to further sleep problems when taken long term. F. It is not regulated by the U.S. Food and Drug Administration (FDA). Rationale: P. 1123

Which information is true regarding the use of benzodiazepines? A. Long-term use is advised for sleep problems B. Rebound insomnia can occur after discontinuation of these drugs C. Immediately giving this type of drug for sleep issues is recommended D. Pregnant women can safely use this drug for short-term treatment of sleep disorders

B. Rebound insomnia can occur after discontinuation of these drugs Rationale: P. 1126

Which action would the nurse perform during the assessment of a patient with a sleep disturbance? A. Teach the patient sleep-hygiene measures B. Review factors affecting the patient's sleep C. Ask the patient if expectations of care are being met D. Involve the sleep partner in the selection of interventions

B. Review factors affecting the patient's sleep Rationale: P. 1114

Which measure would the nurse teach the mother to promote sleep in the newborn? Select all that apply A. Place the crib near an open window B. Rock the baby gently C. Talk to the baby loudly D. Sign a lullaby to the baby E. Hold the baby snugly in a blanket

B. Rock the baby gently D. Sign a lullaby to the baby E. Hold the baby snugly in a blanket Rationale: P. 1121

Which question would the nurse ask during the assessment of a patient who is suspected of having narcolepsy? Select all that apply. A. "Do you snore loudly?" B. "Do you have difficulty staying asleep?" C. "Do you fall asleep at inappropriate times?" D. "Do you have episodes of losing muscle control?" E. "Do you experience headaches after awakening?"

C. "Do you fall asleep at inappropriate times?" D. "Do you have episodes of losing muscle control?" Rationale: P. 1115

Which statement by the patient indicates effective learning about the use of herbs for sleep? Select all that apply. A. "They can cause insomnia." B. "Herbal medicines cause sleep apnea." C. "Herbal medicines always cause allergic reactions." D. "Herbal medicines are not regulated by the US Food and Drug Administration."

C. "Herbal medicines always cause allergic reactions." D. "Herbal medicines are not regulated by the US Food and Drug Administration." Rationale: P. 1123

Which patient can safely receive benzodiazepines for sleep? A. A 70-year-old patient with renal failure B. A nursing mother C. A 30-year-old patient D. A pregnant patient

C. A 30-year-old patient Rationale: P. 1126

Which measure would the nurse suggest to the parents of an infant to promote safe sleeping? A. Place pillows and stuffed toys in the crib B. Give bottles to infants in bed during the night C. Avoid using loose-fitting plastic mattresses D. Make infants sleep on soft mattresses for comfort

C. Avoid using loose-fitting plastic mattresses Rationale: P. 1122

Which factor may contribute to a patient's fatigue and insomnia from abusing alcohol? Select all that apply. A. Nightmares B. Slow onset of sleep C. Awakening often during sleep D. Inability to fall asleep E. Reduced rapid eye movement sleep

C. Awakening often during sleep E. Reduced rapid eye movement sleep Rationale: Patients who take beta-adrenergic blockers may have nightmares. Alcohol speeds up the onset of sleep; it does not cause an inability to fall asleep. P. 1112

Which activity would the nurse encourage for a patient with insomnia? A. Exercise just before bedtime B. Drink caffeine before bedtime C. Perform muscle relaxation techniques before bedtime D. Adjust the environment by keeping the lights on in the bedroom

C. Perform muscle relaxation techniques before bedtime Rationale: P. 1121

Which measure would the nurse suggest to promote sleep in a patient? Select all that apply. A. Avoid taking a warm bath B. Eat a heavy meal at night C. Void before going to sleep D. Use extra blankets, if necessary E. Wear soft, cotton nightclothes

C. Void before going to sleep D. Use extra blankets, if necessary E. Wear soft, cotton nightclothes Rationale: P. 1122

Which condition will the nurse focus the care plan on when caring for a patient who says, "I feel sleepy, fatigued, and depressed during the daytime?" Narcolepsy Parasomnia Chronic insomnia Restless legs syndrome

Chronic insomnia Rationale: Another symptom is anxiety. Narcolepsy is a dysfunction of the sleep-wake cycle, causing people affected by the disease to fall asleep at inappropriate times. It includes daytime sleepiness as a symptom, but it does not cause fatigue and depression. Parasomnias are sleep disturbances such as sleepwalking and are not associated with fatigue and depression. Depression is not associated with restless leg syndrome. P. 1109

Which question would the nurse ask a patient who reports suddenly feeling drowsy and falling asleep at inappropriate times during the day? A. "How do you prepare for sleep?" B. "What do you think about as you try to fall asleep?" C. "Do you or does anyone else in your family snore loudly?" D. "Do you experience loss of muscle control or falling on the floor?"

D. "Do you experience loss of muscle control of falling on the floor?" Rationale: P. 1115

Which assessment question does the nurse ask the patient to determine predisposing factors associated with sleep problems? A. "Do you have trouble staying awake?" B. "Do you have difficulty falling asleep?" C. "Do you have headaches when awake?" D. "Do you have a physical illness that affects your sleep?"

D. "Do you have a physical illness that affects your sleep?" Rationale: P. 1115

Which action by the unlicensed assistive personnel at bedtime requires the nurse to intervene? A. Offering the patient a back rub B. Turning on quiet music C. Dimming the lights in the patient's room D. Giving a patient a cup of coffee

D. Giving a patient a cup of coffee Rationale: PP. 1122-1123

Which intervention is priority for the nurse to suggest to the patient who reports fatigue? A. Revise the daily exercise plan B. Drink a cup of warm milk before going to bed C. Practice relaxation techniques before going to bed D. Plan rest periods in between daily activities

D. Plan rest periods in between daily activities Rationale: P. 1120

Which intervention is appropriate to include in a care plan for improving sleep in the older adult? Decrease fluids 2 to 4 hours before sleep Exercise in the evening 1 hour before bedtime Allow the patient to sleep as late as possible Take a nap for at least an hour to make up for lost sleep

Decrease fluids 2 to 4 hours before sleep

Which sleep disturbance is the nurse likely to observe in the patient with hyperthyroidism? Sleep-related bruxism Enuresis Sleepwalking Difficulty falling asleep

Difficulty falling asleep Rationale: Sleep-related bruxism (teeth grinding), enuresis, and sleepwalking do not occur in hyperthyroidism but are parasomnias that occur in older children. P. 1108

Which condition predisposes a patient to central sleep apnea (CSA)? Select all that apply. Encephalitis Nasal polyps Enlarged tonsils Brainstem injury Deviated septum

Encephalitis Brainstem injury Rationale: Structural abnormalities such as nasal polyps, enlarged tonsils, and a deviated septum predispose a patient to obstructive sleep apnea (OSA). P. 1109

Which intervention is appropriate to include in the plan of care for a patient experiencing narcolepsy? Instruct the patient to increase carbohydrates in the diet Have patient limit fluid intake 2 hours before bedtime Preserve energy by limiting exercise to morning hours Encourage patient to take one or two 20-minutte naps during the day

Encourage patient to take one or two 20-minute naps during the day Rationale: Brief daytime naps no longer than 20 minutes help reduce subjective feelings of sleepiness. The nurse would instruct the patient to increase light meals high in protein, not carbohydrates. Limiting fluid intake 2 hours before bedtime is not appropriate for narcolepsy; however, it is appropriate for older adults. Following a regular exercise program is appropriate but the goal is to promote wakefulness, not to preserve energy. P. 1110

Which information would the nurse include in a teaching session to promote sleep? Exercise 2 hours before bedtime Consume chocolates in the evening Have a large and heavy meal at night Work until excessively fatigued

Exercise 2 hours before bedtime Rationale: Chocolate should be avoided in the evening because it contains caffeine and xanthines that cause sleeplessness. A large and heavy meal should be avoided at night because it may result in indigestion that interferes with sleep. Excessive fatigue resulting from stressful work makes falling asleep difficult. P. 1112

Which complaint is common in patients with obstructive sleep apnea? Fatigue Anxiety Increased sex drive Evening headache

Fatigue Rationale: Anxiety is not associated with obstructive sleep apnea. Decreased, not increased, sex drive is associated with obstructive sleep apnea. Morning (not evening) headaches are associated with sleep apnea. P. 1109

Which physiological implication would the nurse look for in a patient with obstructive sleep apnea? Select all that apply. Fatigue Cataplexy Sleep paralysis Cardiac dysrhythmias Excessive daytime sleepiness

Fatigue Cardiac dysrhythmias Excessive daytime sleepiness Rationale: The nurse would look for cataplexy or sudden muscle weakness and sleep paralysis in a patient in whom narcolepsy is suspected but not for obstructive sleep apnea. P. 1109

Which factor in a patient with anemia who is 24 weeks pregnant would lead to recurrent, rhythmical movements of her feet and legs before the onset of sleep. Select all that apply. Renal failure Gender Pregnancy Gestational age Low iron levels

Gender Pregnancy Low iron levels Rationale: The symptoms in the patient indicate she is suffering from a condition called restless legs syndrome (RLS). Though renal failure is associated with RLS, the patient does not show any sings of renal failure. Gestational age does not play a role in RLS. P. 1108

Which condition is associated with early morning wakefulness and fatigue? Liver failure Hypertension Hyperthyroidism Restless legs syndrome

Hypertension Rationale: Patients with heart (not liver) failure may have frequent sleep disruptions; liver failure is not associated with early morning wakefulness. Hyperthyroidism is associated with taking more time to fall asleep, not early morning wakefulness. Although restless legs syndrome may lead to fatigue, it does not cause early morning wakefulness. P. 1108

Which information would the nurse share with the patient about the effects of hypnotics on sleep? Select all that apply. Hypnotics interfere with the ability to reach deeper sleep stages Hypnotics cause nightmares They increase the speed of onset of sleep Hypnotics suppress rapid eye movement sleep They provide only a temporary increase in the quantity of sleep

Hypnotics interfere with the ability to reach deeper sleep stages They provide only a temporary increase in the quantity of sleep Rationale: Beta-adrenergic blockers cause nightmares. Alcohol speeds onset of sleep. Antidepressants and stimulants suppress rapid eye movement sleep. P. 1112

Which statement made by the patient indicates successful teaching on sleep hygiene? I'm going to do my exercises after I watch the late news I'll have a glass of wine at bedtime to relax I set my alarm to get up at the same time every morning I moved my computer to the bedroom to do my work

I set my alarm to get up at the same time every morning

Which patient statement indicates successful teaching about sleep- hygiene habits? Select all that apply I should limit caffeine intake to morning coffee only I should eat a heavy meal 2 hours before bedtime I should do vigorous exercise in the morning or afternoon I should sleep for long hours during weekends or holidays I should perform relaxation exercises routinely in the morning

I should limit caffeine intake to morning coffee only I should do vigorous exercise in the morning or afternoon I should perform relaxation exercises routinely in the morning

Which action would the nurse perform during the planning phase of a patient with a sleep disturbance? Teach the patient about sleep-hygiene measures Review factors affecting the patients sleep Ask the patient if expectations of care are being met Involve the sleep partner in the selection of interventions

Involve the sleep partner in the selection of interventions

Which sleep deprivation symptom will the nurse likely find in a patient who has insomnia? Select all that apply. Irritability Agitation Increased reflexes Decreased sensitivity to pain Decreased visual alertness

Irritability Agitation Decreased visual alertness Rationale: Reflexes are decreased, not increased. Sensitivity to pain is increased, not decreased. P. 1110

Which chemical promotes sleep? Orexin Hypocretin L-tryptophan Catecholamine

L-tryptophan Rationale: L-tryptophan is a natural protein present in foods such as milk, cheese, and meat; this chemical promotes sleep. Orexins and hypocretins promote wakefulness, not sleep. Catecholamines, which are secreted by neurons in a reticular activating system, promote wakefulness, not sleep. P. 1112

Which conservative approach is included in the patient's treatment plan for obstructive sleep apnea (OSA)? Select all that apply. Limit alcohol consumption Motivate the patient to lose weight Recommend that the patient take sedatives Suggest that the patient take herbal medicines Use jaw and tongue repositioning devices at night

Limit alcohol consumption. Motivate the patient to lose weight. Use jaw and tongue repositioning devices at night. Rationale: In OSA, the upper airways become partially or completely blocked, diminishing nasal airflow or stopping it for at least 10 seconds. Sedatives can make OSA worse and should be avoided. Herbal medicines may produce side effects or interact with other medications the patient is already taking. P. 1109

Which symptom is likely to be found in the patient who has obstructive sleep apnea? Select all that apply Loud snoring Sudden muscle weakness Decreased sex drive Difficulty concentrating Excessive urination during the night

Loud snoring Decreased sex drive Difficulty concentrating Rationale: Sleep apnea occurs because of a lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep. Sudden muscle weakness can occur with narcolepsy, not obstructive sleep apnea. Excessive urination during the night can occur with the use of diuretics, not obstructive sleep apnea. P. 1109

Which is a neurohormone that promotes sleep? Lavender Valerian Melatonin Ramelteon

Melatonin

At which stage of human development does sleep duration at night begin to decline? Toddlerhood Adolescence Young adulthood Middle adulthood

Middle adulthood

Which event does the nurse discuss while explaining rapid eye movement (REM) sleep? Slow-wave sleep Daydreaming Protein synthesis Muscle atonia

Muscle atonia Rationale: Slow-wave sleep occurs in N3, not REM. In N1 (not REM) sleep, upon awakening the patient may feel as though daydreaming has occurred. Protein synthesis occurs in nonrapid eye movement (NREM) sleep, not REM. P. 1107

Which parameter does an electromyogram (EMG) monitor in a patient with a sleep disorder? Muscle tone Eye movements Electrical activity of the heart Electrical activity in the brain

Muscle tone Rationale: Various instruments are used to measure a patient's sleep pattern. Eye movements are measured by an electrooculogram. An electrocardiogram measures the electrical activity of the heart. An electroencephalogram measures electrical activity in the brain. P. 1106

Stage 4 of nonrapid eye movement (NREM) sleep is almost absent in which age group? Infants Toddlers Adolescents Older adults

Older adults Rationale: Stage 4 of NREM sleep is almost absent in older adults because it begins its decline in middle adulthood. In infants, toddlers, and adolescents, stage 4 of NREM sleep is present and important because human growth hormone is released in this stage. P. 1111

Which patient is at risk of fatigue? Patient A: 2 Years Old, 12 Hours of Sleep Patient B: 7 Years Old, 8 Hours of Sleep Patient C: 11 Years Old, 10 Hours of Sleep Patient D: 14 Years Old, 9 Hours of Sleep

Patient B Rationale: Infants: 14-16 hours each day Toddlers: 9-10 hours at night plus 2-3 hours of daytime naps School-age children: 9-11 hours Teenagers: 9 hours Adults: 7-9 hours P. 1111

Which patient requires further assessment to determine the risk of developing obstructive sleep apnea (OSA)? Select all that apply. Patient with a stroke Patient with iron deficiency anemia Patient with hypertension Patient who is a chronic smoker Patient who is 75 years old

Patient with hypertension Patient who is a chronic smoker Patient who is 75 years old Rationale: Patients with a stroke are prone to central sleep apnea, not OSA. Anemia from iron deficiency leads to restless legs syndrome, not OSA. P. 1109

Which characteristics is typical of restless legs syndrome (RLS)? Select all that apply. It is usually associated with nocturia It occurs immediately after waking up Patients have a continuous itching sensation It is more common in those having Alzheimer's disease Patients have recurrent rhythmical movement of the feet and legs

Patients have a continuous itching sensation Patients have recurrent rhythmical movement of the feet and legs Rationale: Patients with RLS feel an itching sensation deep in the muscles. Relief comes only from moving the legs; therefore, the nurse may observe recurrent movement of the patient's legs. However, this need for constant motion prevents the patient from relaxing or sleeping. No association between RLS and nocturia has been cited. This syndrome occurs before sleep onset rather than waking. RLS is not related to Alzheimer's disease, but its incidence is more common in people with iron deficiency anemia and Parkinson's disease. P. 1108

Which statement indicates a correct understanding of sleep disorders? Painful urination is defined as nocturia Restless legs syndrome (RLS) occurs more often in men Peptic ulcers predispose a person to wake up in the middle of the night Nocturia can be seen in people suffering from iron deficiency anemia

Peptic ulcers predispose a person to wake up in the middle of the night Rationale: Nocturia is urination during the night; painful urination (dysuria) is not defined as nocturia. RLS occurs more often in women, not men. People suffering from iron deficiency anemia are prone to RLS, not nocturia. P. 1108

Which action would the nurse take to help the patient manage obstructive sleep apnea? Select all that apply. Refer the patient to a marriage counselor. Provide the patient with emotional support. Instruct the patient to avoid coffee before bedtime. Encourage the patient to lose weight and quit smoking. Advise the patient to create an environment conducive to sleep before bedtime.

Provide the patient with emotional support. Encourage the patient to lose weight and quit smoking. Rationale: Referring the patient to a marriage counselor is premature at this time; there is no data on the question of being married or that the patient is having marital problems, and the focus of the question is on management of sleep apnea. Instructing the patient to avoid coffee before sleep or making the environment conductive to sleep before bedtime will only induce sleep and are used for insomnia, not for obstructive sleep apnea. P. 1109

The patient who tells the nurse about a dream that was vivid and colorful would have to be in which stage of sleep? REM N1 N2 N3

REM Rationale: Although dreams occur during both nonrapid eye movement (NREM) and REM sleep, the dreams of REM sleep are more vivid and elaborate; dreams are believed to be functionally important to learning, memory processing, and adaptation to stress. Vivid dreams do NOT occur in N1, N2, or N3 sleep. P. 1107

Which biological function occurs when a patient is dreaming? Cortical activity decreases Respiratory rate fluctuates Eye movement slowly fluctuates Epinephrine release decreases

Respiratory rate fluctuates Rationale: Cortical activity increases during dreaming. Eye movements are rapid, not slowly fluctuating. Epinephrine release increases during dreaming. P. 1107

A patient with iron deficiency anemia reports rhythmical movements of the feet and legs and an itching sensation in the muscles before sleep. Which condition is likely to be found in the patient? Insomnia Cataplexy Narcolepsy Restless legs syndrome

Restless legs syndrome

The nurse finds that an obese patient snores loudly. The patient stops breathing for a few seconds and then resumes breathing. This happens several times during sleep. What could be the diagnosis? Narcolepsy Sleep apnea Sleep deprivation Paroxysmal nocturnal dyspnea

Sleep apnea

Which class of drugs does the nurse anticipate administering to a patient with narcolepsy to prevent sleep attacks? Hypnotics Stimulants Anticonvulsants Benzodiazepines

Stimulants Rationale: Stimulants help improve alertness and prevent sleep attacks. In narcolepsy, the patient falls asleep uncontrollably at inappropriate times. These are called sleep attacks. Hypnotics, anticonvulsants, and benzodiazepines increase drowsiness and sleeping times, and so these medicines are contraindicated for patients with narcolepsy. P. 1110

What caution should be given to older adults regarding the long-term use of sedatives and hypnotics? They cause headaches and nausea. They are expensive and difficult to obtain. They cause severe depression and anxiety. They lead to sleep disruption.

They lead to sleep disruption.

Which information would the nurse include when educating a patient about measures for treating insomnia? Select all that apply Try to avoid worrisome before bedtime Have warm coffee or tea before bedtime Try to avoid heavy meals 3 hours before bedtime Discontinue use of electronic devices about 30 minutes before going to bed Exercise daily right before sleeping

Try to avoid worrisome before bedtime Try to avoid heavy meals 3 hours before bedtime Discontinue use of electronic devices about 30 minutes before going to bed

Which lifestyle factor would the nurse inform the patient about that might adversely affect sleep patterns? Select all that apply. Wearing socks to bed Working a rotating shift Performing unaccustomed, heavy work Participating in late-night social activities Changing evening mealtime

Working a rotating shift Performing unaccustomed, heavy work Participating in late-night social activities Changing evening mealtime Rationale: A good sleep pattern depends on many lifestyle factors. Working a rotating shift disrupts the sleep-wake cycle and results in poor sleep. Performing unaccustomed, heavy work may cause excessive fatigue and interfere with sleep. Late-night social activities may interfere with sleep by providing too many stimuli. Changing the evening mealtime may interfere with sleep. A heavy meal eaten before bedtime may cause indigestion and sleep irregularities. Wearing socks to bed can positively (not adversely) affect sleep patterns by keeping the patient warm and comfortable. P. 1112

Which range is the normal value of phosphate in human blood? a) 1.3 to 2.1 mEg/L b) 3.0 to 4.5 mg/dL c) 3.5 to 5.0 mEq/L d) 4.5 to 5.6 mg/dL

b) 3.0 to 4.5 mg/dL Rationale: The normal range of phosphate values in human blood is 3.0 to 4.5 mg/dL. The normal value of magnesium is 1.3 to 2.1 mEg/L, the normal value of potassium is 3.5 to 5.0 mEg/L, and the normal value of ionized calcium is 4.5 to 5.6 mg/dL.

Which information would the nurse include in a teaching session about the different stages of sleep? Select all that apply. If awakened in N1 stage, the person feels as though daydreaming has occurred. Dreams occur during rapid eye movement (REM) sleep only. N3 is called slow-wave sleep. Dreams occur during both nonrapid eye movement (NREM) and REM sleep. There is decreased epinephrine release during REM sleep.

If awakened in N1 stage, the person feels as though daydreaming has occurred. N3 is called slow-wave sleep. Dreams occur during both nonrapid eye movement (NREM) and REM sleep. Rationale: REM sleep is associated with increased (not decreased) epinephrine release. P. 1107

Which drug classification or substance causes suppressed rapid eye movement (REM) sleep and increased daytime drowsiness? Alcohol Opiates Nicotine Hypnotics

Opiates Rationale: Alcohol and nicotine suppress REM sleep but do not cause daytime drowsiness. Hypnotics cause drowsiness but do not interfere with REM sleep. P. 1112

The nurse is teaching a group of student nurses about the stages of sleep. Which event does the nurse discuss while explaining rapid eye movement (REM) sleep? Bedwetting Daydreaming Sleepwalking Skeletal muscle paralysis

Skeletal muscle paralysis

The patient reports episodes of sleepwalking to the nurse. Through understanding of the sleep cycle, the nurse recognizes that sleepwalking occurs during which sleep phase? 1. Rapid eye movement (REM) sleep 2. Stage 1 nonrapid eye movement (NREM) sleep 3. Stage 4 NREM sleep 4. Transition period from NREM to REM sleep

3. Stage 4 NREM sleep

Which psychologic symptom is associated with a sleep-deprived patient? Select all that apply. Ptosis Agitation Hyperactivity Disorientation Cardiac arrhythmias

Agitation Hyperactivity Disorientation Rationale: Ptosis and cardiac arrhythmias are physiologic (not psychologic) symptoms associated with a patient who is sleep deprived. P. 1110

Which substance may produce insomnia if consumed in the evening? Select all that apply. Alcohol Nicotine Caffeine A light meal A protein-rich diet

Alcohol Nicotine Caffeine Rationale: Alcohol interferes with the sleep pattern. Nicotine and caffeine act as stimulants and produce sleeplessness. A light meal and a protein-rich diet do not cause insomnia. P. 1112

A patient has narcolepsy. The nurse finds that the patient's drowsiness has increased. What advice does the nurse offer the patient to decrease drowsiness? Select all that apply. "Avoid eating heavy meals." "Avoid long-distance driving." "Avoid the consumption of alcohol." "Avoid eating a protein-rich diet." "Avoid chewing gum."

"Avoid eating heavy meals." "Avoid long-distance driving." "Avoid the consumption of alcohol."

Which instruction does the nurse provide to the patient to reduce sleep attacks when taking armodafinil? Select all that apply. "Avoid traveling long distances." "Avoid performing regular exercise." "Avoid drinking coffee and tea." "Avoid consuming alcohol and heavy meals." "Avoid sitting in hot, stuffy rooms for long periods."

"Avoid traveling long distances." "Avoid consuming alcohol and heavy meals." "Avoid sitting in hot, stuffy rooms for long periods." Rationale: Armodafinil is a stimulant that only partially increases wakefulness and reduces sleep attacks in patients with narcolepsy. Patients with narcolepsy need to avoid activities that increase drowsiness. The nurse does not instruct the patient to avoid performing regular exercise or to avoid drinking coffee or tea, because these reduce sleep attacks and promote wakefulness. P. 1110

Which statement made by the patient indicates successful teaching about light sleep? "There is a gradual increase in vital signs." "Light sleep is also called slow-wave sleep." "Light sleep lasts about 90 minutes." "The time spent in light sleep increases with age."

"The time spent in light sleep increases with age." Rationale: Sleep becomes more fragmented with aging. There is a gradual decrease (not increase) in vital signs during light sleep. Deep sleep (not light sleep) is also called slow-wave sleep. Light sleep lasts only a few minutes, not 90. P. 1111

A patient complains that he falls asleep uncontrollably at inappropriate times and has vivid dreams during such times. Which advice should the nurse give to the patient to avoid factors that increase drowsiness? Select all that apply. 1 Avoid alcohol 2 Avoid smoking 3 Avoid relaxing activities 4 Avoid heavy meals 5 Avoid long-distance driving

1 Avoid alcohol 4 Avoid heavy meals 5 Avoid long-distance driving

A 40-year-old patient is hospitalized for insomnia. The nurse reviews his medical records. The nurse finds that the patient has had insomnia for six months, and it started when he began working night shifts. After thoroughly questioning the patient, the nurse learns that he is stressed due to his workload. Which sleep deprivation symptoms will the nurse most likely find in the patient? Select all that apply. 1 Irritability 2 Agitation 3 Increased reflexes 4 Decreased sensitivity to pain 5 Decreased auditory and visual alertness

1 Irritability 2 Agitation 5 Decreased auditory and visual alertness

A 47-year-old man complains of sleep deprivation. What findings should the nurse expect on assessment? Select all that apply. 1 Ptosis 2 Nystagmus 3 Decreasd reflexes 4 Fine-motor clumsiness 5 Gross-motor clumsiness

1 Ptosis 3 Decreased reflexes 4 Fine-motor clumsiness

Which postoperative care reduces the risk of any complications in the patient who has obstructive sleep apnea? Select all that apply. 1 Using an oral appliance 2 Monitoring the patient's airway 3 Avoiding the elevation of the head of the bed 4 Sleeping in the supine position 5 Placing the continuous positive airway pressure (CPAP) mask on snugly

1 Using an oral appliance 2 Monitoring the patient's airway 5 Placing the continuous positive airway pressure (CPAP) mask on snugly Rationale: PP. 1124-1125

Which statement made by the parent of a school-age child requires follow-up by a nurse? 1. "I encourage evening exercise about an hour before bedtime." 2. "I offer my daughter a glass of warm milk before bedtime." 3. "I will make sure that the room is dark and quiet at bedtime." 4. "We use quiet activities such as reading a book before bedtime."

1. "I encourage evening exercise about an hour before bedtime."

Which sleep-hygiene actions at bedtime can the nurse delegate to the nursing assistant? (Select all that apply.) 1. Giving the patient a backrub 2. Turning on quiet music 3. Dimming the lights in the patients room 4. Giving the patient a cup of coffee 5. Monitoring for the effect of the sleeping medication that was given

1. Giving the patient a backrub 2. Turning on quiet music 3. Dimming the lights in the patients room

What nursing intervention should the nurse provide to promote sleep in a patient who has a sedentary lifestyle? A. Encourage short naps if possible B. Instruct the patient to keep an exercise log C. Have the patient keep a sleep log for a week D. Use active listening when talking to the patient

B. Instruct the patient to keep an exercise log Rationale: P. 1120

The nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? (Select all that apply.) 1. Take brief, 20-minute naps no more than twice a day. 2. Drink a glass of wine with dinner. 3. Eat the large meal at lunch rather than dinner. 4. Establish a regular exercise program. 5. Teach the patient about the side effects of modafinil (Provigil).

1. Take brief, 20-minute naps no more than twice a day. 4. Establish a regular exercise program. 5. Teach the patient about the side effects of modafinil (Provigil).

For up to what age in children should benzodiazepines be used with caution? blank years

12 Rationale: P. 1126

In a patient with narcolepsy, rapid eye movement (REM) sleep occurs within how many minutes of falling asleep? blank minutes

15 Rationale: In a patient who has narcolepsy, REM sleep occurs within 15 minutes of falling asleep. P. 1109

Which psychological symptoms are associated with a sleep deprived patient? Select all that apply. 1 Ptosis 2 Agitation 3 Irritability 4 Disorientation 5 Cardiac arrhythmias

2 Agitation 3 Irritability 4 Disorientation

A patient reports difficulty falling asleep. The nurse asks questions to assess the symptoms of insomnia and analyzes the different stages of the patient's sleep cycle. What are the characteristics of stages 2 and 3 of nonrapid eye movement (NREM) sleep? Select all that apply. 1 Sleepwalking may occur. 2 Body functions become slow. 3 Arousal remains relatively easy. 4 Muscles are completely relaxed. 5 Vital signs are significantly lower than during waking hours.

2 Body functions become slow. 3 Arousal remains relatively easy. 4 Muscles are completely relaxed.

The nurse is assessing a patient who complains of sleep deprivation. Which physiological symptoms should the nurse expect to find in the patient? Select all that apply. 1 Increased response time 2 Ptosis or blurred vision 3 Cardiac arrhythmias 4 Diminished reflexes 5 Decreased hearing

2 Ptosis or blurred vision 3 Cardiac arrhythmias 4 Diminished reflexes 5 Decreased hearing

The nurse is contacting the health care provider about a patient's sleep problem. Place the steps of SBAR (situation, background, assessment, recommendation) in the correct order. 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 2. "Dr, Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 3. "I am calling to ask if you would order a hypnotic such as zolpidem (Ambien) to use on a prn basis." 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as a 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1 C (98.8 F)

2. "Dr, Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as a 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1 C (98.8 F). 3. "I am calling to ask if you would order a hypnotic such as zolpidem (Ambien) to use on a prn basis."

Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? 1. "I'll give the baby a bottle to help her fall asleep." 2. "We'll put the baby on her back to sleep." 3. "We put the baby's stuffed animals in the crib to make her feel safe." 4. "I know the baby will not need to be fed until morning."

2. "We'll put the baby on her back to sleep."

What percentage of sleep time in young adults is rapid eye movement (REM) sleep? Record your answer using a whole number. blank %

20% Rationale: About 20% of sleep time in young adults is REM sleep. P. 1111

Sleep apnea is classified by how many types? blank

3 Rationale: Central apnea Obstructive apnea Mixed apnea P. 1109

Nonrapid eye movement sleep is divided into how many stages, according to the American Academy of Sleep Medicine? Record your answer using a whole number. blank stages

3 stages Rationale: NREM sleep is divided into three stages: N1, N2, and N3 p. 1107

Which statement made by an older adult est demonstrates understanding of taking sleep medication? 1. "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." 2. "Sleep medicines won't cause any sleep problems once I stop taking them." 3. "I'll talk to my health care provider before I use an over-the-counter sleep medication." 4. "I'll contact my health care provider if I feel extreme sleepy in the mornings."

3. "I'll talk to my health care provider before I use an over-the-counter sleep medication."

The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? 1. "I feel refreshed when I wake up in the morning." 2. "I use soft music at night to help me relax." 3. "It takes me about 45 to 60 minutes to fall asleep." 4. "I take pain medication for my leg pain about 30 minutes before I go to bed."

3. "It takes me about 45 to 60 minutes to fall asleep." Rationale:

The nurse is learning about various stages of nonrapid eye movement (NREM) sleep. One particular stage of NREM lasts for 15 to 30 minutes. It is the deepest stage of sleep, and it is very difficult to arouse the sleeper from this stage. The vital signs are lower than during normal waking hours. To which stage of NREM sleep is the nurse referring? Record your answer using a whole number. Stage __________

4

How is stage 1 of nonrapid eye movement (NREM) sleep similar to stage 2 of NREM sleep? 1 Both stages last for 10 to 20 minutes. 2 Both stages include a light level of sleep. 3 The muscles are completely relaxed in both stages 4 The sleeper can be easily awakened in both stages.

4 The sleeper can be easily awakened in both stages.

Which statement made by the patient indicates a need for further teaching on sleep hygiene? 1. "I'm going to do my exercises before I eat dinner." 2. "I'm going to bed every night at about the same time." 3. 'I set my alarm to get up at the same time every morning." 4. "I moved my computer to the bedroom so I could work before I go to sleep."

4. "I moved my computer to the bedroom so I could work before I go to sleep."

The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? 1. Incontinence 2. Nausea and vomiting 3. Bradycardia 4. Respiratory depression

4. Respiratory depression

How much time is spent in rapid eye movement (REM) sleep if the patient's total sleep time is 200 minutes and 80% of sleep time is spent in nonrapid eye movement (NREM) sleep? blank minutes

40 minutes Rationale: If the total sleep time is 200 minutes and 80% of sleep time is spent in nonrapid eye movement (NREM) sleep, then the remaining 20% of sleep time is REM sleep. Therefore, (20/100)(200 minutes) = 0.20 x 200 = 40 minutes. P. 1107

After how many minutes into the sleep cycle does a sleeper usually reach rapid eye movement (REM) sleep? blank minutes

90 Rationale: A sleeper usually reaches REM sleep 90 minutes into the sleep cycle. P. 1107

The nurse works in a sleep clinic. The nurse understands that sleep medicines should be administered with caution in some patients. In which patient can benzodiazepines be given safely? A 70-year-old patient with renal failure A nursing mother A 30-year-old patient A pregnant patient

A 30-year-old patient

Which instruction would the nurse provide to the older patient who has sleep deprivation? Select all that apply. A. Take your analgesics 10 minutes before bedtime B. Keep your path to the bathroom free of obstacles C. Increase fluid intake 2-4 hours before sleep D. Sit in natural sunlight during the morning E. Eat some carbohydrates or drink milk as a light snack before bed

B. Keep your path to the bathroom free of obstacles D. Sit in natural sunlight during the morning E. Eat some carbohydrates or drink milk as a light snack before bed Rationale: P. 1121

Which measure would the nurse suggest to a parent to promote sleep in a preschooler? A. Encourage co-sleeping on a soft mattress B. Offer warm milk before sleeping C. Make sure that the room is dark and quiet D. Suggest a small piece of chocolate mint before bedtime

B. Offer warm milk before sleeping Rationale: P. 1122

Which side effect of benzodiazepines is observed in older adults? Select all that apply. A. Amnesia B. Diarrhea C. Vomiting D. Rebound insomnia E. Respiratory depression

A. Amnesia D. Rebound insomnia E. Respiratory depression Rationale: P. 1125

Which side effect is common in older patients when over-the-counter antihistamines are used for sleeping aids? Select all that apply. A. Confusion B. Constipation C. Urinary retention D. Hyperactivity E. Nightmares

A. Confusion B. Constipation C. Urinary retention Rationale: P. 1123

Which phrase accurately defines narcolepsy? A. Dysfunction of mechanisms that regulate sleep and wake states. B. Disorder characterized by the lack of airflow through the nose and mouth. C. Symptom that patients experience when they have chronic difficulty falling asleep. D. Sudden muscle weakness during intense emotions such as anger, sadness, or laughter.

A. Dysfunction of mechanisms that regulate sleep and wake states. P. 1109

Which instruction would the nurse provide to older adults to enhance the quality of their sleep? Select all that apply. A. Establish a fixed bedtime and stick to it B. Perform muscle relaxation before going to sleep C. Exercise an hour before bedtime to help induce sleep D. Sleep with extra blankets or covers E. Drink a cup of warm tea before bedtime to help induce sleep

A. Establish a fixed bedtime and stick to it B. Perform muscle relaxation before going to sleep D. Sleep with extra blankets and covers Rationale: PP. 1121-1122

Which strategy would the nurse include when teaching a patient with insomnia who recently started working nights? Select all that apply. A. Limit caffeine B. Use earplugs and eyeshades C. Exercise in the morning and late evening D. Avoid heavy meals 5 hours before bedtime E. Avoid using the bedroom for watching television

A. Limit caffeine B. Use earplugs and eyeshades E. Avoid using the bedroom for watching television Rationale: P. 1121

Which finding would the nurse observe upon assessment of a patient with sleep deprivation? Select all that apply. A. Ptosis B. Nystagmus C. Decreased reflexes D. Fine-motor clumsiness E. Gross-motor clumsiness

A. Ptosis C. Decreased reflexes D. Fine-motor clumsiness P. 1110

Which guideline would a nurse share with a patient who is stressed and has insomnia? Select all that apply. A. Try to avoid worrisome thinking when going to bed and to use relaxation exercises B. Use warm water to bathe before bedtime C. Avoid listening to music before bedtime D. Consume milk or a light snack before bedtime E. Get out of the bed if your unable to fall asleep in 15 to 30 minutes

A. Try to avoid worrisome thinking when going to bed and to use relaxation exercises B. Use warm water to bathe before bedtime D. Consume milk or a light snack before bedtime E. Get out of the bed if your unable to fall asleep in 15 to 30 minutes Rationale: P. 1121

Which activity would the nurse include when teaching about sleep-promoting activities to a patient? Select all that apply. A. Using relaxation exercises and meditation B. Reading a light novel in bed to fall asleep C. Eating dinner just 1 hour before bedtime D. Consuming a light snack before bedtime E. Drinking 500 mL of water before going to bed

A. Using relaxation exercises and meditation D. Consuming a light snack before bedtime Rationale: P. 1121

Which patient finding is the nurse likely to observe when assessing sleep patterns? A school-age child who sleeps 15 hours a day A teenager with an upcoming final falling asleep promptly at bedtime An adult who falls asleep quickly after vigorous exercise before bedtime An infant taking several naps during the day

An infant taking several naps during the day Rationale: A school-age child sleeps from 9 to 12 hours a night, not 15 hours a day. A teenager with an upcoming final will not fall asleep promptly because of the stress; it will take some time for the teenager to fall asleep. Vigorous exercise before bedtime will keep an adult awake because exercise is a stimulant; vigorous exercise will not help an adult fall asleep quickly. PP. 1111-1112

Which information would the nurse share with a patient about the use of benzodiazepines to treat sleep problems? Select all that apply. A. Can be safely used by older patients B. Are contraindicated in nursing mothers C. Can be safely used by pregnant women D. Are contraindicated in infants younger than 6 months old E. Are taken in a larger dose initially and the does is gradually decreased

B. Are contraindicated in nursing mothers D. Are contraindicated in infants younger than 6 months old Rationale: P. 1126

Which characteristic is typical of N2 sleep? Select all that apply. A. Lightest level of sleep occurs. B. Body functions become slow. C. Arousal remains relatively easy. D. Relaxation progresses. E. Gastric secretions increase.

B. Body functions become slow. C. Arousal remains relatively easy. D. Relaxation progresses. Rationale: Lightest level of sleep occurs in N1. Gastric secretions increase in rapid eye movement REM sleep. P. 1107

Which action would the nurse take to promote sleep in a patient with sleep apnea after surgery? Select all that apply. A. Raise the foot end of the bed B. Elevate the head of the bed C. Instruct the patient to sleep in a prone position D. Discourage the use of oral appliances E. Encourage the patient to use a continuous positive airway pressure (CPAP) device

B. Elevate the head of the bed C. Instruct the patient to sleep in a prone position E. Encourage the patient to use a continuous positive airway pressure (CPAP) device Rationale: P. 1125

Which type of sleep disorder does the nurse suspect when a patient has jet lag? Disorders of arousal Adjustment sleep disorder Rapid eye movement (REM) sleep- behavior disorder Behaviorally induced circadian rhythm sleep disorder

Behaviorally induced circadian rhythm sleep disorder Rationale: Disorders of arousal include sleepwalking and sleep terrors. Adjustment sleep disorder is classified as insomnias. REM sleep-behavior disorder is a parasomnia associated with REM sleep. P. 1108

Which drug increases a patient's sleep time? Nicotine Stimulants Antidepressants Benzodiazepines

Benzodiazepines Rationale: Nicotine, stimulants, and antidepressants decrease total sleep time. P. 1112

Which statement is true regarding the use of benzodiazepines? Benzodiazepines can be safely prescribed to infants. Benzodiazepines are initially taken in small dosages. Benzodiazepines can be safely used by nursing mothers. Benzodiazepines can be safely used by pregnant women.

Benzodiazepines are initially taken in small dosages.

Which physiologic symptom would the nurse expect to find in a patient with sleep deprivation? Select all that apply. Quick response time Blurred vision Cardiac arrhythmias Diminished reflexes Decreased hearing

Blurred vision Cardiac arrhythmias Diminished reflexes Decreased hearing Rationale: Sleep deprivation may slow down all the body systems. Sleep deprivation would NOT cause a quick response time to questions asked or to any activity because responses have slowed. P. 1110

Which statement made by an older adult best demonstrates understanding regarding taking a sleep medication? A. "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." B. "Sleep medicines won't cause any sleep problems once I stop taking them." C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." D. "I'll contact my health care provider if I feel extremely sleepy in the mornings."

C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." Rationale: P. 1123

Which symptom is the most common complaint by patients who have narcolepsy? A. Sleep paralysis B. Sudden muscle weakness C. Excessive daytime sleepiness D. Vivid dreams while falling asleep

C. Excessive daytime sleepiness Rationale: Excessive daytime sleepiness is the most common complaint by patients who have narcolepsy. Although sleep paralysis, sudden muscle weakness, and vivid dreams while falling asleep do occur, they are not the most common symptoms associated with narcolepsy. P. 1109

The nurse teaches a patient taking a benzodiazepine that this group of medications causes which side effect? A. Nocturia B. Hyperactivity C. Hungover feeling D. Nightmares

C. Hungover feeling Rationale: P. 1125

Which information would the nurse include when teaching the patient about the effects of alcohol on sleep? Select all that apply. Causes nightmares Prevents the onset of sleep Causes awakening from sleep Causes difficulty returning to sleep Reduces rapid eye movement (REM) sleep

Causes awakening from sleep Causes difficulty returning to sleep Reduces rapid eye movement (REM) sleep Rationale: The nurse would explain that alcohol causes awakening from sleep and difficulty returning back to sleep, and it reduces REM sleep. Beta-adrenergic blockers are found to cause nightmares in patients. Alcohol does not prevent the onset of sleep; rather, it enhances the onset of sleep. P. 1112

Which psychological symptoms may be found in a patient who has sleep deprivation? Select all that apply. Confusion Disorientation Decreased motivation Decrease in sleeping time Decreased sensitivity to pain

Confusion Disorientation Decreased motivation Rationale: Although slowed response time does occur, it is a physiologic symptom, not a psychologic symptom. With sleep deprivation sensitivity to pain is increased, not decreased. P. 1110

Which action would the nurse perform during the evaluation phase of a patient with a sleep disturbance? A. Teach the patient sleep-hygiene measures B. Review factors affecting the patients sleep C. Assess the patients developmental level D. Ask the patient if expectations of care are being met

D. Ask the patient if expectations of care are being met Rationale: P. 1126

Which action would the nurse take for a hospitalized individual to promote sleep? A. Avoid allowing extended rest periods B. Give prescribed analgesics at bedtime C. Have the patient follow hospital routines D. Avoid waking the patient for nonessential tasks

D. Avoid waking the patient for nonessential tasks Rationale: P. 1124

Which measure helps promote sleep in older adults? Select all that apply. A. Having tea or coffee before bedtime B. Encouraging naps as many times as possible C. Performing stimulating exercise before bedtime D. Consuming carbohydrates as a light snack before bedtime E. Increasing exposure to natural light 2 hours each morning

D. Consuming carbohydrates as a light snack before bedtime E. Increasing exposure to natural light 2 hours each morning Rationale: PP. 1121 & 1125

Which position for sleeping is comfortable for a patient with a hiatal hernia? A. Side B. Prone C. Supine D. Semi-sitting

D. Semi-sitting Rationale: P. 1125

Which nursing intervention would the nurse provide to a patient who is diagnosed with stress overload? A. Encourage short naps, if possible B. Instruct the patient to keep an exercise log C. Have the patient keep a sleep log for a week D. Use active listening when talking to the patient

D. Use active listening when talking to the patient Rationale: P. 1125

Which nursing measure best promotes sleep in a school-age child? A. Encourage evening exercise. B. Offer a glass of hot chocolate before bedtime. C. Make sure that the room is dark and quiet. D. Use quiet activities consistently before bedtime.

D. Use quiet activities consistently before bedtime. Rationale: P. 1121

Which finding is similar for both obstructive sleep apnea (OSA) and central sleep apnea (CSA)? Loud snoring Decreased oxygen saturation level No movement of the chest wall Relaxed throat muscles

Decreased oxygen saturation level Rationale: OSA causes loud snoring; CSA causes mild and intermittent snoring. CSA ceases the movement of the chest wall; patients with OSA show chest wall movement. OSA occurs when muscles of the throat relax during sleep; CSA involves a dysfunction in the respiratory control center of the brain. P. 1109

Which effect will likely occur in a patient who takes an antidepressant for depression? Decreased total sleep time High blood pressure Difficulty breathing Increased daytime sleepiness

Decreased total sleep time Rationale: Antidepressants cause a decrease in total sleep time. Antidepressants can also suppress rapid eye movement sleep. Antidepressants are not associated with high blood pressure, nor difficulty breathing. A patient who is taking a benzodiazepine can experience increased daytime sleepiness. P. 1112

Which patient effect can be caused from the noise generated during the delivery of care? Select all that apply. Delayed healing Increased agitation Decreased heart rate Lowered blood pressure Impaired immune function

Delayed healing Increased agitation Impaired immune function Rationale: Noise may cause stress and lead to delayed healing, increased agitation, and impaired immune function. Noise increases heart rate and raises blood pressure; it does not decrease heart rate nor blood pressure. P. 1112

Which class of medication does the nurse expect to have caused a patient to report disturbed sleep because of frequent nighttime voiding? Diuretics Hypnotics Benzodiazepines Beta- adrenergic blockers

Diuretics Rationale: Diuretics cause nocturia, which results in disturbed sleep because of frequent nighttime voiding. Hypnotics, benzodiazepines, and beta-adrenergic blockers do not cause nocturia. Hypnotics cause a hangover during the day, excessive drowsiness, and confusion. Benzodiazepines increase daytime sleepiness and alter rapid eye movement sleep. Beta-adrenergic blockers cause nightmares and insomnia. P. 1112

Which physiological change increases when a patient is asleep? Heart rate Cell division Basal metabolic rate Muscular contractions

Increased cell division Rationale: Cell division increases during sleep and helps in the renewal of tissues. The heart rate decreases during sleep; this action benefits the cardiac function. The basal metabolic rate decreases during sleep; this action conserves the body's energy supply. Muscular contractions decrease during sleep; this action preserves chemical energy for cellular processes. P. 1107

Which sleep deprivation symptom is psychologic? Slowed reflexes Fine- motor clumsiness Increased sensitivity to pain Decreased auditory alertness

Increased sensitivity to pain Rationale: Increased sensitivity to pain is a psychologic symptom in a patient with sleep deprivation. Slowed reflexes, fine-motor clumsiness, and decreased auditory alertness are physiologic symptoms of sleep deprivation. P. 1110

A sleeper's random eye movement (REM) sleep is around 30% of the sleep time. The sleeper belongs to which age group? Infants Neonates Young adults Preschoolers

Infants Rationale: In infants, around 30% of the sleep time is random eye movement (REM) sleep. In neonates, around 50% of the sleep time is REM sleep. In young adults and preschoolers, around 20% of the sleep time is REM sleep. P. 1111

Which sleep disorder would the nurse monitor for in a woman who experiences menopausal symptoms such as hot flashes, mood swings, and irritability. Nocturia Insomnia Obstructive apnea Central sleep apnea

Insomnia Rationale: Insomnia may occur during menopause because of hormonal imbalance. P. 1111

Which information is true about gender disparities in patients with sleep disorders? Sleep apnea is more common in women than in men Insomnia is the most common sleep disorder in women Restless legs syndrome (RLS) is more common in men than in women Excessive sleepiness is common in women with menopausal symptoms

Insomnia is the most common sleep disorder in women Rationale: Sleep apnea is more common in men. RLS is more common in women. Insomnia rather than excessive sleepiness is common in women with menopausal symptoms. P. 1109

Which type of anemia will likely lead to restless legs syndrome? Folate Cobalamin Vitamin B12 Iron

Iron Rationale: Rhythmical movements of the feet and legs and an itching sensation in the muscles before sleep are symptoms of restless legs syndrome, which is cause by iron deficiency anemia. P. 1108

At which stage of human development does sleep duration at night begin to decline? Toddlerhood Adolescence Young adulthood Middle adulthood

Middle adulthood Rationale: Starting in middle adulthood, stage 4 sleep of nonrapid eye movement sleep begins to decline. Sleeping time at night does not decline during toddlerhood, adolescence, or young adulthood. P. 1111

Which common symptom does the patient likely report when being evaluated for obstructive sleep apnea? Select all that apply. Morning headache Early wakening Excessive daytime sleepiness Difficulty falling asleep Irritability

Morning headache Excessive daytime sleepiness Irritability Rationale: Early wakening occurs with hypertension and insomnia, not obstructive sleep apnea. Difficulty falling asleep occurs with insomnia, not obstructive sleep apnea. P. 1109

During which stage of sleep does the body release human growth hormone? N1 N2 N3 Rapid eye movement (REM)

N3 Rationale: Human growth hormone is released during stage 3 of nonrapid eye movement (NREM) sleep (N3). Stage 1 NREM sleep (N1) is the lightest level of sleep, lasting for just a few minutes. Stage 2 NREM sleep (N2) is a period of sound sleep. REM is the vivid dreaming stage. P. 1107

Which stage of the sleep cycle is decreased in the patient who has hypothyroidism? N1 N2 N3 Rapid eye movement (REM)

N3 Rationale: Hypothyroidism decreases the last sleep stage (N3) of nonrapid eye movement sleep. P. 1108

According to the American Academy of Sleep Medicine, which stage of nonrapid eye movement (NREM) sleep is the deepest stage of sleep, is very difficult to arouse the sleeper from, and are vital signs lower than during normal waking hours? Nblank

N3 Rationale: N3 is the deepest stage of sleep, is very difficult to arouse the sleeper from, and vital signs are lower than during normal waking hours. P. 1107

Which class of drugs does the nurse suspect is responsible for the patient reporting daytime drowsiness and a lack of dreams? Antibiotics Antipyretics Opiates Diuretics

Opiates Rationale: Opiates cause increased daytime drowsiness and suppress rapid eye movement (REM) sleep, which can result in a lack of dreams. Antibiotics generally do not cause a lack of dreams and daytime drowsiness. Antipyretics generally do not cause daytime drowsiness or suppress REM sleep. Diuretics are not associated with daytime drowsiness or a lack of dreams; however, diuretics can cause nighttime awakenings resulting from nocturia. P. 1112

Which sleep disorder is classified as a sleep-related breathing disorder? Narcolepsy Nightmare disorder Sleep-related bruxism Primary central sleep apnea

Primary central sleep apnea Rationale: Narcolepsy is classified as a hypersomnia that is not caused by or classified as a sleep-related breathing disorder. Nightmare disorder is classified as a parasomnia that is usually associated with rapid eye movement sleep; it is not classified as a sleep-related breathing disorder. Sleep-related bruxism is classified as a sleep-related movement disorder, not a sleep-related breathing disorder. P. 1109

Which information would the nurse include when teaching staff about the physiology of sleep? Prostaglandin D2 controls sleep Another name for Process S is circadian process Human growth factor is released during nonrapid eye movement (NREM) stage 3 sleep The ascending reticular activating system (RAS) maintains wakefulness Hypocretins promote NREM sleep

Prostaglandin D2 controls sleep Human growth factor is released during nonrapid eye movement (NREM) stage 3 sleep The ascending reticular activating system (RAS) maintains wakefulness Rationale: Sleep involves a sequence of physiologic states maintained by central nervous system activity. Sleep is controlled by prostaglandin D2, L-tryptophan, and growth factors. During NREM stage 3 sleep, human growth factor is released. The ascending RAS maintains alertness and wakefulness in response to visual, auditory, pain, and tactile stimuli. Another name for Process S is homeostatic process, not circadian process. Hypocretins promote wakefulness and rapid (not nonrapid) eye movement sleep. PP. 1106-1107

Which condition will likely result when a person is moderately fatigued because of exercising 2 hours before bedtime? Insomnia Sleep apnea Restful sleep Excessive daytime sleepiness

Restful sleep Rationale: Allows the body to cool down and causes moderate fatigue; this promotes relaxation. Exhausting or stressful work makes falling asleep difficult, resulting in insomnia. Sleep apnea is caused by a lack of airflow through the nose and mouth for a period of 10 seconds or longer during sleep. Excessive daytime sleepiness is a condition observed in patients with obstructive sleep apnea. P. 1112

Which information would the nurse share with the family caregivers of a patient with narcolepsy? Select all that apply. Sleep paralysis is usually present in patients who have narcolepsy Symptoms of narcolepsy first appear in the adolescent stage Patients who have narcolepsy are prescribed sleep-promoting medications Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states Excessive nighttime sleepiness is a common complaint associated with narcolepsy

Sleep paralysis is usually present in patients who have narcolepsy Symptoms of narcolepsy first appear in the adolescent stage Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states Rationale: Patients with narcolepsy are often associated with cataplexy and sleep paralysis. The symptoms of narcolepsy first appear in adolescents. Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states. Patients with narcolepsy are treated with stimulants or wakefulness-promoting agents, not sleep-promoting medications. Patients with narcolepsy often have excessive daytime, not nighttime, sleepiness. PP. 1109-1110

Which characteristic occurs in both N1 and N2 or nonrapid eye movement (NREM) sleep? Lasts for 10 to 20 minutes Includes a light level of sleep Muscles are completely relaxed Sleeper can be easily awakened

Sleeper can be easily awakened Rationale: N1 lasts for a few minutes, not 10 to 20 minutes. N1 is the lightest level of sleep; N2 is a period of sound sleep. Muscles are completely relaxed in N3, not in N1 and N2. P. 1107

While monitoring a patient's vital signs, the nurse finds that the patient's pulse and respiration during sleep are significantly lower than during waking hours. The nurse also recalls that during this stage of sleep the body releases human growth hormone. The patient is in which nonrapid eye movement (NREM) stage of sleep? Stage 1 Stage 2 Stage 3 Stage 4

Stage 4

Which sleep-related side effect is seen in both antidepressants and anticonvulsants? Nocturia Daytime drowsiness Decreased total sleep time Suppressed rapid eye movement (REM) sleep

Suppressed rapid eye movement (REM) sleep Rationale: Nocturia is associated with the use of diuretics. The use of anticonvulsants is associated with daytime drowsiness but not with antidepressants. The use of antidepressants is associated with decreased total sleep time but not with anticonvulsants. P. 1112

Which information is true regarding sleep regulation? L-tryptophan controls wakefulness in the body The hypothalamus is the major sleep center of the body The homeostatic process influences internal organization of sleep Circadian rhythms regulate the length and depth of sleep

The hypothalamus is the major sleep center of the body Rationale: The following information is WRONG: L-tryptophan controls sleep; this chemical does not promote wakefulness. The circadian rhythm (not the homeostatic process) influences the internal organization of sleep. The homeostatic process (not circadian rhythms) regulates the length and depth of sleep. P. 1106

Which aspect of care would the be included when teaching a patient with narcolepsy? The need to perform strenuous exercise The importance of avoiding caffeine The recommendation to take regular naps of no more than 20 minutes The proper method of using continuous positive airway pressure (CPAP)

The recommendation of taking regular naps of no more than 20 minutes Rationale: The patient should avoid strenuous exercise because this can cause drowsiness. Narcolepsy is unrelated to caffeine intake. CPAP is helpful in improving sleep in patients with sleep apnea; it has no role in narcolepsy. P. 1110

Which information would the nurse share with a patient about the major risk factors for obstructive sleep apnea (OSA)? These include obesity and hypertension Smoking and heart failure are the main ones Alcohol and type 2 diabetes are the main ones These include smoking and a family history of OSA

These include obesity and hypertension Rationale: Smoking, heart failure, alcohol, type 2 diabetes, and a family history of OSA are not major risk factors for OSA. However, smoking and heart failure do increase the risk of OSA, but they are not major risk factors. P. 1109

What is the nurse least likely to ask parents while performing a sleep assessment of an infant? To describe the infant's eating pattern To describe the sleeping environment of the infant To keep a sleep log of the infant's sleep behavior only at night To evaluate the typical behavior patterns that foster or impair sleep

To keep a sleep log of the infant's sleep behavior only at night

Which activity would the nurse include when teaching about sleep-promoting activities to a patient? Select all that apply Using relaxation exercises and meditation Reading a light novel in bed to fall asleep Eating dinner just 1 hour before bedtime Consuming a light snack before bedtime Drinking 500mL of water before going to beddo not

Using relaxation exercises and meditation Consuming a light snack before bedtime