Chapter 43. Sleep and the Nursing Process EAQ

How long before bedtime should a patient take melatonin? Record your answer using a whole number. _______________________ hour(s)

2 Melatonin should be taken 2 hours before bedtime.

Which questions should the nurse ask during the assessment of a patient who is suspected of having narcolepsy? Select all that apply. 1 "Do you snore loudly?" 2 "What do you do to prepare for sleep?" 3 "Do you fall asleep at inappropriate times?" 4 "Do you have episodes of falling to the floor?" 5 "Do you experience headaches after awakening?"

3, 4 If a nurse suspects narcolepsy, he or she should ask if the patient falls asleep at inappropriate times and has episodes of falling to the floor. If the nurse suspects insomnia, he or she should ask how easily the patient falls asleep. If the nurse suspects sleep apnea, he or she should ask if the patient snores loudly and experiences headache after awakening.

Which intervention is appropriate to include on a care plan for improving sleep in the older adult? 1 Decrease fluids 2 to 4 hours before sleep. 2 Exercise in the evening to increase fatigue. 3 Allow the patient to sleep as late as possible. 4 Take a nap during the day to make up for lost sleep.

1 Decreasing fluids 2 to 4 hours before sleep reduces the likelihood that the older adult's sleep will be disrupted during the night by the need to void.

The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? 1 "I always feel tired when I wake up in the morning." 2 "I go to bed at the same time each night." 3 "It takes me about 15 minutes to fall asleep." 4 "Sometimes, I have to get up during the night to urinate."

1 This statement indicates that the patient is not experiencing quality sleep, and the statement should be followed up with more extensive questions and assessment of the problem. Patients are the best resource for describing sleep problems and how these problems are a change from their usual sleep and waking patterns. A general description of the problem followed by more focused questions usually reveals specific characteristics that are useful in planning therapies. To begin, you need to understand the nature of the sleep problem, its signs and symptoms, its onset and duration, its severity, any predisposing factors or causes, and the overall effect on the patient. Ask specific questions related to the sleep problem.

The nurse works in a sleep clinic. What instructions should the nurse provide to the older adults to enhance the quality of their sleep? Select all that apply. 1 Establish a fixed bedtime and stick to it. 2 Perform muscle relaxation before going to sleep. 3 Exercise an hour before bedtime to help induce sleep. 4 Watch a favorite movie or television program to relieve stress. 5 Drink a cup of coffee before bedtime to help induce sleep

1, 2, 4 Maintaining a consistent schedule helps to induce sleep. Performing muscle relaxation will help to reduce anxiety and help the patient to enhance the quality of sleep. It is not advised to use the bedroom for studying, watching television, or other unrelated sleep activities. Exercising has a stimulant effect. Exercising before bedtime prevents sleep. Coffee contains caffeine, which is a stimulant and prevents sleep.

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 6 months, and that it started when he began working night shifts. After thoroughly questioning the patient, the nurse learns that the patient is stressed due to his workload. The nurse teaches him sleep hygiene habits and guidelines for promoting sleep. What do these primarily include? Select all that apply. 1 Try to avoid worrisome thinking when going to bed and to use relaxation exercises. 2 Use warm water to bathe before bedtime. 3 Avoid listening to music during bedtime. 4 Consume milk or a light snack before bedtime. 5 Get out of the bed if unable to fall asleep in 15 to 30 minutes.

1, 2, 4, 5 The patient should be taught how to make his home environment more conducive to sleep. Taking a warm bath and consuming milk or a light snack before bedtime promote sleep. If the patient is unable to sleep after 15 to 30 minutes in bed, he should get out of bed and do some quiet activity until he feels sleepy. The nurse should instruct the patient to listen to soft music at bedtime. This will help him relax. The nurse should also encourage him to try to avoid worrisome thinking when going to bed and to use relaxation exercises.

A patient has a history of obstructive sleep apnea. Which postoperative care reduces the risk of any complications in the patient? 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 Using a nasal continuous positive airway pressure (CPAP) device

1, 2, 5 Patients with obstructive sleep apnea have a risk of developing postoperative complications. Following surgery, the patient may reach deep levels of rapid eye movement sleep that cause muscle relaxation. This muscle relaxation can worsen obstructive sleep apnea and obstruct the airway. An oral appliance can be used to keep the airway patent by advancing the mandible or tongue to relieve pharyngeal obstruction. The nurse should monitor the patient for an increased risk of respiratory complications. Using a nasal continuous positive airway pressure device helps to prevent airway collapse. The patient would be more comfortable if the head of the bed were elevated. The patient should not sleep in the supine position, because it may obstruct the airway.

Which questions should the nurse ask during the assessment phase of the nursing process when caring for a patient with suspected sleep apnea? Select all that apply. 1 "Do you snore loudly?" 2 "How easily do you fall asleep?" 3 "What do you do to prepare for sleep?" 4 "Do you fall asleep at inappropriate times?" 5 "Do you experience headaches after awakening?"

1, 5 If the nurse suspects sleep apnea, the nurse should ask if the patient snores loudly and experiences headaches after awakening during the assessment phase. The nurse should ask a patient suffering from insomnia how easily the patient falls asleep and what the patient does to prepare for sleep. The nurse should ask a patient suffering from narcolepsy if the patient falls asleep at inappropriate times.

What should a nurse teach a patient about the use of benzodiazepine to treat sleep problems? Select all that apply. 1 "Benzodiazepines can be safely used by older patients." 2 "Benzodiazepines are contraindicated in nursing mothers." 3 "Benzodiazepines can be safely used by pregnant women." 4 "Benzodiazepines are contraindicated in infants younger than 6 months old." 5 "Benzodiazepines are taken in a larger dose initially and the dose is gradually decreased."

2, 4 Benzodiazepines are contraindicated in nursing mothers because the drug is excreted in breast milk. Benzodiazepines are contraindicated in infants younger than 6 months old. The use of benzodiazepines in older adults is potentially dangerous because of the tendency of the drugs to remain active in the body for a longer time. Pregnant patients should avoid benzodiazepines, because their use is associated with risk of congenital anomalies. Benzodiazepines are prescribed in a small initial dose; the dosage then gradually increases.

A mother is unable to put her newborn baby to sleep. What measures should the nurse teach the mother to promote sleep in the newborn? Select all that apply. 1 Put the crib near an open window. 2 Rock the baby gently. 3 Talk to the baby loudly. 4 Sing a lullaby to the baby. 5 Hold the baby snugly in a blanket

2, 4, 5 Many factors influence sleep. The requirements for sleep vary in children and adults. The activities that could promote sleep in the baby include rocking the baby gently, singing a lullaby, and holding the baby snugly in a blanket. These measures create a peaceful environment for the baby to sleep. An appropriate room temperature is required to promote sleep and therefore, cribs should be placed away from open windows. Talking to the baby in a soft tone can also help the baby to sleep.

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. 1 It can cause urinary retention. 2 It should not be used indefinitely. 3 It may cause diarrhea and anxiety. 4 It may interfere with prescribed medications. 5 It can lead to further sleep problems when taken long term. 6 It is not regulated by the U.S. Food and Drug Administration (FDA).

2, 4, 5, 6 Melatonin is a neurohormone produced in the brain that helps control circadian rhythms and promote sleep. Short-term use of melatonin has been found to be safe, with mild side effects of nausea, headache, and dizziness occurring infrequently. Over the long term, these drugs lead to further sleep disruption even when they initially seem to be effective. Caution patients about the dosage and use of herbal compounds because the FDA does not regulate them. Herbal compounds may create interactions with prescribed medication, and patients need to avoid using these together.

Which measures help to promote sleep in older adults? Select all that apply. 1 Having tea or coffee before bedtime 2 Encouraging naps as many times as possible 3 Performing stimulating exercise before bedtime 4 Decreasing fluid intake 2 to 4 hours before sleep 5 Increasing exposure to bright light during the day

4, 5 In order to promote sleep in older patients, fluid intake should be decreased 2 to 4 hours before bedtime. In order to promote sleep, the patient should have increased exposure to bright light during the day. Tea and coffee should not be consumed before bedtime. Stimulating exercise should not be performed before bedtime. If naps are not a routine part of daily life, they should be eliminated.

What nursing intervention should the nurse provide to a patient who is diagnosed with stress overload? 1 Encourage short naps if possible 2 Instruct the patient to keep an exercise log 3 Have the patient keep a sleep log for a week 4 Use active listening when talking to the patient

4 The nurse should use active listening when talking to a patient who has been diagnosed with stress overload. A patient who complains of fatigue should take short naps. A patient with a sedentary lifestyle should keep an exercise log. A nurse should tell the patient suffering from insomnia to keep a sleep log for a week.

The nurse is teaching a patient about the use of herbal medicines. Which statements by the patient indicate effective learning? Select all that apply. 1 "Herbal medicines cause insomnia." 2 "Herbal medicines cause sleep apnea." 3 "Herbal medicines always cause allergic reactions." 4 "Herbal medicines may interact with prescribed medication." 5 "Herbal medicines are not regulated by the U.S. Food and Drug Administration."

4, 5 Herbal medicines may interact with prescribed medications. While using herbal medicines precaution should be taken regarding dosing and use because herbal medicines are not regulated by the U.S. Food and Drug Administration. Therefore, the patient should inform the health care provider before taking any herbal preparation. Herbal medicines do not cause insomnia or sleep apnea. Herbal medicines do not always cause allergic reactions.

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, 4, 5 The patient's symptoms indicate narcolepsy. Alcohol, heavy meals, and long-distance driving tend to induce drowsiness and should be avoided. Smoking is not related to narcolepsy. The patient should not avoid relaxing activities; engaging in exhausting activities may cause drowsiness and should be avoided.

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

20 About 20% of sleep time in young adults is rapid eye movement sleep

A patient has a hiatal hernia. Which position for sleeping is comfortable for the patient? 1 Side position 2 Prone position 3 Supine position 4 Semi-sitting position

4 A patient with a hiatal hernia patient experiences a burning sensation because of gastric reflux, which causes sleep disturbances. To prevent sleep disturbances the patient should eat a small meal several hours before bedtime and sleep in a semi-sitting position. The side position, prone position, and supine position may not help to prevent sleep disturbances, because the hernia may cause discomfort.

The nurse is teaching sleep-promoting activities to a patient. Which activities should the nurse include? Select all that apply. 1 Relaxation exercises and meditation 2 Reading a light novel in bed to get sleep 3 Eating dinner just 1 hour before bedtime 4 Eating a light snack before bedtime 5 Drinking 500 mL of water before going to bed

1, 4 Relaxing and meditation help promote sleep by relaxing the patient. Consuming carbohydrates or milk as a light snack before bedtime is a bedtime routine that prepares the body for sleep. Intake of liquids should be limited from 2 to 4 hours before going to bed. It is not advised to use the bedroom for studying, watching television, or other nonsleep activities. It is better not to eat heavy meals for 3 hours before going to bed. Sleep may be difficult with a heavy stomach.

What nursing intervention should the nurse provide to promote sleep in a patient who has a sedentary lifestyle? 1 Encourage short naps if possible 2 Instruct the patient to keep an exercise log 3 Have the patient keep a sleep log for a week 4 Use active listening when talking to the patient

2 The nurse should instruct a patient with a sedentary lifestyle to keep an exercise log. A patient who complains of fatigue should take short naps. A patient suffering from insomnia should keep a sleep log for a week. The nurse should use active listening when talking to a patient who has been diagnosed with stress overload.

What measure should the nurse suggest to a mother to promote sleep in preschoolers? 1 Encourage co-sleeping on a soft mattress 2 Offer warm milk before sleeping 3 Make sure that the room is dark and quiet 4 Offer a glass of hot chocolate before bedtime

2 In order to promote sleep in a preschooler, the nurse should suggest that the mother offer warm milk before sleeping. A dairy product such as warm milk contains L-tryptophan, which helps to promote sleep. Co-sleeping should occur on a firm mattress. Because preschoolers often have bedtime fears, the room should not be completely dark. Coffee, tea, colas, and chocolate can keep a person awake.

Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching? 1 "I won't put the baby to bed with a bottle." 2 "For the first few weeks we're putting the cradle in our room." 3 "My grandmother told me that babies sleep better on their stomachs." 4 "I know I'll have to get up during the night to feed the baby when he wakes up."

3 "My grandmother told me that babies sleep better on their stomachs" indicates that the mother needs further teaching. She needs to be educated on the back-to-bed concept for infant sleeping. Parents should place infants on their backs to prevent suffocation and decrease the risk of sudden infant death syndrome (SIDS).

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? 1 A 70-year-old patient with renal failure 2 A nursing mother 3 A 30-year-old patient 4 A pregnant patient

3 Benzodiazepines can be administered safely in young adults because the side effects are few. The drug should not be administered to an older adult who has renal failure because the drug tends to remain in the body for a longer time and may have a cumulative effect. The drug may be passed into the breast milk; therefore, a nursing mother should not be prescribed benzodiazepines. Benzodiazepines can cause congenital anomalies, so they should be avoided in pregnant patients.

What is the nurse least likely to ask parents while performing a sleep assessment of an infant? 1 To describe the infant's eating pattern 2 To describe the sleeping environment of the infant 3 To keep a sleep log of the infant's sleep behavior only at night 4 To evaluate the typical behavior patterns that foster or impair sleep

3 The nurse should ask the parents of an infant to keep a 24-hour log of their infant's waking and sleeping behavior for several days to determine the cause of the problem. The nurse should ask about the infant's eating pattern and sleep environment because these factors influence sleep behavior. The nurse should ask the parents to describe the typical behavior patterns that foster or impair sleep.

The nurse teaches a patient taking a benzodiazepine that this group of medications causes which symptom of a sleep problem? 1 Nocturia 2 Hyperactivity 3 Grogginess and feeling hung over 4 Nightmares

3 Benzodiazepines cause a hangover effect and rebound insomnia. The other sleep problems are not related to benzodiazepines. Beta-adrenergic blockers may cause nightmares. Diuretics may cause nighttime awakenings caused by nocturia.

A patient reports difficulty in sleeping. Which measures does the nurse suggest to promote sleep in the patient? Select all that apply. 1 Avoid taking a warm bath. 2 Eat a heavy meal at night. 3 Void before going to sleep. 4 Use extra blankets if necessary. 5 Wear soft, cotton nightclothes

3, 4, 5 The need to urinate may disturb the patient while sleeping. Voiding before going to sleep prevents sleep disturbances caused by a full bladder. Using extra blankets prevents the patient from feeling chilled. By wearing soft, cotton nightclothes the patient can feel comfortable and warm. A warm bath is also helpful for the patient to feel relaxed and to promote sleep. Consumption of a light meal improves sleep in the patient. Consumption of a heavy meal at night should be avoided because it may cause indigestion and sleep disturbances.

A patient asks about the effects of hypnotics on sleep. What statements would the nurse say to the patient? Select all that apply. 1 "Hypnotics cause nightmares." 2 "Hypnotics increase the speed of onset of sleep." 3 "Hypnotics suppress rapid eye movement sleep." 4 "Hypnotics interfere with the ability to reach deeper sleep stages." 5 "Hypnotics provide only a temporary increase in the quantity of sleep."

4, 5 Hypnotics interfere with reaching deeper sleep stages. They also provide only a temporary increase in the quantity of sleep. Beta-adrenergic blockers cause nightmares. Alcohol speeds onset of sleep. Antidepressants and stimulants suppress rapid eye movement sleep.

What nursing intervention should the nurse provide to a patient who is diagnosed with fatigue? 1 Encourage short naps if possible 2 Instruct the patient to keep an exercise log 3 Have the patient keep a sleep log for a week 4 Use active listening when talking to patient

1 The nurse should instruct a patient who complains of fatigue to take short naps. A patient with a sedentary lifestyle should keep an exercise log. A patient suffering from insomnia should be asked to keep a sleep log for a week. A nurse should use active listening when talking to a patient who has been diagnosed with stress overload.

What are the side effects of the antihistamine medications? 1 Confusion 2 Constipation 3 Urinary retention 4 Muscle weakness 5 Difficulty concentrating

1, 2, 3 Antihistamine medications have a long duration of action and can cause side effects such as confusion, constipation, and urinary retention. They also increase the risk of falls. Muscle weakness and difficulty concentrating are not side effects of antihistamines because the drugs do not act on those specific receptors.

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 6 months, and that it started when he began working night shifts. After thoroughly questioning the patient, the nurse learns that he is stressed due to his workload. The nurse teaches him sleep hygiene habits. Which strategies should the nurse include in the teaching? Select all that apply. 1 Limit caffeine. 2 Use earplugs and eyeshades. 3 Exercise in the morning and evening. 4 Avoid heavy meals 5 hours before bedtime. 5 Avoid using the bedroom for studying, snacking, or watching television.

1, 2, 5 Regular sleep hygiene habits help people relax. The nurse should instruct the patient to have caffeine before starting his night shift, but limit it throughout his waking hours. Caffeine is a stimulant and may increase alertness. Using earplugs and eyeshades helps prevent distractions during sleep. The bedroom should be used only for sleeping. It should not be used for any other activities, such as studying, snacking or watching television. The patient should exercise during the morning. Exercising before bed can make a person too alert and prevent sleep,so it is preferable to do it after rising from sleep rather than before sleep. Eating before sleeping is not advised, because a full stomach can interfere with sleep, but the patient does not have to avoid meals 5 hours before bedtime; 2 to 3 hours beforehand is enough time.

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 Avoid awakening patient for nonessential tasks. 3 Give prescribed sleeping medications at dinner. 4 Turn television on low to late-night programming

2 Avoiding awakening the patient for nonessential tasks promotes sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as laboratory draws and bathing during the night unless essential. Patients should try to follow home routines related to sleep habits. The other tasks do not promote sleep.

Which statement is true regarding the use of benzodiazepines? 1 Benzodiazepines can be safely prescribed to infants. 2 Benzodiazepines are initially taken in small dosages. 3 Benzodiazepines can be safely used by nursing mothers. 4 Benzodiazepines can be safely used by pregnant women.

2 Benzodiazepines are prescribed in a small initial dose and increments are added gradually. Benzodiazepines are contraindicated in infants younger than six months old. The use of benzodiazepines is contraindicated in nursing mothers because they are excreted in breast milk. The use of benzodiazepines is contraindicated in pregnant patients because their use is associated with a risk of congenital anomalies.

Which statement made by an older adult best demonstrates understanding regarding taking a 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 extremely sleepy in the mornings."

3 By stating that he or she will consult a health care provider before using an over-the-counter sleep medication, the older adult shows an understanding of the risks of over-the-counter sleep medications. The use of nonprescription sleep medications is not advisable. Over the long term, these drugs lead to further sleep disruption, even when they initially seemed to be effective. Caution older adults about using over-the-counter antihistamines because of their long duration of action, which can cause confusion, constipation, urinary retention, and an increased risk of falls.

Which nursing measure best promotes sleep in a school-age child? 1 Encourage evening exercise. 2 Offer a glass of hot chocolate before bedtime. 3 Make sure that the room is dark and quiet. 4 Use quiet activities consistently before bedtime

4 A bedtime routine (e.g., same hour for bedtime, snack, or quiet activity) used consistently helps young children avoid delaying sleep. Quiet activities such as reading stories, coloring, and allowing children to sit in a parent's lap while listening to music or a prayer are routines that are often associated with preparing for bed. Parents need to reinforce patterns of preparing for bedtime.

Which action by the nursing assistant at bedtime requires the nurse to intervene? 1 Giving the patient a back rub 2 Turning on quiet music 3 Dimming the lights in the patient's room 4 Giving a patient a cup of coffee

4 Encourage patients not to drink or ingest caffeine before bedtime. Coffee, tea, cola, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night. Coffee, tea, colas, and alcohol act as diuretics and cause a person to awaken in the night to void.

A nursing instructor asks a nursing student about the pharmacological approaches for treating sleep disturbances. Which statement by the student indicates a need of further teaching? 1 "Melatonin controls circadian rhythms and promotes sleep." 2 "The drug ramelteon works by improving circadian rhythms." 3 "Valerian is an herbal product that can be used to treat mild insomnia." 4 "Melatonin should be taken in a dose between 0.3 to 1 mg 1 hour before bedtime."

4 Melatonin should be taken in a dose between 0.3 and 1 mg 2 hours (not 1 hour) before bedtime. Melatonin controls circadian rhythms and promotes sleep. Ramelteon works by improving a patient's circadian rhythm. Valerian is an herbal product that is effective in treating mild insomnia.