skills- chap. 43 sleep

Headache Excessive daytime sleepiness Snoring Rationale Common symptoms for obstructive sleep apnea include headache, snoring, and excessive daytime sleepiness caused by poor sleep during the night. The other symptoms are not related to obstructive sleep apnea. p. 996

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. Headache Early wakening Excessive daytime sleepiness Difficulty falling asleep Snoring

Benzodiazepines Rationale Benzodiazepines increase the total sleep time. Nicotine, stimulants, and antidepressants decrease the total sleep time. p. 998

What drug is used to increase a patient's total sleep time? Nicotine Stimulants Antidepressants Benzodiazepines

Encephalitis Brainstem injury Rationale Encephalitis and brainstem injuries predispose a patient to central sleep apnea (CSA). Structural abnormalities such as nasal polyps, enlarged tonsils, and a deviated septum predispose a patient to obstructive sleep apnea (OSA). p. 996

After assessing a patient, the nurse identifies that the patient is predisposed to central sleep apnea. What assessment findings would suggest this condition? Select all that apply. Encephalitis Nasal polyps Enlarged tonsils Brainstem injury Deviated septum

90 Rationale A sleeper usually reaches rapid eye movement (REM) sleep 90 minutes into the sleep cycle. p. 993

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

15 minutes Rationale In a patient who has narcolepsy, rapid eye movement (REM) sleep occurs within 15 minutes of falling asleep. p. 996

In a patient with narcolepsy, rapid eye movement (REM) sleep occurs within how many minutes of falling asleep? Record your answer using a whole number.

The sleeper can be easily awakened in both stages. Rationale In stages 1 and 2 of nonrapid eye movement (NREM) sleep, the sleeper can be awakened easily. Stage 1 lasts for a few minutes; stage 2 lasts 10 to 20 minutes. Muscles are completely relaxed in stage 3 of NREM sleep. Stage 1 is the lightest level of sleep; stage 2 is a period of sound sleep. Test-Taking Tip: Whether you are taking a written or clinical exam, budget your time. Remember that some tasks or questions may require more time than others. p. 993

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

Stage 3 involves initial stages of deep sleep. Rationale Stage 3 involves the initial stages of deep sleep, whereas stage 4 is the deepest stage of sleep. Both stages last 15 to 30 minutes. In both stages, the sleeper cannot be easily awakened and the sleeper's vital signs are lower than they are during waking hours. p. 993

How is stage 3 of nonrapid eye movement sleep different from stage 4 of nonrapid eye movement? Stage 3 lasts 15 to 30 minutes. Stage 3 involves initial stages of deep sleep. In stage 3, the sleeper can be easily awakened. In stage 3, vital signs are lower during the waking hours.

Skeletal muscle paralysis Rationale REM sleep is a stage that usually begins about 90 minutes after sleep has begun. Events that occur during this stage of sleep include the loss of skeletal muscle tone or skeletal muscle paralysis. Bedwetting, or enuresis, may occur during stage 4 of nonrapid eye movement (NREM) sleep. In stage 1 of NREM sleep, upon awakening the patient may feel as though daydreaming has occurred. Sleepwalking occurs during stage 4 of NREM sleep. p. 994

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

Respiratory rate decreases. Rationale Respiratory rate decreases during sleep. Cortical activity, oxygen consumption, and epinephrine production increase during sleep. p. 994

What biological function occurs when a patient is sleeping? Cortical activity decreases. Respiratory rate decreases. Oxygen consumption decreases. Epinephrine production decreases.

Stage 3 Rationale Stage 3 of the nonrapid eye movement (NREM) sleep involves the initial stages of deep sleep. Stage 1 includes the lightest level of sleep. Stage 2 is a period of sound sleep. Stage 4 is the deepest stage of sleep. p. 994

Which phase of nonrapid eye movement (NREM) sleep involves the initial stages of deep sleep? Stage 1 Stage 2 Stage 3 Stage 4

Irritability Agitation Decreased auditory and visual alertness Rationale The patient may be irritable and agitated due to sleep deprivation. He may also experience decreased auditory and visual alertness. His reflexes would be decreased, and he would experience increased sensitivity to pain. p. 997

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. Irritability Agitation Increased reflexes Decreased sensitivity to pain Decreased auditory and visual alertness

Ptosis Decreased reflexes Fine-motor clumsiness Rationale A person's response to sleep deprivation is variable. Sleep deprivation may cause ptosis, decreased reflexes, and fine-motor clumsiness. These manifestations are due to the loss of rapid eye movement (REM) sleep. Nystagmus and gross-motor clumsiness do not occur with sleep deprivation. p. 997

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

Children experience more stage 4 nonrapid eye movement (NREM) sleep. Personality has an influence on dreams. Dreams occur during both NREM and REM sleep. Rationale Normal sleep has two phases: nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep has four stages. Children experience more stage 4 NREM sleep because they need it more. Dreaming is a phenomenon that occurs both in the NREM and REM phases of sleep. However, the dreams of REM sleep are more vivid and colorful compared to those of NREM sleep. Dreams are influenced by personality. Dreams of a creative person are well structured and have positive content, but those of a depressed person are of helplessness. REM sleep is associated with increased cortical activity and epinephrine release. Test-Taking Tip: Do not read too much into the question or worry that it is a trick. If you have nursing experience, ask yourself how an inexperienced classmate would answer this question from only the information provided in the textbooks or given in the lectures. p. 994

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

"Exercise 2 hours before bedtime to promote sleep." Rationale Exercising 2 hours before bedtime promotes sleep because exercise cools the body and maintains a state of fatigue that promotes relaxation. 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. Moderate fatigue usually achieves restful sleep. Excess fatigue resulting from stressful work makes falling asleep difficult. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. p. 999

A nurse is teaching a patient who is sleep deprived about factors that can promote sleep. What statement if made by the nurse should be included in the teaching? "Exercise 2 hours before bedtime to promote sleep." "Consume chocolates in the evening to promote sleep." "Have a large and heavy meal at night to promote sleep." "Work until you are excessively fatigued to promote sleep."

"Light sleep is also called slow-wave sleep." Rationale Deep sleep is also called slow-wave sleep. Arousal is very easy during light sleep, which is present in stages 1 and 2 of nonrapid eye movement (NREM) sleep. Shifts to light sleep tend to occur suddenly, whereas shifts to deep sleep tend to be gradual. Time spent in light sleep increases with age because sleep becomes more fragmented with aging. Newborns and children spend more time in deep sleep. p. 993

A nurse teaches a patient about light sleep. Which statement if made by the patient indicates a need for further learning? "It is very easy to wake up during light sleep." "Light sleep is also called slow-wave sleep." "Shifts to light sleep tend to occur suddenly." "The time spent in light sleep increases with age."

Avoid alcohol Avoid heavy meals Avoid long-distance driving Rationale 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. Study Tip: Remember that being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience. p. 996

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. Avoid alcohol Avoid smoking Avoid relaxing activities Avoid heavy meals Avoid long-distance driving

Insomnia Rationale Insomnia may occur during menopause due to hormonal imbalance. The patient is unable to fall asleep, may experience frequent awakenings from sleep, and there may be nonrestorative sleep. Nocturia, obstructive apnea, and central sleep apnea are not associated with menopause. p. 998

A patient experiences menopausal symptoms such as hot flashes, mood swings, and irritability. Which sleep disorder is likely to be found in the patient? Nocturia Insomnia Obstructive apnea Central sleep apnea

"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. Patients with narcolepsy often have excessive daytime, not nighttime, sleepiness. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 996

A patient has been diagnosed with narcolepsy. What would the nurse teach the family caregivers about 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."

"Avoid eating heavy meals." "Avoid long-distance driving." "Avoid the consumption of alcohol." Rationale Narcolepsy is a condition in which the sleep-wake cycle mechanism is disturbed and drowsiness increases. Heavy meals can worsen drowsiness and should be avoided. Long-distance driving can be risky because the patient tends to fall asleep while driving. Alcohol also causes drowsiness and should be avoided. Consumption of a protein-rich diet and chewing gum are helpful in decreasing drowsiness. Test-Taking Tip: If you can think about what would help you stay awake and alert, the same techniques apply for a patient with narcolepsy. Reread the choices keeping how you stay awake in mind, and the answers are clear. p. 997

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."

Behaviorally induced circadian rhythm sleep disorder Rationale A patient experiencing behaviorally induced circadian rhythm sleep disorder when jet lag affects the circadian rhythm. Inadequate sleep hygiene and an adjustment sleep disorder are classified as insomnias. Rapid eye movement (REM) sleep-behavior disorder is a parasomnia associated with REM sleep. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 995

A patient informs a nurse about sleep disturbances caused by jet lag. What sleep disorder does the nurse suspect? Inadequate sleep hygiene Adjustment sleep disorder Rapid eye movement (REM) sleep-behavior disorder Behaviorally induced circadian rhythm sleep disorder

Stimulants Rationale In narcolepsy, the patient falls asleep uncontrollably at inappropriate times. These are called sleep attacks. Therefore, stimulants should be included in the patient's treatment plan to help improve alertness. Stimulants increase wakefulness and reduce sleep attacks. Hypnotics, anticonvulsants, and benzodiazepines increase drowsiness and sleeping time, so these medicines are contraindicated for narcoleptic patients. p. 996

A patient is diagnosed with narcolepsy. Which class of drugs does the nurse anticipate will be in the patient's treatment plan to prevent sleep attacks? Hypnotics Stimulants Anticonvulsants Benzodiazepines

Provide the patient with emotional support. Encourage the patient to lose weight and quit smoking. Rationale Obesity, smoking, and diabetes are all risk factors for obstructive sleep apnea. The treatment for obstructive sleep apnea includes treatment for the underlying cardiac or respiratory causes. The nurse should provide emotional support to the patient. The patient should also be advised to lose weight and quit smoking. Referring him to a marriage counselor will not help to solve his problem associated with sleep apnea. Instructing the patient to avoid coffee before sleep or making the environment conducive to sleep before bedtime will only induce sleep. These measures will not help to treat obstructive sleep apnea. p. 996

A patient is overweight and is a chronic smoker with type II diabetes. The patient is suffering from obstructive sleep apnea that is affecting his marital relationship. What nursing actions should the nurse perform to help the patient manage 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.

Opiates Rationale Opiates suppress rapid eye movement (REM) sleep and increase daytime drowsiness. Alcohol and nicotine suppress REM sleep, but do not cause daytime drowsiness. Hypnotics cause drowsiness, but do not interfere with REM sleep. p. 998

A patient is prescribed a medication that suppresses rapid eye movement (REM) sleep and increases daytime drowsiness. What is the classification of this medication? Alcohol Opiates Nicotine Hypnotics

"Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states." Rationale Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states. Sleep apnea is a disorder characterized by the lack of airflow through the nose and mouth. Insomnia is a symptom that patients experience when they have chronic difficulty falling asleep. Cataplexy is sudden muscle weakness during intense emotions such as anger, sadness, or laughter. Test-Taking Tip: If you can eliminate any responses as incorrect based on your knowledge, you will not be guessing randomly but will be exercising "informed guessing." p. 996

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

Alcohol promotes sleep. Alcohol awakens the patient early and causes difficulty in returning to sleep. Alcohol reduces rapid eye movement (REM) sleep. Rationale Alcohol promotes sleep, but it also awakens the patient early and makes it hard to return to sleep. It also reduces REM sleep. Alcohol is not a stimulant and does not prevent the patient from falling asleep. p. 999

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. Alcohol promotes sleep. Alcohol prevents the patient from falling asleep. Alcohol causes the patient to remain awake. Alcohol awakens the patient early and causes difficulty in returning to sleep. Alcohol reduces rapid eye movement (REM) sleep

Body functions become slow. Arousal remains relatively easy. Muscles are completely relaxed. Rationale In stage 2 of nonrapid eye movement stage (NREM) sleep, the body functions become slow. The sleeper can be easily aroused in this stage. The muscles are completely relaxed in stage 3. A person may sleepwalk during stage 4 of NREM sleep. Also during stage 4, the vital signs are lower than they are during waking hours.

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. Sleepwalking may occur. Body functions become slow. Arousal remains relatively easy. Muscles are completely relaxed. Vital signs are significantly lower than during waking hours.

"How easily do you fall asleep?" "What causes you to awaken early?" "What do you think of when you try to fall asleep?" Rationale Insomnia is a condition in which the patient has difficulty falling asleep. Information about the patient's problem falling asleep and his or her reasons for waking up early helps determine the sleep pattern. If the patient is thinking about a specific issue when trying to sleep, it may be a source of stress. The questions about eating out and living with parents do not contribute to determining the sleep pattern. p. 996

A patient reports difficulty falling asleep. Which questions should the nurse ask to assess the patient's insomnia? Select all that apply. "How frequently do you eat out?" "How easily do you fall asleep?" "What causes you to awaken early?" "What do you think of when you try to fall asleep?" "Do you stay with your parents?"

Narcolepsy Rationale Sleep paralysis is a symptom associated with narcolepsy. It occurs when patients feel like they are unable to move or talk just before waking or falling asleep. Sleep paralysis is not associated with cataplexy, mixed sleep apnea, or central sleep apnea. Cataplexy is sudden muscle weakness while experiencing intense emotions such as anger, sadness, or laughter. It may occur any time during the day. Mixed sleep apnea is associated with both central sleep apnea (CSA) and obstructive sleep apnea (OSA). CSA involves dysfunction in the respiratory control center of the brain.

A patient reports to the nurse, "I feel like I'm unable to move or talk just before waking or falling asleep." Which sleep disorder does the nurse suspect? Cataplexy Narcolepsy Mixed sleep apnea Central sleep apnea

Rapid eye movement sleep Rationale Vivid and colorful dreaming occurs during rapid eye movement sleep. Dreams also occur in stage 2, stage 3, and stage 4 of nonrapid eye movement sleep, but they are less vivid. Stage 2 of NREM sleep lasts 10 to 20 minutes and is a period of sound sleep. Stage 3 of NREM sleep lasts 15 to 30 minutes and involves the initial stages of deep sleep. Stage 4 of NREM sleep lasts approximately 15 to 30 minutes and is the deepest stage of sleep. Study Tip: Because full-color dreaming creates visual pictures in the patient's mind, it makes sense that it occurs during rapid eye movement sleep. p. 994

A patient tells the nurse about a dream that was vivid and colorful. In which stage of sleep does such a dream occur? Rapid eye movement sleep Stage 2 of nonrapid eye movement (NREM) sleep Stage 3 of nonrapid eye movement sleep Stage 4 of nonrapid eye movement sleep

"Alcohol causes awakening from sleep." "Alcohol causes difficulty returning to sleep." "Alcohol reduces rapid eye movement (REM) sleep." Rationale The nurse should explain that alcohol causes awakening from sleep and difficulty returning back to sleep. Alcohol also reduces rapid eye movement (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. 998

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. "Alcohol causes nightmares." "Alcohol prevents the onset of sleep." "Alcohol causes awakening from sleep." "Alcohol causes difficulty returning to sleep." "Alcohol reduces rapid eye movement (REM) sleep."

Gender Pregnancy Lower level of iron Rationale The symptoms in the patient indicate that she is suffering from a condition called restless legs syndrome (RLS). This condition is more common in women, pregnant females, and those with low iron levels. Though renal failure is associated with RLS, the patient does not show any other signs of renal failure. Gestational age does not play a role in RLS. p. 995

A patient with anemia who is 24 weeks pregnant complains to the nurse of recurrent, rhythmical movements of her feet and legs before the onset of sleep. What could be the reason for her condition? Select all that apply. Renal failure Gender Pregnancy Her gestational age Lower level of iron

Restless legs syndrome 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 caused by iron deficiency anemia. In cataplexy, sudden muscle weakness occurs during intense emotions such as sadness, anger, or laughter. Insomnia refers to difficulty falling asleep. Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states. p. 995

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

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. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. pp. 997-998

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

Limit alcohol consumption. Motivate the patient to lose weight. Avoid the consumption of stimulants before going to bed. Rationale In obstructive sleep apnea, the upper airways become partially or completely blocked, diminishing nasal airflow or stopping it for as long as 30 seconds. Consumption of alcohol interferes with the quality of sleep. Weight reduction is helpful in decreasing sleep apnea, because it helps to reduce airway obstruction and promotes lung expansion. Consumption of stimulants causes sleeplessness, so they should be avoided. Sedatives should only be prescribed by the health care provider. Herbal medicines may produce side effects or interact with other medications the patient is already taking. p. 996

An obese patient is diagnosed with obstructive sleep apnea. Which conservative approaches are included in the patient's treatment plan? Select all that apply. Limit alcohol consumption. Motivate the patient to lose weight. Recommend that the patient take sedatives. Recommend that the patient take herbal medicines. Avoid the consumption of stimulants before going to bed.

Middle adulthood Rationale During middle adulthood, sleeping time at night begins to decline. 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. 998

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

Sleep apnea Rationale Sleep apnea is most common in obese patients. Typical symptoms include snoring and periods of apnea. Narcolepsy occurs when a patient falls asleep unexpectedly. Sleep deprivation could result from sleep apnea. Paroxysmal nocturnal dyspnea occurs when a patient has shortness of breath during the night. p. 996

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

Blurred vision Decreased judgment 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. Test-Taking Tip: Sleep deprivation makes people less alert. "Increased reflexes" and "Increased visual alertness" can be eliminated when you realize they represent heightened alertness. p. 997

The nurse has a sleep disorder due to working rotating shifts. Which physiological symptoms are observed in the nurse? Select all that apply. Blurred vision Increased reflexes Decreased judgment Slowed response time Increased visual alertness

Ptosis or blurred vision Cardiac arrhythmias Diminished reflexes Decreased hearing Rationale Sleep deprivation may slow down all the body systems. This slowing may result in ptosis or blurred vision, cardiac arrhythmias, diminished reflexes, and decreased hearing. Sleep deprivation would not increase the response time to questions asked or to any activity, because responses have slowed. Study Tip: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency. p. 997

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. Increased response time Ptosis or blurred vision Cardiac arrhythmias Diminished reflexes Decreased hearing

Loud snoring Decreased sex drive Difficulty concentrating Rationale Sleep apnea occurs due to a lack of airflow through the nose and mouth for periods of 10 seconds or longer during sleep. Loud snoring, decreased sex drive, and difficulty concentrating are symptoms of sleep apnea. Muscle weakness and excessive urination during the night are not symptoms of sleep apnea. p. 996

The nurse is assessing a patient who has sleep apnea. Which symptoms are likely to be found in the patient? Select all that apply. Loud snoring Muscle weakness Decreased sex drive Difficulty concentrating Excessive urination during the night

Patients have a continuous itching sensation. There is recurrent rhythmical movement of the feet and legs. Rationale Patients with restless leg syndrome (RLS) feel an itching sensation deep in the muscles. Relief comes only from moving the legs, so 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 restless legs syndrome and nocturia has been cited. This syndrome occurs usually before sleep onset rather than waking. RLS is not related to thrombocytopenia, but its incidence is more common in people with iron deficiency anemia. p. 995

The nurse is attending to a patient diagnosed with restless leg syndrome (RLS). What are the characteristics of this syndrome? 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 thrombocytopenia. There is recurrent rhythmical movement of the feet and legs.

Difficulty falling asleep Rationale Hyperthyroidism is characterized by increased levels of thyroxine hormones. Due to the hormonal imbalance, hyperthyroidism affects the sleep cycle of the patient. As a result, the patient takes more time to fall asleep. Fatigue, chest pain, and sleepwalking are not associated with hyperthyroidism. p. 995

The nurse is caring for a patient with hyperthyroidism. What is the nurse likely to observe in the patient? Fatigue Chest pain Sleepwalking Difficulty falling asleep

Working a rotating shift Performing unaccustomed, heavy work 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. Study Tip: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) The amount of time needed, (2) The amount of time available, (3) The best time to study, and (4) Time for emergencies and relaxation. p. 996

The nurse is consulting with a 44-year-old patient who suffers from insomnia. Which lifestyle factors would the nurse inform the patient might affect sleep patterns? Select all that apply. Working a rotating shift Performing unaccustomed, heavy work Late-night social activities Changing evening mealtime A weight gain

Encourage patient to take one or two 20-minute naps during the day. Rationale A person with narcolepsy has the problem of falling asleep uncontrollably at inappropriate times. Brief daytime naps no longer than 20 minutes help reduce subjective feelings of sleepiness. Other management methods that help are following a regular exercise program, practicing good sleep habits, avoiding shifts in sleep, strategically timing daytime naps if possible, eating light meals high in protein, practicing deep breathing, chewing gum, and taking vitamins. Patients with narcolepsy need to avoid factors that increase drowsiness (e.g., alcohol; heavy meals; exhausting activities; long-distance driving; and long periods of sitting in hot, stuffy rooms). Test-Taking Tip: Use this mnemonic or make up one of your own: A person with narcole psy benefits from a power nap. p. 996

The nurse is developing a plan of care for a patient experiencing narcolepsy. Which intervention is appropriate to include on the plan? 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-minute naps during the day.

Prostaglandin D2 controls sleep. Major sleep center is located in the hypothalamus. The ascending reticular activating system (RAS) maintains wakefulness. Rationale Sleep involves a sequence of physiological states maintained by central nervous system activity. Sleep is controlled by prostaglandin D2, L-tryptophan, and growth factors. The major sleep center in the body is located in the hypothalamus, which produces hypocretins. The ascending reticular activating system maintains alertness and wakefulness in response to the visual, auditory, pain, and tactile stimuli. The bulbar synchronizing region releases serotonin and helps the body go to sleep. The medulla does not play a role in sleep. The hypocretins promote wakefulness and rapid eye movement sleep. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function. p. 992

The nurse is explaining the physiology of sleep to the student nurses. What information should the nurse include? Select all that apply. Prostaglandin D2 controls sleep. The release of serotonin from the bulbar synchronizing region prevents sleep. Major sleep center is located in the hypothalamus. The ascending reticular activating system (RAS) maintains wakefulness. Hypocretins promote nonrapid eye movement sleep.

REM sleep Rationale Although dreams occur during both 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. Study Tip: Keep a bedside journal and write down dreams as you awaken, whether you feel rested, and the hours you slept. After a few weeks, reread the sleep chapter in your text to learn what your sleep habits can tell you about yourself. This information may be valuable for planning study times before the exam. p. 994

The patient reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs during which sleep phase? REM sleep Stage 1 NREM sleep Stage 4 NREM sleep Transition period from NREM to REM sleep

Do not study in your bed. Turn off your cell phone at bedtime. Avoid drinking coffee or soda before bedtime. Rationale Adolescents need to practice good sleep hygiene practices. Beds should be used for sleeping only. Activities other than sleep should not be done in bed. A person should try to go to bed at the same time each night. Create an environment that is quiet and free of distractions. Turning off cell phones prevents sleep disruptions. Coffee or soda contains caffeine. Caffeine acts as a stimulant, 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. Study Tip: Sleep hygiene practices are especially important for you as you prepare for the exam. All electronic devices—cell phone, television, computer, etc.—should be turned off before bedtime so you can sleep without disruptions. pp. 998, 1006, 1007

The school nurse is teaching a group of high school students about health-promoting behaviors that improve sleep. Which points should be included in the education? Select all that apply. Do not study in your bed. Go to sleep each night whenever you feel tired. Turn off your cell phone at bedtime. Avoid drinking coffee or soda before bedtime. Turn on the television to help you fall asleep.

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) = 40 minutes. p. 993

The total sleep time of a patient is 200 minutes. If 80% of sleep time is spent in nonrapid eye movement (NREM) sleep, how much time is spent in rapid eye movement (REM) sleep? Record your answer using a whole number.

They lead to sleep disruption. Rationale The long-term use of sleeping medications in older adults can lead to sleep disruption. Because of the slower metabolism and excretion of sleep medications in older adults, the potential for sleep impairment occurs. If sleep medications are needed, the lowest dose possible should be used short term. Test-Taking Tip: The value of sufficient, undisturbed sleep is becoming clearer. Look for answers that support sleep promotion. p. 1008

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.

Excessive daytime sleepiness Rationale Excessive daytime sleepiness is the most common complaint by patients who have narcolepsy. Sleep paralysis, sudden muscle weakness, and vivid dreams while falling asleep not the most common symptoms associated with narcolepsy. Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care. p. 996

What is the most common complaint by patients who have narcolepsy? Sleep paralysis Sudden muscle weakness Excessive daytime sleepiness Vivid dreams while falling asleep

Both decrease the oxygen saturation level. Rationale Both obstructive sleep apnea (OSA) and central sleep apnea (CSA) decrease the oxygen saturation level. 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. 996

What is the similarity between obstructive sleep apnea (OSA) and central sleep apnea (CSA)? Both cause loud snoring. Both decrease the oxygen saturation level. Both cease the movement of the chest wall. Both occur when muscles of the throat relax.

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. pp. 993-994

What physiological change happens when a patient is asleep? Increased heart rate Increased cell division Increased basal metabolic rate Increased muscular contractions

A recommendation to take regular naps of no more than 20 minutes Rationale In counseling a patient who experiences narcolepsy, the nurse should emphasize good sleep hygiene and stress the importance of maintaining a regular schedule. The nurse should emphasize getting adequate nocturnal sleep. The patient should take regular naps at the times the patient is prone to increased sleepiness. The naps should not be longer than 20 minutes. They help reduce the subjective feelings of sleepiness. The patient should avoid strenuous exercise, because it can cause drowsiness. Narcolepsy is unrelated to caffeine intake. Continuous positive airway pressure (CPAP) is helpful in improving sleep in patients with sleep apnea; it has no role in narcolepsy. p. 996

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

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. Catecholamines, which are secreted by neurons in a reticular activating system, promote wakefulness. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. p. 998

Which chemicals promote sleep? Orexins Hypocretins L-tryptophan Catecholamines

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 a risk for developing CSA due to a fall in oxygen saturation blood 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 for developing OSA and not CSA. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice questions. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 996

Which patients are at risk for 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

Agitation Irritability Disorientation Rationale Agitation, irritability, and disorientation are psychological symptoms associated with a patient who is sleep deprived. Ptosis and cardiac arrhythmias are physiological symptoms associated with a patient who is sleep deprived. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 997

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

Confusion Disorientation Decreased motivation Rationale Sleep deprivation produces psychological symptoms due to neurological slowness. Confusion, disorientation, and decreased motivation may develop due to sleep deprivation. Sleep deprivation increases sleeping time when the patient does fall asleep, and increases sensitivity to pain. p. 997

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

Suppressed rapid eye movement (REM) sleep Rationale Both antidepressants and anticonvulsants suppress rapid eye movement (REM) sleep. Nocturia is associated with the use of diuretics. The use of anticonvulsants is associated with daytime drowsiness. The use of antidepressants is associated with decreased total sleep time. p. 998

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

"My grandmother told me that babies sleep better on their stomachs." Rationale "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). Test-Taking Tip: For questions about infant sleep, remember that one of the first campaigns for preventing SIDS and promoting babies sleeping on their backs was called the Back to Sleep Campaign. Think of how a mother feels when her baby awakens in the middle of the night; she really wants the infant to go back to sleep! p. 997

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."

"I'll have a glass of wine at bedtime to relax." Rationale The statement "I'll have a glass of wine at bedtime to relax" indicates a need for further teaching. Alcohol should be avoided before bed because it speeds the onset of sleep, reduces REM sleep, awakens the person during the night, and causes difficulty returning to sleep. p. 1006

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."

Stage 4 Rationale During stage 4 of NREM sleep, a patient's vital signs are significantly lower than during waking hours. This is a deep, slow-wave sleep stage during which the body releases human growth hormone. Stage 1 NREM sleep is the lightest level of sleep and lasts for just a few minutes. Stage 2 NREM sleep is a period of sound sleep that lasts for 10 to 20 minutes. Stage 3 NREM sleep involves the initial stages of deep sleep lasting for 15 to 20 minutes. p. 994

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