SLEEP
A client is admitted to a psychiatric hospital after a month of unusual behavior that has included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. Which disorder does the nurse associate with these behaviors? Bipolar disorder, manic phase Antisocial personality disorder Obsessive-compulsive disorder Chronic undifferentiated schizophrenia
Bipolar disorder, manic phase This kind of hyperactive behavior is typical of the manic flight into reality associated with mood disorders. The behaviors are more indicative of a mood disorder than a personality disorder. Ritualistic, not manic, behavior is indicative of obsessive-compulsive disorder. A flat affect and apathy are more indicative of a schizophrenic disorder.
A patient who recently immigrated to the United States tells the nurse, "I am unable to sleep and concentrate on my work." What might be the reason for this condition? Sleep apnea Hypersomnia Sleep terror disorder Circadian rhythm sleep disorder
Circadian rhythm sleep disorder When a person travels from one time zone to another, he or she may face difficulty in adjusting to the time changes. This causes difficulty in sleeping, memory problems, depression, weight gain, and impaired concentration levels. This type of sleep disorder is termed circadian rhythm sleep disorder. Sleep apnea is shallow or absent breathing during sleep. Hypersomnia is a sleep-wake disorder in which a person sleeps excessively during the daytime, even after a normal 8 to 12 hours of sleep at night. A patient who has sleep terror disorder wakes suddenly in a terrified state from deep sleep.
Which hormone levels peak during the client's sleep? Select all that apply. Select all that apply Cortisol Calcitonin Thyrotropin Progesterone Growth hormone
Cortisol Thyrotropin Growth hormone
Which intervention is appropriate to include on a care plan for improving sleep in the older adult? Decrease fluids 2 to 4 hours before sleep. Exercise vigorously 1 hour before bedtime to increase fatigue. Allow the patient to sleep as late as possible. Take a nap during the day to make up for lost sleep
Decrease fluids 2 to 4 hours before sleep. 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. Exercise within 2 hours of normal sleep time can hamper sleep and should be avoided. Excessive exercise and exhaustion can hinder normal sleep. Encourage older adults to maintain the usual bedtime and routines as much as possible.
A 3-month-old infant with developmental dysplasia of the hip (DDH) is placed in a Pavlik harness. The home care nurse sees the infant sleeping without the harness. When asked about this, the parent explains that the baby will not sleep with the harness on. How should the nurse respond? Assure the parent that the harness may be removed for a short nap. Encourage the parent to reapply the harness after her baby falls asleep. Explain to the parent the importance of wearing the harness continuously. Instruct the parent to eliminate one of the infant's daily naps, thereby reducing the time spent out of the harness.
Explain to the parent the importance of wearing the harness continuously.
The night nurse reports that a young client with paranoid schizophrenia has been awake for several nights. The day nurse reviews the client's record and finds that this client did not have an interrupted sleep pattern disorder before transfer from a private room to a four-bed room 3 days ago. What factor should the nurse identify as most likely related to the client's sleeplessness? Fear of the other clients Concern about family at home Watching for an opportunity to escape Trying to work out emotional problems
Fear of the other clients Because the client has paranoid feelings that other people are out to do harm, assignment to a four-bed room may be threatening. Concern about family at home seems unlikely, because the disruption appears to have started with the transfer to a four-bed room. Watching for an opportunity to escape is possible but unlikely; planning an escape is usually not part of a schizophrenic pattern of behavior. Trying to work out emotional problems is possible but not likely; clients with schizophrenia have difficulty solving problems.
A 30-year-old patient presents to the clinic complaining of difficulty sleeping and is diagnosed with disrupted sleep pattern. The nurse is reconciling the patient's medications. Which of the following medications would the nurse suspect is the cause of the patient's disrupted sleep pattern? Gabapentin (Neurontin) Diphenhydramine (Benadryl) Pseudoephedrine (Sudafed) Zolpidem (Ambien)
Pseudoephedrine (Sudafed)
What are physiologic symptoms assessed in a client with sleep deprivation? Select all that apply. Select all that apply Ptosis and blurred vision Agitation and hyperactivity Confusion and disorientation Increased sensitivity to pain Decreased auditory alertness
Ptosis and blurred vision Decreased auditory alertness Ptosis may result from a loss of elasticity of the eyelids, which is a physiologic symptom of sleep deprivation. Decreased auditory alertness and blurred vision are also physiologic symptoms of sleep deprivation. Agitation, hyperactivity, confusion, disorientation, and increased sensitivity to pain are psychologic symptoms of sleep deprivation.
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 (REM) sleep Stage 2 of non-rapid eye movement (NREM) sleep Stage 3 of NREM sleep Stage 4 of NREM sleep
Rapid eye movement (REM) sleep Vivid and full-color dreaming occurs during REM sleep. Dreams also occur in stages 2, 3, and 4 of NREM 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 initial stages of deep sleep. Stage 4 of NREM sleep lasts approximately 15 to 30 minutes and is the deepest stage of sleep.
A patient with iron deficiency anemia reports rhythmic 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 leg syndrome
Rhythmic movements of the feet and legs and an itching sensation in the muscles before sleep are symptoms of restless leg syndrome, which may be caused by iron deficiency anemia. Insomnia refers to difficulty falling asleep. In cataplexy, sudden muscle weakness occurs during intense emotions such as sadness, anger, or laughter. Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states.
A lactating woman who reports a loss of interest in daily activities, loss of appetite, and sleeplessness is diagnosed with depression. What would be the drug of choice for this client if she wishes to continue breast-feeding?
Sertraline is the drug of choice for lactating woman with depression because it does not cause any effects on breast-feeding infants. Fluoxetine should be taken with caution because it may cause adverse effects on the infant at high dosages. Sumatriptan is the drug of choice for lactating woman suffering from migraines because it does not adversely affect to the fetus. Bromocriptine is contraindicated in lactating woman.
What would the nurse instruct the parent to refrain from doing if a 4-year-old child has nightmares on a routine basis? Keeping the lights on Sleeping with the child Tucking in a favorite soft toy with the child Leaving the room after comforting the child
Sleeping with the child If a child has nightmares, the parent should avoid sleeping with the child. Sleeping with the child may create a habit of delaying bedtime. In case of nightmares, keeping the lights on may help the child to overcome fear. Tucking in a soft toy gives the feeling of security to the child. The parent should comfort the child and leave the child in his or her own bed so that the child does not use the fear as an excuse to delay bedtime.
The nurse is caring for a newborn and instructs the parents, "Place your baby on her back for sleeping." Which condition does the nurse want to prevent in the newborn? Bruxism Narcolepsy Sleep apnea Sudden infant death syndrome
Sudden infant death syndrome is the sudden and unexpected death of a newborn or infant. The newborn may experience breathlessness due to laryngeal chemoreflex stimulation if placed in the prone position. Placing the newborn in the supine position prevents the laryngeal chemoreflex stimulation; thus it may lessen the newborn's risk of sudden infant death syndrome. Bruxism is the clenching of the teeth during sleep and occurs due to stress; it does not occur in newborns. Narcolepsy is a neurologic disorder that affects the sleep cycle and wakefulness; it usually occurs in adolescents. Sleep apnea is the absence of breath for at least 10 seconds and up to 2 minutes during sleep; it mostly occurs in adult men.
A client is experiencing feelings of sadness and is having difficulty concentrating and sleeping. What are additional common signs and symptoms of depression that the nurse should expect when performing an assessment of this client? Rigidity and a narrowing of perception Alternating episodes of fatigue and high energy Diminished pleasure in activities and alteration in appetite Excessive socialization and interest in activities of daily living
Diminished pleasure in activities and alteration in appetite Depression is characterized by feelings of hopelessness, helplessness, and despair, leaving little room for any pleasure; alteration in appetite (either decreased or increased) is common in depressed clients. Although there is a narrowing of perception, rigidity is uncommon with depression. Fatigue is continually present and does not alternate with a high energy level. There is a loss of interest in socialization and little participation in activities of daily living.
A chronically ill, older client tells the home care nurse that the daughter with whom the client lives seems run-down and disinterested in her own health, as well as the health of her children, who are 5, 7, and 12 years old. The client tells the nurse that the daughter coughs a good deal and sleeps a lot. Why is it important that the nurse pursue the daughter's condition for potential case findings? Tuberculosis has been rising dramatically in the general population. Older adults with chronic illness are more susceptible to tuberculosis. There is a high incidence of tuberculosis in children less than 12 years of age. Death from tuberculosis has been generally on the decrease in the United States (Canada).
Older adults with chronic illness are more susceptible to tuberculosis. The client's chronic illness and older age increase vulnerability; the daughter's condition should be explored in greater detail. Tuberculosis is only one of many potential causes of the daughter's clinical condition. Children who have not yet reached puberty and adolescence have the lowest incidence of tuberculosis. Morbidity and mortality resulting from tuberculosis are increasing, not decreasing.
Which action is the least likely to prevent sleep disturbances? Avoiding reading, writing, and eating in bed Getting out of bed if unable to fall sleep after 20 minutes Performing strenuous exercise within an hour before going to bed Lowering the temperature of the bedroom and keeping it dark and quiet
Performing strenuous exercise within an hour before going to bed To prevent sleep disturbances, a client should not perform strenuous exercise within six hours before bedtime. A client should avoid reading, writing, and eating in bed. To prevent sleep disturbances, a client should get out of bed if he or she is not able to fall sleep after 20 minutes. The client should also lower the temperature of the bedroom and keep it dark and quiet.
How are toddlers different from children of other age groups? Toddlers grow more rapidly than infants do. Toddlers need more calories than infants do. Toddlers have fewer febrile seizures than preschoolers do. Toddlers sleep more during the daytime than preschoolers do
Toddlers sleep more during the daytime than preschoolers do A toddler sleeps an average of 12 hours during the day, whereas a preschooler sleeps for 12 hours during the night and less in the daytime. The growth rate of toddlers is much slower than that of infants. A toddler needs fewer kilocalories than an infant does but needs more protein relative to body weight. Dehydration and febrile seizures occur during periods of high body temperature in children between 6 months and 3 years of age.
The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? Have patient follow hospital routines. Avoid awakening patient for nonessential tasks. Give prescribed sleeping medications at dinner. Turn television on low to late-night programming.
Avoid awakening patient for nonessential tasks. Avoiding awakening 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 absolutely essential. Patients should try to follow home routines related to sleep habits. The nurse should make every effort to allow the patient to follow his or her regular sleep schedule. The prescribed sleeping medications should be administered at the ordered time. Administering a sleeping medication at dinner may cause the patient to go to sleep too soon, thereby disrupting the patient's bedtime routine. All distractions should be eliminated. The television should be turned off.
A nurse who is observing a sleeping newborn at 2 hours of age identifies periods of irregular breathing and occasional twitching movements of the arms and legs. The neonate's heart rate is 150 beats/min; the respiratory rate is 50 breaths/min; and the glucose strip reading is 60 mg/dL (3.3 mmol/L). What does the nurse conclude that these findings indicate? Hypoglycemia Seizure activity Expected adaptations Respiratory distress syndrome
Expected adaptations During periods of active or irregular sleep, healthy newborns have some twitching movements and irregular respirations; the heart rate, respirations, and blood glucose level are within expected limits. Hypoglycemia in newborns is characterized by a blood glucose level below 30 mg/dL (1.7 mmol/L). Twitching is a common finding in healthy neonates and does not indicate seizure activity; it often occurs with crying or stimulation. There are no signs of respiratory distress syndrome. The newborn respiratory rate ranges between 30 and 60 breaths/min; irregular breathing is expected.
A patient on sedative-hypnotic therapy reports to the nurse, "I don't think these drugs are working on me anymore; I'm having trouble sleeping again." After assessing the patient, the nurse finds that the patient has developed drug tolerance to these medications. Which suggestions might the nurse offer the patient to improve sleep? "Drink tea before bedtime." "Exercise before bedtime." "Drink warm milk before bedtime." "Eat a heavy meal before bedtime."
"Drink warm milk before bedtime." Drug tolerance may develop after long-term usage of sedative-hypnotics. In this condition, the patient's body does not respond positively to the drug. Sedative-hypnotics cause central nervous system depression and may induce sleep, but with long-term use, they may become nontherapeutic. Serotonin is the neurotransmitter that promotes sleep. Milk is rich in tryptophan, which stimulates the release of serotonin. Thus drinking warm milk at bedtime may induce sleep. Tea acts as a central nervous system stimulant and disturbs sleep. Exercise in the evening may also interfere with sleep. Eating a heavy and/or spicy meal before bedtime increases metabolism and interferes with sleep; therefore the nurse suggests that the patient avoid eating large amounts before bedtime.
Which statement made by the patient indicates a need for further teaching regarding sleep hygiene? "I'm going to do my low-impact exercises before I eat lunch." "I'll have a large 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 large glass of wine at bedtime to relax." The statement "I'll have a large glass of wine at bedtime to relax" indicates a need for further teaching. Small amounts of alcohol may help some people fall asleep; however, drinking large amounts should be avoided before bed because it speeds onset of sleep, reduces rapid eye movement sleep, awakens the person during the night, and causes difficulty returning to sleep. Exercise promotes relaxation; however, it should be done in moderation. Excessive exercise, especially in the evening, interferes with sleep. Routines and rituals are important at any age in regards to sleep. Getting up and going to bed at the same time promotes healthy sleeping habits. The bedroom should be designated for sleep, not work.
The parents tell the nurse that their preschooler often awakes from sleep screaming in the middle of the night. The preschooler is not easily comforted and screams if the parents try to restrain the child. What does the nurse instruct the parents? "Always read a story to the child before bedtime." "Intervene only if necessary to protect the child from injury." "Discuss counseling options with the primary health care provider." "Try to wake the child and ask the child to describe the dream."
"Intervene only if necessary to protect the child from injury." Waking up screaming from sleep at night indicates sleep terrors. The nurse should advise the parents to observe the child and intervene only if there is a risk for injury. Reading a story before bedtime helps to calm the child before sleeping, but it does not ensure that the child will not have a sleep terror. There is no need for professional counseling, because sleep terrors are a common phenomenon in preschool-age children. The child is not aware of anybody's presence during a sleep terror, so it is not appropriate to wake up the child; this may cause the child to scream and thrash more.
In a noisy room a sleeping newborn initially startles and exhibits rapid movements; however, the baby soon goes back to sleep. What is the most appropriate nursing action in response to this behavior? 'Documenting an intact reflex Assessing the infant's vital signs Testing the infant's ability to hear Stimulating the infant's respirations
'Documenting an intact reflex The initial response is a reflection of the startle reflex; when the stimulus is repetitive, the response to the stimulus decreases. This decrease in response is called habituation and is expected. Assessing the infant's vital signs and stimulating the infant's respirations are not necessary because the neonate's response is expected. The infant is responding to noise and therefore hears.
An 84-year-old widow with dementia who had been living with her daughter before hospitalization is being discharged with a referral to the visiting nurse. When the nurse visits, the client is in bed sleeping at 10:00 am. Her daughter states that she gives her mother sleeping pills to stop her wandering at night. How should the nurse respond? Explore hiring a home health aide to stay with the client at night. Discuss the possibility of having the client placed in a nursing home. Suggest moving the client among family members on a monthly basis. Empathize with the daughter but suggest that wrist restraints would be preferable.
Explore hiring a home health aide to stay with the client at night. Exploring hiring a home health aide to stay with the client at night will reduce the need for sleeping pills, which may exacerbate the older client's confusion. The family is not asking that the client be moved from the home; the nurse's focus should be helping reduce the confusion the client experiences at night, keeping the client safe, and easing the burden on the family. Continually changing a cognitively impaired client's environment and routine will increase confusion and anxiety. This client needs a consistent environment with a set daily routine of activities, which provides structure and comfort. Restraints add to the client's confusion and tend to worsen inappropriate behavior.
During a home visit to a client, the nurse identifies tremors of the client's hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Of the additional assessment findings, which one should the nurse report to the practitioner? Increased appetite Recent weight loss Feelings of warmth Fluttering in the chest
Fluttering in the chest--Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure. Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening. Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening. Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening.
At 5 am, 2 hours after a long labor and vaginal birth, a client is transferred to the postpartum unit. What is the nurse's priority when planning morning care for this client? Planning nursing care activities that provide time for the client to rest and sleep Preparing for the probability of hemorrhage by massaging the client's uterus frequently Arranging an individual session in which the client can learn about successful breastfeeding Anticipating safety needs by instructing the client to remain in bed and call for assistance whenever ambulating
Planning nursing care activities that provide time for the client to rest and sleep After laboring all night the client is tired and needs uninterrupted rest. Massaging the fundus frequently is unnecessary unless the uterus becomes boggy. Providing a lesson on breastfeeding is premature. The client is not ready to learn because she needs to rest and sleep after a long labor. It is necessary for the client to call for assistance only the first time she ambulates; otherwise the client may ambulate ad libitum.
During a routine 32-week prenatal visit, a client tells the nurse that she has had difficulty sleeping on her back at night. Which guidance should the nurse provide regarding sleeping position? "Turn from side to side." "Try to sleep on your stomach." "Elevate the head of the bed on blocks." "Place two pillows under your knees for sleep."
The side-lying position will relieve back pressure; it also promotes uterine perfusion and fetal oxygenation. At 32 weeks' gestation the abdomen is too distended for the pregnant woman to lie in the prone position. Elevating the head of the bed will not relieve back pressure; it is used to limit gastroesophageal reflux. Lying on the back is contraindicated because it puts pressure on the vena cava, resulting in hypotension and uteroplacental insufficiency. Pillows under the knees are contraindicated because they place pressure on the popliteal area, which compresses the venous circulation, increasing the risk of thrombophlebitis.
What would the nurse state is true about a toddler's sleep? Total sleep averages 12 hours a day. In the awake period, a toddler exhibits sleepwalking. A toddler normally takes several naps during the day. It is uncommon for toddlers to awaken during the night.
Total sleep averages 12 hours a day. Toddlers sleep 12 hours a day on an average. In the awake period, preschoolers rather than toddlers exhibit brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting. An infant normally takes several naps during the day but usually sleeps an average of 8 to 10 hours during the night. It is common for toddlers to awaken during the night.
