Ch 34: Sleep-Wake Disorders
c) "I make sure that I take a long nap each afternoon to compensate for my frequent waking at night" Pg. 663 Daytime sleeping can interfere with the normal sleep-wake cycle. Occasional use of hypnotics is acceptable and moderate exercise that is not performed before bedtime can help with insomnia. Alcohol can inhibit sleep in older adults.
10. A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following recent falls and a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? a) "I've got a bottle of diazepam at home, but I only take them once or twice a month" b) "I make it a rule not to drink any alcohol in the evening" c) "I make sure that I take a long nap each afternoon to compensate for my frequent waking at night" d) "I try my best to get out for a walk after breakfast or after supper"
d) Excessive sleepiness Pg. 668 Excessive sleepiness is the first symptom to appear. Sleep paralysis is the inability to move or speak when falling asleep or waking up. Narcolepsy is not associated with hallucinations or night terrors.
35. Which of the following is the primary symptom to occur in narcolepsy? a) Hallucinations b) Sleep paralysis c) Night terrors d) Excessive sleepiness
a) The relapse of PTSD symptoms Pg. 657-659 Sleep-wake disorders occur independently of the diagnosis of other mental disorders, but they are also seen in people with mental disorders such as PTSD and depression. Insomnia often increases the risk for relapse of the mental disorder but there is no research to support that it will trigger the onset of a new mental health disorder. Type 2 diabetes will not convert to the type 1 form of the disorder.
38. A client with a history of both managed posttraumatic stress disorder (PTSD) and type 2 diabetes now presents with new reports of insomnia. Considering the most urgent, immediate risk for a client, what will the nurse assess for regularly? a) The relapse of PTSD symptoms b) The conversion of type 2 to type 1 diabetes c) The symptoms associated with early onset dementia d) The development of obsessive-compulsive disorder (OCD)
b) Insomnia Pg. Of all the sleep-wake disorders and sleep-related problems, insomnia is the most prevalent.
7. After teaching a group of nursing students about sleep-wake disorders, the instructor determines that the education was successful when the students identify which of the following as the most prevalent disorder? a) Obstructive sleep apnea syndrome b) Insomnia c) Narcolepsy d) Parasomnia
d) Sleep deprivation Pg.
8. The client is a single mother studying broadcast journalism. The client works two part-time jobs in addition to school to cover family and educational expenses. Last night driving home from work the client drifted off the road and nearly had an accident. Luckily there was no harm, but the client realized the need to change a life factor, because the client is most likely suffering the negative consequences of: a) Insomnia b) Generalized anxiety disorder c) Excessive fatigue syndrome d) Sleep deprivation
b) It is possible to develop a dependence on the medication Pg.
1. The nurse is assisting a client in understanding the drawback of using benzodiazepine receptor agonists (BzRAs) to promote sleep. Which drawback is the most important to inform the client about? a) Withdrawal symptoms include increased sleepiness b) It is possible to develop a dependence on the medication c) Residual sedation lasts all day after small doses d) Most people experience some breathing difficulty
d) Individuals who are sleepwalking are typically confused if awakened Pg. 671 Individuals who are sleepwalking usually experience confusion if awakened during an episode. There is no direct link between sleepwalking and substance abuse, and treatment usually focuses on ensuring safety rather than administering medications. Sleepwalking is not considered an indicator of more serious pathology.
11. Which of the following statements about sleepwalking is most accurate? a) Sleepwalking is usually treated through pharmacotherapy b) Sleepwalking is an indicator of a more serious psychiatric-mental health disorder c) The disorder is commonly linked to substance abuse d) Individuals who are sleepwalking are typically confused if awakened
c) "Do you ever find that you feel especially groggy in the morning after taking them?" Pg. 664 OTC sleep aids are often antihistamines, drugs which have a long half life and which often leave the client groggy in the morning. OTC sleep aids do not have a notable effect on sleepwalking, snoring or early morning wakening.
12. A client reports to the nurse that he has been experiencing increased sleep latency during a time of interpersonal stress and has been taking over the counter sleep aids several times a week. When assessing for the potential adverse effects of this medication, the nurse should include what question? a) "Do you find that you awaken especially early in the morning after taking those drugs?" b) "Has anyone in your family ever observed you sleepwalking when you take those medications?" c) "Do you ever find that you feel especially groggy in the morning after taking them?" d) "Have you ever been told that you snore more when you take over the counter sleep aids?"
a) Encourage the client to keep a sleep diary to accurately monitor sleep patterns Pg. 659 Initially, it is useful to obtain a detailed sleep diary in order to better understand a client's specific sleep patterns. In most cases, this precedes referrals. The client's family history may be relevant, but obtaining a sleep diary is a priority.
13. A client reports recent sleep patterns that are suggestive of insomnia. What is the nurse's best initial action? a) Encourage the client to keep a sleep diary to accurately monitor sleep patterns b) Facilitate a referral to a support group focused on sleep disorders c) Facilitate a referral to a sleep disorders clinic d) Assess the client's family history of sleep disorders
d) "It is the amount of time it takes to fall asleep" Pg. 654 Sleep latency, the amount of time it takes to fall asleep, is measured from "lights out," or bedtime, to initiation of sleep. Sleep efficiency, not latency, is the ratio of total sleep time to time in bed. Sleep occurs in stages, and the timing of sleep is regulated by circadian rhythms; however, this is not an accurate response regarding sleep latency. Sleep architecture, not latency, is the pattern of non-rapid eye movement (NREM) and rapid eye movement (REM) that occur in about a 90- to 110-minute cycles.
14. The client asks the nurse, "I don't understand what sleep latency is for my journal." Which response by the nurse is accurate? a) "It is the ratio of total sleep time to time in bed" b) "It is the pattern of non-rapid eye movement (NREM) and rapid eye movement (REM)" c) "It is the stages of sleep and is regulated by circadian rhythms" d) "It is the amount of time it takes to fall asleep"
a) Loud snoring or gasping during sleep Pg. 669 Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with repetitive episodes of reduced airflow (hypopnea) or cessation of airflow (apnea) resulting from collapse of the upper airway. Clients with this condition experience sleep disruption and excessive daytime sleepiness. They typically snore loudly and may gasp or choke during sleep. Narcolepsy is characterized by an irresistible urge to sleep and associated with cataplexy (sudden bilateral loss of postural muscle tone) and other rapid eye movement (REM) sleep phenomena. Teeth grinding is not associated with obstructive sleep apnea syndrome.
15. A client states that he has been treated for obstructive sleep apnea syndrome. You note this and report to the oncoming evening nurse to be aware of which of the following symptoms? a) Loud snoring or gasping during sleep b) Feeling unrested during the day c) Evidence of teeth grinding while asleep d) Irresistible urge to sleep with cataplexy
c) "The body absorbs the medication quickly. You will be able to fall asleep faster" Pg. 659 Benzodiazepine receptor agonists (BzRAs) are all absorbed rapidly and reduce sleep latency (the amount of time it takes to fall asleep after the lights have been turned off) with medication at recommended doses. Although these medications decrease sleep latency, they may not be the most effective for clients who have trouble sleeping through the night.
16. When discussing options for medications to aid sleep, the client asks the nurse why it would be beneficial to take a benzodiazepine receptor agonist. Select the nurse's best response. a) "The body absorbs the medication slowly. You will experience sleepiness throughout the day" b) "The body absorbs the medication slowly. You will not wake up before your alarm sounds" c) "The body absorbs the medication quickly. You will be able to fall asleep faster" d) "The body absorbs the medication quickly. You will be able to stay asleep longer"
a) Benzodiazepines b) Barbiturates c) Amphetamines d) Antidepressants e) Alcohol Pg. 662 Medications that decrease REM include alcohol, amphetamines, barbiturates, benzodiazepines, and antidepressants, such as tricyclics and MAOIs.
17. A nurse is reviewing the medication history of several clients experiencing difficulty with sleep. Which medication would the nurse most likely identify as playing a role due to its effect on decreasing rapid eye movement (REM) sleep? Select all that apply. a) Benzodiazepines b) Barbiturates c) Amphetamines d) Antidepressants e) Alcohol
a) Polysomnography Pg. 667 Polysomnography is clinical testing used to assess for sleep disorders. Results of polysomnography describe a person's sleep architecture (timing and distribution of sleep stages) and any abnormalities occurring during sleep. EEG, pulmonary function testing, and Doppler studies are not used to assess for sleep disorders.
18. A client is scheduled to undergo testing to assess for a sleep disorder. The nurse would expect to prepare the client for which test? a) Polysomnography b) Doppler studies c) Pulmonary function testing d) Electroencephalography (EEG)
d) "Would you consider yourself as being depressed?" Pg. 657-659 Many factors affect sleep, but one of the major reasons for insomnia is depression, which accounts for most cases. Asking if the client considers oneself as being depressed will assess for this condition. There is no currently accepted correlation between paranoia (Are you afraid for your personal safety?), hallucinations (Can you hear or see things others cannot hear or see?), or compulsive (Do you engage in compulsive hand washing or other ritualistic behaviors?) behaviors with the development of insomnia.
19. The nurse is assessing a client reporting the symptoms associated with insomnia. What assessment question demonstrates the nurse's understanding of mental health issues often related to the development of insomnia? a) "Do you engage in compulsive hand washing or other ritualistic behaviors?" b) "Are you afraid for your personal safety?" c) "Can you hear or see things others cannot hear or see?" d) "Would you consider yourself as being depressed?"
b) Hormone fluctuations decrease sleep quality Pg.
2. The nurse is caring for a client who is post-operative from a total hysterectomy. The nurse should anticipate which change is going to impact the client's recovery from surgery? a) Hormone changes cause prolonged slow wave sleep (SWS) b) Hormone fluctuations decrease sleep quality c) Hormone changes increase sleepiness d) Hormone changes cause episodes of extreme mood elevation
a) "There may be something else going on with your husband such as delirium or a problem with his medications" Pg. 671 New onset sleepwalking in an older adult is usually a manifestation of another problem such as delirium, drug toxicity or a seizure disorder. It is not a normal age-related change and a benzodiazepine is not a prudent initial treatment.
20. A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns? a) "There may be something else going on with your husband such as delirium or a problem with his medications" b) "This is not an uncommon event that often accompanies older age" c) "I'll likely prescribe a benzodiazepine for this when I next see your husband" d) "This is understandably upsetting for you, but as long as the environment is safe it's likely not significant"
c) Client believes that client experiences auditory hallucinations on awakening d) Client has frequently awakened unable to move or speak Pg. 668 Sleep paralysis and hypnagogic hallucinations are symptoms of narcolepsy. Repeated toe, ankle and leg movements are associated with periodic limb movement disorder while an urge to move her legs would suggest restless legs syndrome. Narcolepsy is not normally associated with long sleep latency periods.
21. A a client is suspected of having narcolepsy. When reviewing the client's history and sleep analysis, which finding would the nurse identify as supporting this condition? Select all that apply. a) Client complains of a powerful urge to move legs when in bed at night b) Client's sleep latency is normally around one hour c) Client believes that client experiences auditory hallucinations on awakening d) Client has frequently awakened unable to move or speak e) Client repeatedly moves large toe, ankle and knee during sleep
c) A 55-year old overweight male Pg. 669 Incidence of OSA increases with age, especially for those older than 50 years of age (Nasr, Wendt, & Kora, 2010), affecting both men and women. OSA is most common in middle-age overweight men. The female-to-male ratio is estimated to be 1:8, with women becoming more likely to develop this syndrome after menopause. Men are twice as likely to snore as women.
22. Which of the following would the nurse identify as having the greatest risk for developing obstructive sleep apnea syndrome? a) A 40-year old woman with COPD b) A 35-year old male with unstable angina c) A 55-year old overweight male d) A female with chronic insomnia
b) Hypothalamus Pg. 654 The biologic clock that regulates our circadian rhythms is located in the suprachiasmatic nucleus, an area of the hypothalamus that lies on top of the optic chiasm.
23. An instructor is describing the sleep-wake cycle to a group of nursing students. The instructor determines that the education was successful when the group identifies that the body's biological clock is located in which of the following? a) Pituitary gland b) Hypothalamus c) Frontal cortex d) Temporal lobe
b) Avoid caffeine and nicotine before bedtime c) Limit the bedroom to sleeping and sex e) Stick to a regular bedtime and rising time Pg. 663 Interventions to promote sleep hygiene include limiting the bedroom to sleeping and sex and not using the room to watch television, study, or talk on the telephone. A regular bedtime and rising time is the most important healthy sleep habit to establish. Sleeping in can disturb sleep on the subsequent night. Caffeine and nicotine are strong stimulants and fragment sleep. Alcohol should be avoided because it has an alerting affect when it wears off. Naps should be avoided.
24. A client reports difficulty sleeping when the clocks are changed in the spring and fall. Which should the nurse recommend to help this client achieve adequate sleep? Select all that apply. a) Limit alcohol to the dinner hour b) Avoid caffeine and nicotine before bedtime c) Limit the bedroom to sleeping and sex d) Plan "power naps" throughout the day e) Stick to a regular bedtime and rising time
a) Habits associated with normal sleep Pg. 667 As an rule, interventions should stress the importance of sleep hygiene and the habits associated with a healthy sleep pattern. Although further assessment of the client may lead to the need for the use of stimulants, caffeine, or serotonin antagonist medications, the nurse should begin the plan of care with the least invasive intervention.
25. The nurse is seeing a client who has been given a diagnosis of hypersolemnence. Which treatment intervention should be discussed first with the client? a) Habits associated with normal sleep b) Benefits of serotonin antagonist medications c) Commonly prescribed stimulant medications d) Directions on the use of caffeine
d) Maintain regular sleep schedules on weekdays and weekends Pg. 663 Sleep hygiene includes maintaining a regular sleep schedule on weekdays and weekends, modifying the environment to reduce noise and light, maintaining a comfortable environmental temperature, sleeping in a comfortable bed, discouraging eating a large or spicy meal near bedtime, avoiding going to bed on an empty stomach, and avoiding caffeine within 6 hours of bedtime. It is recommended to consume a light carbohydrate snack or warm milk prior to bedtime.
26. A client reports difficulty falling asleep, maintaining sleep throughout the night, and feeling not rested upon wakening in the morning. Education for home care should include... a) Avoid eating before bedtime b) Turn the thermostat to a cooler than usual temperature c) Vary sleep-wake times with daily schedules d) Maintain regular sleep schedules on weekdays and weekends
d) 17 to 18 hours Pg. 656 Newborns need 17 to 18 hours of sleep each day, which occurs in 3- to 4-hour episodes throughout the day. By age 6 months, 12 hours of sleep at night and two 1- to 2-hour naps each day are needed. After age 5 years, children gradually need less sleep. Preadolescents need about 10 hours of sleep each night, and napping is rare. A teenager's sleep need is only slightly less, at about 9 hours. During young adulthood, about 8 hours of sleep is needed.
27. After reviewing information about sleep patterns and changes occurring over the lifespan, a group of nursing students demonstrates understanding when they identify that newborns require how much sleep per day? a) 13 to 14 hours b) 11 to 12 hours c) 8 to 9 hours d) 17 to 18 hours
d) Promoting client safety Pg. 657-659 Safety is the priority for people with insomnia disorder. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Sedatives and other sleep medications could potentially increase risk for falls if safety issues are not dealt with first. There is no information related to the client's bedtime rituals which may be appropriate.
28. An 85-year-old client has been diagnosed with insomnia disorder. Which of the following would be the priority for this client? a) Administering a sleep aid b) Assisting with adopting better bedtime ritual c) Encouraging use of a sedating medication d) Promoting client safety
c) Continued sense of fear after awakening Pg. 672 The repeated occurrence of frightening dreams that fully awaken an individual is the essential characteristic of nightmare disorder. Typically, the individual can recall detailed dream content that involves physical danger (e.g., attack or pursuit) or perceived danger (e.g., embarrassment or failure). Upon awakening, the individual is fully alert and experiences a persisting sense of anxiety or fear. Many people have difficulty returning to sleep.
29. A client is telling a nurse about repeated frightening dreams that the client has been having and that have awakened the client from sleep. When assessing this complaint further, which would the client most likely report? a) Ability to return to sleep with relative ease b) Inability to recall specific details of the dream c) Continued sense of fear after awakening d) Some drowsiness and confusion upon awakening
d) Safety Pg. Safety is a priority for people with primary insomnia. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Nutrients, mobility, and security are not priorities in this client population.
3. Which of the following is a priority when caring for clients diagnosed with insomnia? a) Security b) Nutrients c) Mobility d) Safety
a) Install deadbolt locks c) Secure all the windows d) Keep a sleep log to assist in identifying how much sleep the child needs to prevent a sleepwalking event e) Ensure that the child gets adequate sleep Pg. 671-672 General safety precautions for sleepwalkers include the following: Ensure adequate sleep and anticipate sleepwalking when there is a significant sleep loss. Keep a log to assist in identifying when the event occurs and consider using a noise device on the door. Also deadbolts should be used and windows should be secured.
30. A mother brings her 6-year-old son to the sleep clinic and tells the nurse that the child sleepwalks approximately 5 out of 7 nights each week. The mother adds that her son is very difficult to awaken during these episodes; when she can awaken him, he looks confused and just stares at her. What are some general safety interventions the nurse can recommend to this mother for this client? Select all that apply. a) Install deadbolt locks b) Keep the child's sleep sessions short c) Secure all the windows d) Keep a sleep log to assist in identifying how much sleep the child needs to prevent a sleepwalking event e) Ensure that the child gets adequate sleep
c) Insomnia disorder Pg. 657-659 Insomnia disorder is characterized by dissatisfaction with sleep quantity or quality and difficulty initiating or maintaining sleep, or in waking early in the morning, and being unable to return to sleep at least 3 nights per week for at least 3 months. Insomnia has a greater prevalence among older people and among divorced, separated, and widowed adults. The essential characteristic of hypersomnolence disorder is excessive sleepiness at least three times a week for at least 3 months. The overwhelming urge to sleep is the primary symptom of narcolepsy. This irresistible urge to sleep occurs at any time of the day, regardless of the amount of sleep. Falling asleep often occurs in inappropriate situations, such as while driving a car or reading a newspaper. Non-rapid eye movement (NREM) sleep arousal disorders including sleepwalking and sleep terror types, usually occur the first third of the major sleep episode.
31. The nurse is counseling a client who is grieving the loss of her spouse 4 months ago. The client reports having trouble falling and staying asleep at least 3 to 4 nights per week. The nurse recognizes the client is most likely experiencing which sleep-wake disorder? a) Narcolepsy b) Non-rapid eye movement (NREM) sleep arousal disorder c) Insomnia disorder d) Hypersomnolence disorder
a) Avoiding caffeine after mid-afternoon b) Using the bedroom for sleep and sex d) Establishing a regular time for bed Pg. 663 Appropriate sleep hygiene measures include setting and maintaining a regular bedtime and rising time, avoiding caffeine after mid-afternoon, avoiding alcohol, exercising regularly but avoiding exercise the 3 hours before bedtime, and using the bedroom for sleep and sex.
32. A nurse is teaching a client about sleep hygiene and ways to promote sleep. Which of the following would the nurse include in the education plan? Select all that apply. a) Avoiding caffeine after mid-afternoon b) Using the bedroom for sleep and sex c) Drinking a glass of wine before bed d) Establishing a regular time for bed e) Exercising about 2 hours before bedtime
d) Medications Pg. 662 Many prescribed and over-the-counter drugs, herbal remedies, and illegal substances affect the central nervous system and influence sleep. Lithium, lasix, and prednisone are examples of such drugs.
33. A client reports always feeling tired. During the health history, the client reports drinking 2 to 3 cups of decaffeinated coffee each day and warm milk before bedtime. The client adds that she retires at the same time each night. She lists use of the following medications: lithium, lasix, and prednisone. What does the nurse suspect is the cause of this client's sleep disturbance? a) Bedtime ritual b) Warm milk c) Decaffeinated coffee d) Medications
c) Insomnia Pg. 657-659 Insomnia refers to difficulty falling asleep or maintaining sleep. Dissatisfaction with sleep quantity is also present. Symptoms of insomnia include difficulty falling asleep, experiencing mood alterations, being tired in the morning, and dozing during the day.
34. A client who comes to the sleep clinic reports being tired in the morning. Upon further assessment, the client discusses difficulty falling asleep at night and waking up in a bad mood in the morning. The client also acknowledges difficulty staying awake during the day. Which of the following diagnoses would the nurse suspect? a) Depression b) Restless leg syndrome c) Insomnia d) Narcolepsy
c) "You should avoid eating or watching television in your bedroom" Pg. 664-666 Stimulus control is a technique used when the bedroom environment no longer provides cues for sleep but has become the cue for wakefulness. Patients are instructed to avoid behaviors in the bedroom incompatible with sleep, including watching television, doing homework, and eating. This allows the bedroom to be reestablished as a stimulus for sleep. Another behavioral intervention is sleep restriction. Clients often increase their time in bed to provide more opportunity for sleep, resulting in fragmented sleep and irregular sleep schedules. Clients are instructed to spend less time in bed and avoid napping. Relaxation training, such as imagery, is used when patients complain of difficulty relaxing, especially if they are physically tense or emotionally distressed. Cognitive behavior therapy helps to identify maladaptive behaviors and cognition that contribute to insomnia.
36. A nurse is teaching a client with insomnia about stimulus control. Which of the following would the nurse include in the education? a) "You should focus your attention on pleasant images to reduce stress" b) "Let's look at your behavior and thoughts contributing to your problem" c) "You should avoid eating or watching television in your bedroom" d) "Try spending less time in bed along with avoiding any naps"
a) "I don't sleep well anymore, but then I'm getting old" Pg. 656 The belief that sleep disturbance is a normal part of aging is particularly common among older adults and may prevent them from seeking help with genuine sleep problems. For this reason, health care providers must be especially cognizant of performing sleep assessments with older adult clients and assisting them with interventions to improve sleep.
37. The nurse is admitting an older adult client to the medical-surgical unit for observation following a fall in her home. Which of the following findings would require additional assessment? a) "I don't sleep well anymore, but then I'm getting old" b) "Sometimes after dinner I sit in my big chair, and before you know it I'm asleep!" c) "I don't sleep as much as when I was younger" d) "I usually wake up early in the morning, even before the sun comes up, just raring to go!"
a) Exercise regularly b) Abstain from alcohol c) Refrain from caffeine after mid-afternoon d) Provide a comfortable environment Pg. 663 Components of the education plan should include exercising regularly, providing a comfortable environment, refraining from caffeine after mid-afternoon, and abstaining from alcohol. The client should also avoid taking naps.
39. Which of the following should be included in the client education plan to promote good sleep habits? Select all that apply. a) Exercise regularly b) Abstain from alcohol c) Refrain from caffeine after mid-afternoon d) Provide a comfortable environment e) Take naps
b) One of the major reasons for insomnia is depression Pg.
4. When educating a client on insomnia, which of the following would the nurse include? a) Most individuals with insomnia have a psychiatric disorder b) One of the major reasons for insomnia is depression c) More men than women have problems with insomnia d) Increasing age is a factor that helps reduce the risk for insomnia
d) Obstructive sleep apnea syndrome Pg. 669 Obstructive sleep apnea syndrome is the most commonly diagnosed breathing-related sleep disorder. It is characterized by snoring during sleep and episodes of sleep apnea that can disrupt sleep and contribute to daytime sleepiness.
40. A client comes to the sleep clinic and reports fatigue and daytime sleepiness. Assessment reveals a weight gain of 40 lbs over the last year following smoking cessation and a history of gastroesophageal reflux disease (GERD). The client's wife says that her husband snores so loudly, she cannot remember the last time that she slept well. From what should the nurse suspect this client is suffering? a) Narcolepsy b) Insomnia c) Restless leg syndrome d) Obstructive sleep apnea syndrome
d) Sleep paralysis Pg. 668 Sleep paralysis, the inability to move or speak when falling asleep or waking up, is often described as terrifying and is accompanied by a sensation of struggling to move or speak. Although the diaphragm is not involved, patients may also complain of not being able to breathe or feeling suffocated. These episodes are typically brief in duration and usually terminate spontaneously or when the individual is touched.Cataplexy is the bilateral loss of muscle tone triggered by a strong emotion, such as anger or laughter. This muscle atonia can range from subtle (drooping eyelids) to dramatic (buckling knees). Respiratory muscles are not affected. Hypnagogic hallucinations are intense dreamlike images that occur at sleep onset and usually involve the current environment.Hypersomnolence refers to excessive sleepiness.
41. A client with narcolepsy tells the nurse that it often feels like he is being suffocated when he is falling asleep. He also says, "I get terrified because I can't seem to move." The nurse identifies this as which of the following? a) Cataplexy b) Hypnagogic hallucinations c) Hypersomnolence d) Sleep paralysis
a) Establishing a consistent sleep routine reduces injury c) Sleep during the day is not the same as sleep at night d) Irregular bowel patterns can result from sleep associated with shift work Pg. 657 Sleep duration during daytime hours is typically shorter and the quality is less consolidated than nighttime sleep. Health and safety problems associated with managing shift work may include increased gastrointestinal disorders. A consistent sleep schedule regardless of the shift being worked promotes better sleep quality and can reduce the risk of injury due to fatigue. Sleeping less or even more prior to the next night shift is not likely to provide increased wakefulness because fatigue is often the result of circadian rhythm disturbances. Less sleep leads to decreased serotonin levels and can result in depressive disorders.
42. When providing education to a group of health care providers who do shift work, a nurse educator should include which statements? Select all that apply. a) Establishing a consistent sleep routine reduces injury b) Less sleep can promote increased serotonin levels c) Sleep during the day is not the same as sleep at night d) Irregular bowel patterns can result from sleep associated with shift work e) Sleeping less after a night shift promotes wakefulness on the next shift
d) Sleep efficiency Pg. 654 Sleep efficiency is the ratio of total sleep time to time in bed. In order to determine how much actual sleep the client is getting while the client is physically laying in bed, the nurse would need to help the client pinpoint wakeful periods throughout the night. Because the client is feeling unrested when waking, there exists the possibility that the client is sleeping less than the reported 8 or 9 hours per night even though he or she is laying in bed for those many hours each night. Sleep latency refers to the amount of time it takes to fall asleep and is measured from "lights out," or bedtime, to initiation of sleep. Sleep architecture is the pattern of non-rapid eye movement (NREM) and rapid eye movement (REM) that are in a 90- to 110-minute cycle. Sleep occurs in stages, and the timing of sleep is regulated by circadian rhythms. Rhythm is movement with a cadence, a measured flow that occurs at regular intervals, with a cycle of coming and going, ebbing and rising, to return at the start point and begin again.
43. The nurse is seeing a client who reports sleeping 8 or 9 hours per night but waking up feeling unrested. The nurse is interested in determining how much actual sleep the client is getting while the client is physically laying in bed in order to identify the underlying problem preventing quality sleep. What does the nurse need to help the client investigate further? a) Rhythm b) Sleep architecture c) Sleep latency d) Sleep efficiency
b) "I will keep the window open so that I can hear if my partner sleepwalks outside" Pg. 671-672 All these statements are accurate regarding safety for individuals who sleepwalk except for keeping the window open. Windows should be secured to limit their opening and not left open so that the sleepwalker can be heard if he or she wanders outside. Ensuring adequate sleep is essential because the occurrence of sleepwalking dramatically increases after sleep loss. Family members should be aware of the likelihood of sleepwalking for the first 2-3 hours after the sleepwalker goes to bed.
44. The nurse provides safety education to family of a client who sleepwalks. Which statement indicates to the nurse a need for additional teaching? a) "I should anticipate that my partner will sleepwalk 2 to 3 hours after going to bed" b) "I will keep the window open so that I can hear if my partner sleepwalks outside" c) "I will install a noise device on the bedroom door so that it alerts others when sleepwalking occurs" d) "I should ensure that my partner gets plenty of sleep"
c) Stimulus control Pg. 663, 666 Stimulus control is a technique used when the bedroom environment no longer provides cues for sleep, but has become the cue for wakefulness. Clients are instructed to avoid behaviors in the bedroom that are incompatible with sleep, including watching television, doing homework, and eating. This allows the bedroom to be reestablished as a stimulus for sleep. With sleep restriction, clients are instructed to spend less time in bed and avoid napping. Relaxation training is used when clients complain of difficulty relaxing, especially if they are physically tense or emotionally distressed. A variety of procedures to reduce somatic arousal can be used. Cognitive-behavioral therapy (CBT) is useful in changing negative learned responses that perpetuate the insomnia.
45. A client with insomnia is instructed to avoid watching television and refraining from doing anything in the bedroom except sleep. Which intervention is being used? a) Relaxation training b) Sleep restriction c) Stimulus control d) Cognitive-behavioral therapy
c) Ramelteon Pg. 664-665 Ramelteon is the melatonin receptor agonist. Triazolam is a benzodiazepine. Zolpidem and eszopiclone are nonbenzodiazepines.
46. A client is prescribed a melatonin receptor agonist to treat her insomnia. The nurse would identify which drug as being prescribed? a) Eszopiclone b) Zolpidem c) Ramelteon d) Triazolam
a) Reticular activating system (RAS) Pg. 654 Wakefulness is maintained by the reticular activating system (RAS) in the brain. As the cycle of the RAS dwindles, neurotransmitters that promote sleep take over. The cerebellum is responsible for balance and coordination. The hypothalamus of the brain controls body temperature. The brain stem contains the midbrain, pons, and medulla, which are vital to life.
47. The nurse caring for a client with a sleep disorder understands that wakefulness is maintained by which of the following areas of the brain? a) Reticular activating system (RAS) b) Brain stem c) Cerebellum d) Hypothalamus
c) Improved alertness during work Pg. 670 Compared with day and evening shift workers, night and rotating shift workers have a shorter sleep duration and poorer quality of sleep. They may also be sleepier while performing their jobs. This disorder is further exacerbated by insufficient daytime sleep resulting from social and family demands and environmental disturbances (traffic noise, telephone).
48. After teaching a group of nursing students about shift-work type circadian rhythm disorder, the instructor determines the need for additional education when they identify which of the following as characteristic of a person who rotates shifts? a) Poorer quality of sleep b) Insufficient daytime sleep c) Improved alertness during work d) Shorter sleep duration
c) Behavioral therapies, counseling and education may be of some use for the client Pg. 666 Behavioral therapies may be beneficial in the treatment of insomnia. Drugs may be of use in the short term and should be used judiciously rather than completely avoided. The efficacy of melatonin is unproven and his insomnia would likely be categorized as secondary insomnia, given the obvious contribution of stressors.
49. A physician is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for "sleeping pills" to help him through this time. Which of the following statements forms a valid basis for the physician's plan for treatment? a) Melatonin supplements will be the safest and most effective long term pharmacological treatment b) Sedatives and hypnotic drugs will not provide safe relief of the man's health problem c) Behavioral therapies, counseling and education may be of some use for the client d) The man is suffering from primary insomnia
a) Delayed sleep phase type Pg.
5. The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour each night, as well as the extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. Which circadian rhythm disorder would the nurse suspect? a) Delayed sleep phase type b) Non-24-hour sleep-wake type c) Advanced sleep phase type d) Irregular sleep phase type
a) Melatonin receptor agonist Pg. 664 Ramelteon is classified as a melatonin receptor agonist. Triazolam is an example of a benzodiazepine. Zolpidem is an example of a nonbenzodiazepine. Trazodone is an example of a sedating antidepressant.
50. A client is prescribed Ramelteon (Rozerem). The nurse understands that this drug is classified as which of the following? a) Melatonin receptor agonist b) Benzodiazepine c) Nonbenzodiazepine d) Sedating antidepressant
c) Chronopharmacotherapy Pg. 670 Chronopharmacotherapy resets the biologic clock by using short-acting hypnotics to induce sleep. Luminotherapy (light therapy) is used to manipulate the circadian system. Chronotherapy manipulates the sleep schedule by progressively delaying bedtime until an acceptable bedtime is attained. Electroconvulsive therapy induces a grand mal seizure and is used as a treatment for depression.
51. Which type of therapy resets the biologic clock by using short-acting hypnotics to induce sleep? a) Luminotherapy b) Electroconvulsive therapy c) Chronopharmacotherapy d) Chronotherapy
b) Multiple sleep latency test c) Nocturnal polysomnography Pg. 668 Narcolepsy diagnosis should be confirmed by polysomnogram followed by a multiple sleep latency test. Electrocardiograms, electroencephalograms, and electromyograms are used in diagnosing sleep apnea.
52. Which is an essential test used in diagnosing narcolepsy? Select all that apply. a) Electroencephalography b) Multiple sleep latency test c) Nocturnal polysomnography d) Electromyography e) Electrocardiography
a) Administration of methylphenidate (Ritalin) Pg. 667 Treatment for narcolepsy focuses on managing the symptoms of excessive daytime sleepiness and cataplexy. Stimulants, such as methylphenidate (Ritalin) and modafinil (Provigil), are used to decrease daytime sleepiness. Tricyclic antidepressants are used to treat cataplexy. Scheduled naps appear useful in assisting clients with severe sleepiness not addressed by the use of stimulant medications.
53. Narcolepsy, a disorder characterized by excessive daytime sleepiness and cataplexy (sudden bilateral loss of postural muscle tone), is effectively treated with... a) Administration of methylphenidate (Ritalin) b) Behavior modification techniques c) SSRIs d) Discouraging daytime napping
a) The client is post-menopausal Pg. 669 Women are more likely to develop obstructive sleep apnea after menopause. Incidence of obstructive sleep apnea increases with age with the highest for people over 50 years of age. A body mass index of 20 denotes a healthy body weight. Obstructive sleep apnea is more likely in a client who is overweight or obese. Hypertension is a risk factor for OSA, and a blood pressure average of 105/65 may be considered hypotensive.
54. A nurse is assessing a client who reports feeling unrested throughout the day. Which factor should signal the nurse to assess further for obstructive sleep apnea (OSA)? a) The client is post-menopausal b) The client has a body mass index of 20 c) The client has an average blood pressure of 105/65 d) The client is 35 years old
d) 6 to 6.5 hours Pg. 654 The average sleep duration of adults in the U. S. has plateaued between 6 and 6.5 hours from a high of 8.5 hours in 1960.
55. A nurse is reading a journal article about sleep. When reviewing the statistics about the average person in the Unites States, which of the following would the nurse most likely find as the average duration of sleep? a) 7 to 7.5 hours b) 9 to 9.5 hours c) 8 to 8.5 hours d) 6 to 6.5 hours
d) Polysomnogram Pg. 668 The bilateral loss of muscle tone triggered by strong emotion such as laughter is called cataplexy, a symptoms of narcolepsy. Given the presence of this symptom, further investigation for cataplexy secondary to narcolepsy is warranted. This would serve to rule out any other possible condition. Confirmation of the diagnosis can be made by using a polysomnogram. Education can only be provided once a diagnosis is confirmed. Weight management is a not an intervention used to treat cataplexy secondary to narcolepsy. The condition is not necessarily associated with being overweight or obese. Medication management should be considered once the diagnosis is confirmed.
56. The nurse assesses a female client who reports losing tone in her legs after laughing heavily. The nurse should anticipate the client will require which intervention? a) Medication management b) Education c) Weight management d) Polysomnogram
c) 12 hours Pg. 656 Sleep patterns change dramatically over the course of the life span. Newborns need 17 to 18 hours of sleep each day, which occurs in 3- to 4-hour episodes throughout the day. By age 6 months, 12 hours of sleep at night and two 1- to 2-hour naps each day are needed.
57. A nurse is conducting a teaching session for a group of pregnant couples about infants and their sleep habits. Which amount of sleep would the nurse identify as being required by 6-month-old infants? a) 14 hours b) 10 hours c) 12 hours d) 8 hours
c) Daily use of caffeine Pg. 666 Caffeine is a stimulant that results in delayed sleep onset, decreased total sleep time, increased wake after sleep onset, and decreased REM and slow-wave sleep. Caffeine-containing beverages include coffee, tea, cola, chocolate, and some non-cola soft drinks. Caffeine is also found in over-the-counter (OTC) cold preparations and stimulants.
58. When performing a nursing history with a client reporting a sleep disturbance, it is important to assess for which potential contributing factor to sleep difficulties? a) Use of over-the-counter antihistamines b) Recent cessation of smoking c) Daily use of caffeine d) Chronic stress
b) Circadian rhythm Pg. The circadian rhythm is a pacemaker or biological clock that regulates the daily patterning of sleep. In mammals this structure is the suprachiasmic nucleus located in the hypothalamus. The circadian pacemaker stimulates changes in the daily patterns of sleep and wake that are endogenous (stimulated internally) to the organism.
6. The pacemaker that regulates sleep-wake cycles in humans and contributes to sleep disorders is... a) Caudate nucleus and pineal glands b) Circadian rhythm c) Medulla d) Hippocampus
a) "I need to take any caffeine-containing cold medicine no later than mid-afternoon" Pg. 663 Caffeine is a stimulant that results in delayed sleep onset, decreased total sleep time, increased wake after sleep onset, and decreased rapid eye movement (REM) and slow-wave sleep. Caffeine is found in over-the-counter cold preparations and stimulants. Although people differ in the intensity and duration of their response to caffeine-containing products, the effects of such products may last as long as 8 to 14 hours. Nicotine also has a powerful influence on sleep, producing more arousal with higher doses. Withdrawal from nicotine can result in irritability and inadequate sleep. Many people use alcohol to self-treat insomnia. Although its acute sedative effects may lead to drowsiness and shorten sleep latency, its longer-term effects include arousal and wakefulness.
9. The nurse has been teaching a client ways to improve sleep patterns at home. The nurse evaluates teaching to have been effective when the client states which of the following? a) "I need to take any caffeine-containing cold medicine no later than mid-afternoon" b) "I quit smoking a few days ago so I should be sleeping better already" c) "A glass of wine before bed should help me sleep all through the night" d) "There isn't enough caffeine in most drinks to really affect sleep"
