Chapter 33: Nursing Care of Persons with Insomnia and Sleep Problems

15. A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the medication's effect on which of the following? A) GABA B) Serotonin C) Dopamine D) Norepinephrine

A) GABA

18. After teaching a class about circadian rhythm disorders, a nursing instructor determines that the teaching was successful when the class identifies which of the following as a subtype? Select all that apply. A) Delayed sleep phase B) Nightmare C) Sleep terror D) Jet lag E) Shift work

A) Delayed sleep phase D) Jet lag E) Shift work

17. A nursing instructor is describing the prevalence of obstructive sleep apnea (OSA) as being greater in individuals with mental health disorders. Which disorders would the instructor include as being associated with OSA? Select all that apply. A) Depression B) Borderline personality disorder C) Schizophrenia D) Posttraumatic stress disorder E) Anxiety

A) Depression D) Posttraumatic stress disorder E) Anxiety

3. A student nurse is preparing a nursing care plan for a client who has insomnia and is experiencing sleep deprivation. Which nursing diagnosis would the nurse most likely identify as reflecting a priority care issue? A) Risk for Injury B) Ineffective Coping C) Deficient Knowledge D) Anxiety

A) Risk for Injury

12. A group of nursing students is reviewing information about factors affecting the pattern and quality of sleep. The students demonstrate a need for additional review when they identify which of the following? A) Sleep patterns are relatively constant across the lifespan. B) Women report more problems with sleep than men. C) Working night shifts and sleeping during the day can affect sleep. D) Environmental influences on sleep can be internal or external.

A) Sleep patterns are relatively constant across the lifespan.

8. A client has been admitted to the psychiatric unit with a diagnosis of narcolepsy. Which client statement would the nurse interpret as reflecting this condition? A) Sometimes when I'm falling asleep, I see and hear things that my wife doesn't. B) I often have brief periods of intense excitement when going to sleep, and my legs won't hold still. C) I lie there and worry all night, and it keeps me awake. I just can't relax. D) I think my sleep pattern is messed up because I took sleeping pills when I was younger.

A) Sometimes when I'm falling asleep, I see and hear things that my wife doesn't.

10. A nurse is working with a client diagnosed with insomnia. When developing a teaching plan for the client, which sleep promotion intervention would the nurse implement first? A) Encouraging the client to consider stopping smoking B) Instructing the client to keep regular bedtimes and rising times C) Encouraging the client to take frequent naps D) Administering prescribed sleep medications

B) Instructing the client to keep regular bedtimes and rising times

2. The nurse is assessing the sleep patterns of a 70-year-old female client with a mental disorder. Based on the knowledge of circadian rhythms and the influence of age, which of the following would the nurse anticipate that the client would report about her sleep pattern? A) When I was younger, I didn't notice any differences in how I felt in the morning or evening. B) Now it seems like I am sleepier at night and more alert in the morning. C) When I worked days, I'd always have trouble feeling sleepy in the morning. D) When I was younger, the amount of sleep I got didn't seem to matter.

B) Now it seems like I am sleepier at night and more alert in the morning.

9. A nurse is preparing a presentation on sleep disorders for a community group. Which of the following would the nurse include when explaining the differences between narcolepsy and obstructive sleep apnea syndrome? A) Symptoms of both disorders are essentially the same, so it is difficult to differentiate between the two disorders. B) People with narcolepsy awaken from a nap feeling rested and replenished, but those with obstructive sleep apnea do not. C) People with obstructive sleep apnea syndrome can experience temporary paralysis with naps. D) Naps are not recommended for clients with narcolepsy because of their association with severe loss of muscle tone.

B) People with narcolepsy awaken from a nap feeling rested and replenished, but those with obstructive sleep apnea do not.

6. A nurse is working with a psychiatric client who was admitted to the inpatient facility and is being discharged. The client asks the nurse what he should do when he goes home to promote getting adequate sleep. Which response by the nurse would be most appropriate? A) Go to bed at the same time every night and watch a television show that relaxes you. B) Save your bedroom for sleeping; that means no work and no TV in the bedroom. C) Why don't you ask your psychiatrist for a prescription for a sleeping pill? D) Make sure to keep the bedroom warm and toasty.

B) Save your bedroom for sleeping; that means no work and no TV in the bedroom.

13. The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. When reviewing the effect of caffeine on sleep with the client, which of the following would the nurse incorporate into the discussion as a caffeine effect? A) Decreased sleep latency B) Increased total sleep time C) Decreased REM sleep D) Increased slow-wave sleep

C) Decreased REM sleep

1. A nurse is giving a presentation to a community group about sleep and its relationship to health. In explaining the relationship between REM sleep and body temperature, which statement by the nurse would be most appropriate? A) There is no observable relationship between REM sleep and body temperature. B) With higher levels of REM sleep, we also experience higher body temperatures. C) Our REM sleep and body temperature cycles are inversely related. D) The extent of our experience of REM sleep is directly proportional to a rise in body temperature.

C) Our REM sleep and body temperature cycles are inversely related.

7. A client with a mental disorder is being discharged from the inpatient unit. During the client's stay in the hospital, the client eventually was able to get an adequate night's sleep even though the client had experienced chronic insomnia over the years. The client's spouse asks the nurse what the family can do in the client's home environment to promote healthy sleep. Which response by the nurse would be most appropriate? A) It is basically up to your husband to focus on promoting his own sleep. B) You might consider a glass of wine about 30 minutes before he is ready to go to bed. C) Remember to keep stimulating activities at a minimum before he goes to bed. D) Give him a spicy snack with a warm cup of tea at night before bedtime.

C) Remember to keep stimulating activities at a minimum before he goes to bed.

11. A nurse is obtaining information about a client's sleep patterns and asks him about the total amount of sleep time compared with the amount of time spent in bed. The nurse is assessing which of the following? A) Sleep latency B) Sleep architecture C) Sleep efficiency D) Sleep wake cycle

C) Sleep efficiency

5. The nurse is discussing sleep enhancing strategies with a client who is experiencing insomnia. Which of the following would be most appropriate for the nurse to suggest? A) Eat right before you go to bed as long as it is something rich that will make you sleepy. B) Try exercising a bit right before your bedtime so you will feel tired and sleepy. C) Drinking a warm cup of tea right before bedtime will help to relax you. D) Establish a regular time for going to bed and getting up in the morning.

D) Establish a regular time for going to bed and getting up in the morning.

4. A female client who is receiving counseling at a community health center has complained about being unable to sleep at each of the last three weekly sessions. The nurse interviews the family members to determine the effect of the client's problem on them. Which response would the nurse most likely expect to hear? A) It really hasn't seemed to be a problem for us. B) There's been little change in how she gets along with other family members. C) The not sleeping has really had a positive effect on her and us. D) It's been exhausting living with her these past few weeks.

D) It's been exhausting living with her these past few weeks.

16. A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent as a melatonin receptor agonist? A) Trazodone B) Estazolam C) Mirtazapine D) Ramelteon

D) Ramelteon

14. A client with insomnia is taught to avoid watching television, eating, and doing work in the bedroom. Which technique is being used? A) Sleep restriction B) Relaxation training C) Cognitive behavior therapy D) Stimulus control

D) Stimulus control