Chapter 34: Rest and Sleep Part 2

Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent? 1)Use IM dosage forms for longer duration 2)Administer safely with other CNS depressants for insomnia 3)Monitor geriatric patients for the common occurrence of paradoxical reactions. 4)Evaluate for physical dependence that occurs within 48 hours of beginning the drug.

3)Monitor geriatric patients for the common occurrence of paradoxical reactions.

The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply): 1)Extended time to fall asleep 2)Falling asleep at inappropriate times 3)Difficulty staying asleep 4)Feeling tired after a night's sleep

1, 3, 4 These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia.

A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply: 1) Chronic stress 2) Severe anxiety 3) Generalized pain 4) Excessive caffeine 5) Chronic depression 6) Environmental noise

1, 4, 6 Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.

A client taking a beta adrenergic blockers for hypertension can experience interference with sleep patterns such as: 1)Nocturia 2)Increased daytime sleepiness 3)Increased awakening from sleep 4)Increased difficulty falling asleep

2) Increased daytime sleepiness Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.

Which of the following sleep disorders is the most prevalent? 1)Hypersomnia 2)Insomnia 3)Parasomnia 4)Sleep-awake schedule disturbance.

2) Insomnia Approximately 1/3 of American adults have some type of sleep disorder, and insomnia is the most common.

When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about: 1) Nonsteroidal antiinflammatory drugs (NSAIDs) 2) Opioids 3) Anticonvulsants 4) Antidepressants 5) Adjuvants

2) Opioids Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.

To validate the suspicion that a married male client has sleep apnea the nurse first: 1) asks the client if he experiences apnea in the middle of the night 2) Questions the spouse if she is awakened by her husband's snoring 3) Places the client on a continuous positive airway pressure (CPAP) device 4) Schedules the client for a sleep test

2) Questions the spouse if she is awakened by her husband's snoring The first thing the nurse would do is question the spouse. This may lead to determining whether more tests are needed

Older adults who take long-acting sedatives or hypnotics are likely to experience: 1)Hallucinations 2)Ataxia 3)Alertness 4)Dyspnea

2)Ataxia If longer-acting barbiturates are used in older adults, these clients may experience daytime sedation, ataxia, and memory deficits.

Which of the following substances is a natural hormone produced by the pineal gland that induces sleep? 1)Amphetamine 2)Melatonin 3)Methylphenidate 4)Pemoline

2)Melatonin Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.

Select all that apply that is appropriate when there is a benzodiazepine overdose: 1)Administration of syrup of ipecac 2)Gastric lavage 3)Activated charcoal and a saline cathartic 4)Hemodialysis 5)Administration of Flumazenil

2, 3, 5 If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation.

Select all that apply to the use of barbiturates in treating insomnia: 1)Barbiturates deprive people of NREM sleep 2)Barbiturates deprive people of REM sleep 3)When the barbiturates are discontinued, the NREM sleep increases. 4)When the barbiturates are discontinued, the REM sleep increases. 5)Nightmares are often an adverse effect when discontinuing barbiturates.

2, 4, 5 Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares.

The nurse finds a client sleepwalking down the unit hallway. An appropriate intervention the nurse implements is: 1) Asking the client what he or she is doing and call for help 2) Quietly approaching the client and then loudly calling his or her name 3) Lightly tapping the client on the shoulder and leading him or her back to bed 4) Blocking the hallway with chairs and seating the client

3) Lightly tapping the client on the shoulder and leading him or her back to bed The nurse should not startle the client but should gently awaken the client and lead him or her back to bed.

During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating: 1)"Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time." 2)"Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis." 3)"Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses." 4)"There really is no difference; the terms are used interchangeably."

3) Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.

Which of the following medications are the safest to administer to adults needing assistance in falling asleep? 1) Sedatives 2) Hypnotics 3) Benzodiazepines 4) Anti-anxiety agents

3)Benzodiazepines The group of drugs that are the safest are the benzodiazepines. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.

To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.) 1)Drinking a glass of wine just before retiring to bed 2)Eating a large meal 1 hour before bedtime 3)Consuming a small glass of warm milk at bedtime 4)Performing mild exercises 30 minutes before going to bed 5) Take a warm bath or shower before bedtime

3)Consuming a small glass of warm milk at bedtime 5) Take a warm bath or shower before bedtime 4 and relax the body and promote sleep.

A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply. 1)Eat a heavy snack before bedtime 2)Read in bed before shutting out the light 3)Leave the bedroom if you are unable to sleep 4)Drink a cup of warm tea with milk at bedtime 5)Exercise in the afternoon rather than the evening 6)Count backwards from 100 to 0 when your mind is racing.

3, 5, 6 Lying in bed when one is unable to sleep increases frustration and anxiety which further impede sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backwards requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.

Narcolepsy can be best explained as: 1)A sudden muscle weakness during exercise 2)Stopping breathing for short intervals during sleep 3)Frequent awakenings during the night 4)An overwhelming wave of sleepiness and falling asleep

4) An overwhelming wave of sleepiness and falling asleep Narcolepsy is a dysfunction of mechanisms that regulate the sleep and wake states. Excessive daytime sleepiness is the most common complaint associated with this disorder. During the day a person may suddenly feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur within 15 minutes of falling asleep.

A nursing measure to promote sleep in school-age children is to: 1)Make sure the room is dark and quiet 2)Encourage evening exercise 3)Encourage television watching 4)Encourage quiet activities prior to bed time.

4) Encourage quiet activities prior to bed time. The amount of sleep needed during the school years is individualized because of varying states of activities and levels of health. A 6-year old averages 11-12 hours of sleep nightly, whereas an 11-year old sleeps about 9-10 hours. The 6- or 7-year old can usually be persuaded to go to bed by encouraging quiet activities.

When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is: 1)Headache 2)Early awakening 3)Impaired reasoning 4)Excessive daytime sleepiness

4) Excessive daytime sleepiness Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.

Which of the following conditions characterizes rapid eye movement (REM) sleep? 1)Disorientation and disorganized thinking 2)Jerky limb movements and position changes 3)Pulse rate slowed by 5 to 10 beats/minute 4)Highly active brain and physiological activity levels.

4) Highly active brain and physiological activity levels. Highly active brain and physiological activity levels characterize REM stage. Stages 3 and 4 of NREM sleep are characterized by disorientation and disorganization, During REM sleep, the body movement ceases except for the eyes. The pulse rate slows by 5-10 beats/minute during NREM sleep, not REM sleep.

Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants? 1)Prevent any activity within the hospital setting while on oral muscle relaxants 2)Make sure that the patient knows that sedation should be minimal with these agents. 3)Cardiovascular stimulation, a common side effect, would lead to hypertension 4)Make sure the patient's call light is close by in case of the need for assistance with activities.

4) Make sure the patient's call light is close by in case of the need for assistance with activities.

Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent? 1) Alteration in tissue 2) perfusion 3) Fluid volume excess 4) Risk for injury 5) Risk for infection

4) Risk for injury Sedative-hypnotics cause CNS depression, putting the patient at risk for injury.

6. Which nursing observation of the patient in intensive care indicates the patient is sleeping comfortably during NREM sleep? a. Eyes closed, lying quietly, respirations 12, heart rate 60 b. Eyes closed, tossing in bed, respirations 18, heart rate 80 c. Eyes closed, mumbling to self, respirations 16, heart rate 68 d. Eyes closed, lying straight in bed, respirations 22, heart rate 66

ANS: A During NREM sleep, biological functions slow. During sleep, the heart rate decreases to 60 beats/min or less. The patient experiences decreased respirations, blood pressure, and muscle tone. Heart rates above 60 are too high and respirations of 22 are too high to indicate comfortable NREM sleep.

8. The nurse is discussing lack of sleep with a middle-aged adult. The nurse recognizes that insomnia in this age group is commonly due to a. Anxiety. b. Teenagers keeping them awake. c. Caring for pets. d. Late night television.

ANS: A During middle adulthood, the total time spent sleeping at night begins to decline. Anxiety, depression, and illness can affect sleep, and women can experience menopausal symptoms. Insomnia is common because of the changes and stresses associated with middle age. Teenagers, caring for pets, and late night television can influence the amount of sleep; however, these are not the most common causes of insomnia in this age group.

22. The nurse is caring for a patient on the medical-surgical unit who is experiencing an exacerbation of asthma. Which of the following interventions would be most appropriate to help the patient sleep? a. Bed placed in semi-Fowler's position b. Increased BNC oxygen to 5 L a minute c. A snack provided before bedtime d. Encouraging the patient to read

ANS: A For patients with a physical illness, the nurse helps control symptoms that disrupt sleep. Placing the patient in an upright position eases the work of breathing. Increasing the oxygen provided would require a reason to do so, and a physician's order is required. Providing a snack and encouraging the patient to read may be good interventions for patients, but the most appropriate would be raising the head of the bed.

11. The nurse is completing an assessment on an older patient who is having difficulty falling asleep. Which factor has the potential to contribute to this difficulty? a. Depression b. Smoking c. Alcohol d. Fatigue

ANS: A Older adults and other individuals who experience depressive mood problems experience delays in falling asleep, earlier appearance of REM sleep, frequent awakening, feelings of sleeping poorly, and daytime sleepiness. A person who is moderately fatigued usually achieves restful sleep, especially if the fatigue is the result of enjoyable work or exercise. Hypertension often causes early-morning awakening and fatigue. Alcohol speeds the onset of sleep. Hypothyroidism decreases stage 4 sleep.

The nurse is providing an educational session on sleep regulation for new nurses in the Sleep Disorder Treatment Center. Which of these statements by the nurses would best indicate that learning has occurred? a. "If the patient has a disease process in the central nervous system, it can influence the functions of sleep." b. "If the patient has a disease process in the cranial nerves, it can influence the functions of sleep." c. "If the patient has an interruption in the motor pathways, it can influence the functions of sleep." d. "If the patient has an interruption in the spinal reflexes, it can influence the functions of sleep."

ANS: A Sleep involves a sequence of physiological states maintained by the central nervous system. Current theory indicates that it is an active multiphase process that involves many parts of the brain and hormone and chemical secretion. A disease process associated with the cranial nerves, motor pathway, or spinal reflexes may influence a person's ability to sleep, but the best answer is the central nervous system.

15. The nurse is caring for a patient who has been in holding in the emergency department for 24 hours. The nurse is concerned about the patient experiencing sleep deprivation. What would be the best action for the nurse to take? a. Expedite the process of obtaining a medical-surgical room for the patient. b. Pull the curtains shut, dim the lights, and decrease the number of visitors. c. Obtain an order for a medication to help the patient sleep. d. Ask everyone in the unit to try to be quiet so the patient can sleep.

ANS: A The most effective treatment for sleep deprivation is elimination or correction of factors that disrupt the sleep pattern. Nurses play an important role in identifying treatable sleep deprivation problems. Obtaining a private room in the designated unit for the patient will help with decreasing stimuli and promoting more rest than an individual can obtain in an emergency department even with the interventions mentioned.

16. The nurse is completing a sleep assessment on a patient. The nurse utilizes which of the following tools to complete the assessment? a. Visual Analogue Scale b. OUCHER scale c. FACES scale d. Glasgow Coma Scale

ANS: A The visual analog scale is utilized for assessing sleep quality. Cataplexy, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day; there is no cataplexy scale for sleep assessment. A polysomnogram involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep; this is used in a sleep laboratory study. Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness; however, there is no assessment tool called the RAS scale.

24. The nurse is evaluating outcomes for the patient with the nursing diagnosis of Insomnia. During this process, the nurse recognizes that a. The patient is the best evaluator of sleep. b. Interventions will need to be adjusted. c. Medical conditions will not influence outcomes. d. Observations of the patient provide needed data.

ANS: A With regard to problems with sleep, the patient is the source for evaluating outcomes. The patient is the only one who knows whether sleep problems have improved and what has been successful. Interventions are not the best indicator; achievement of goals according to the patient is the best. Observations do provide needed data, but in the case of insomnia, the patient is the source for evaluating the restfulness of sleep.

1. The nurse is caring for a patient who has not been able to sleep well while in the hospital. The nurse recognizes that lack of sleep can manifest in which of the following signs and symptoms? (Select all that apply.) a. Changes in physiological function such as temperature b. Decreased appetite and weight loss c. Anxiety, irritability, and restlessness d. Impaired judgment e. Nausea, vomiting, and diarrhea f. Shortness of breath and chest pain

ANS: A, B, C, D The biological rhythm of sleep frequently becomes synchronized with other body functions. Changes in body temperature correlate with sleep pattern. When the sleep-wake cycle becomes disrupted, changes in physiological function such as temperature can occur. Patients can experience decreased appetite, loss of weight, anxiety, restlessness, irritability, and impaired judgment. Gastrointestinal and respiratory/cardiovascular symptoms such as shortness of breath and chest pain are not symptoms of a disrupted sleep cycle.

3. The patient and the nurse discuss the need for sleep. After the discussion, the patient is able to state factors that hinder sleep. Which statements indicate that the patient has a good understanding of sleep? (Select all that apply.) a. "Drinking coffee at 7 PM could interrupt my sleep." b. "Worry about work can disrupt my sleep." c. "Exercising 2 hours before bedtime can decrease relaxation." d. "Changing the time of day that I eat dinner can disrupt sleep." e. "Taking an antacid can decrease sleep." f. "Staying up late for a party can interrupt sleep patterns."

ANS: A, B, C, F Caffeine, alcohol, and nicotine consumed late in the evening produce insomnia. Worry over personal problems or situations frequently disrupts sleep. Alterations in routines, including changing mealtimes and staying up late at night for social activities, can disrupt sleep. Exercising 2 hours before bedtime actually increases a sense of fatigue and promotes relaxation. Taking an antacid does not decrease sleep

Question: A nurse assesses a patient's body temperature in the late afternoon as 37.2°C (99°F). What would be the nurse's best action related to this slight elevation in temperature? a. Assess the patient for infection. b. Record the temperature as a normal finding. c. Call the physician for an order for antipyretics. d. Decrease the room temperature.

Answer: b. A slight increase in body temperature in the late afternoon is the result of a normal circadian rhythm and does not need to be reported unless it becomes higher. This slight variation from normal does not necessarily mean an infection is present. A warm environment might cause an elevation in body temperature, but the most likely cause is normal circadian rhythm.

2. The nurse is caring for a patient in the intensive care unit who is having trouble sleeping. The nurse explains the purpose of sleep and its benefits. What points should the nurse include in her teaching? (Select all that apply.) a. NREM sleep contributes to body tissue restoration. b. During NREM sleep, biological functions increase. c. Restful sleep preserves cardiac function. d. Sleep contributes to cognitive restoration. e. REM sleep decreases cortical activity. f. REM sleep assists with memory storage and learning

ANS: A, C, D, E Sleep contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration. It allows the body to rest and conserve energy. This is beneficial for the cardiac system by allowing the heart to beat fewer times each minute. During stage 4, the body releases growth hormone for renewal and repair of specialized cells such as the brain. REM sleep is necessary for brain tissue restoration and cognitive restoration and is associated with a change in cerebral blood flow and increased cortical activity. Sleep assists with memory storage and learning ANS: A, C, DSleep contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration. It allows the body to rest and conserve energy. This benefits the cardiac system by allowing the heart to beat fewer times each minute. During stage 4, the body releases growth hormone for renewal and repair of specialized cells such as the brain. During NREM sleep, biological functions slow. REM sleep is necessary for brain tissue restoration and cognitive restoration and is associated with a change in cerebral blood flow and increased cortical activity.

The nurse is caring for a patient who is having trouble sleeping. To encourage decreased stimulus to the reticular activating system and activation of the bulbar synchronizing region, which actions would the nurse implement? a. Encourage television for distraction. b. Encourage relaxed positions/encourage deep breathing c. Walk with the patient. d. Provide a favorite beverage.

ANS: B Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness. Researchers also hypothesize that the release of serotonin from specialized cells in the bulbar synchronizing region (BSR) produces sleep. As the patient closes his eyes and assumes relaxed positions, stimuli to the RAS decrease, and at some point the BSR takes over. Television, walking, and drinking a favorite beverage would not necessarily encourage sleep. Relaxation exercises such as slow, deep breathing for 1 or 2 minutes relieve tension and prepare the body for rest. Instruct patients to wear loose-fitting nightwear. Walking and drinking a favorite beverage would not necessarily encourage sleep.

17. The nurse is beginning a sleep assessment on a patient. Which of the following would be the most appropriate question to ask? a. "What is going on?" b. "How are you sleeping?" c. "Are you taking any medications?" d. "What did you have for dinner last night?"

ANS: B Asking patients how they are sleeping is an introductory question. After this beginning question is asked, problems with sleep such as the nature of the problem, signs and symptoms, onset and duration of the issue, severity, predisposing factors, and the effect on the patient can be assessed. What is going on is too broad and open ended for information about sleep to be obtained specifically. Medications and food intake can be part of the detailed assessment of sleep issues.

25. A patient has received a nursing diagnosis of sleep deprivation. Which of the following statements by the patient would indicate that outcomes are being met? a. "I wake up only once a night to go the bathroom." b. "I feel rested when I wake up in the morning." c. "I go to sleep within 30 minutes of lying down." d. "I only take a 20-minute nap during the day."

ANS: B Being able to sleep and feeling rested would indicate that outcomes are being met for sleep deprivation. Limiting a nap to 20 minutes is an intervention to promote sleep. Going to sleep within 30 minutes indicates that the patient may not be experiencing insomnia. Waking up during the night may indicate insomnia, and decreasing fluids in the evening is an intervention to help prevent this situation. Waking up only once may indicate nocturia is improving but does not relate to sleep deprivation.

10. The nurse is having a conversation with an adolescent regarding the need for sleep. The adolescent states that it is common to stay up with friends several nights a week. Which nursing action should the nurse take? a. Discuss with the adolescent's parent staying up with friends and the need for sleep. b. Discuss with the adolescent sleep needs and the effects of excessive daytime sleepiness. c. This is a normal occurrence for adolescents and action is not required. d. Explore the reason for staying up late with friends several nights a week.

ANS: B On average, a teenager needs about 71/2 hours of sleep per night. Many activities at school, social activities, and jobs can reduce the number of sleep hours, resulting in excessive daytime sleepiness. This can lead to decreased performance at school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol. Discussion regarding adolescent sleep needs should first occur with the adolescent. Although it may be common for this adolescent to want to visit with friends and experience activities that go late into the night, these activities can and do impact the hours of sleep and the physical needs of the adolescent, no matter the reason for the late nights, and they do need to be addressed.

21. The nurse is preparing an older patient's evening medications. Which of the following does the nurse recognize as relatively safe for difficulty sleeping? a. Benadryl (diphenhydramine) b. Ramelteon (Rozerem) c. Valerian d. Lorazepam

ANS: B Ramelteon (Rozerem), a melatonin receptor agonist, is well tolerated and appears to be effective in improving sleep by improving the circadian rhythm and shortening time to sleep onset. It is safe for long- and short-term use particularly in older adults. The use of benzodiazepines in older adults is potentially dangerous because of the tendency of the drugs to remain active in the body for a longer time. As a result, they also cause respiratory depression, next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination, which leads to increased risk of falls. Caution older adults about using over-the-counter antihistamines because their long duration of action can cause confusion, constipation, and urinary retention. Use of nonprescription sleeping aids is not advisable. Patients need to learn the risks associated with these drugs and should be aware that the U.S. Food and Drug Administration does not regulate herbal products.

7. The nurse is discussing with a new mother the sleep requirements of a neonate. Which of these comments would indicate that the patient has an understanding of the neonate's sleeping pattern? a. "I can't wait to get the baby home to play with the brothers and sisters." b. "I will ask my mom to come after the first week, when the baby is more alert." c. "I will get the baby on a sleeping schedule the first week while my mom is here." d. "I won't be able to nap during the day because the baby will be awake."

ANS: B The patient indicates an understanding when asking the mother to come after the first week. The neonate up to the age of 3 months averages about 16 hours of sleep a day, sleeping almost constantly during the first week. The baby will sleep rather than play. The baby will not be on a sleeping schedule the first week home. The mother will be able to nap since the baby sleeps 16 hours a day.

4. A community health nurse is providing an educational session at the senior center on how to promote sleep. Which practices should the nurse recommend? (Select all that apply.) a. Take a nap in the afternoon. b. Sleep where you sleep best. c. Use sedatives as a last resort. d. Decrease fluids 2 to 4 hours before sleep. e. Watch television right before sleep. f. Get up if unable to fall asleep in 15 to 30 minutes.

ANS: B, C, D, F The nurse should instruct the patient to sleep where she sleeps best, to use sedatives as a last resort, to decrease fluid intake to cut down on bathroom trips, and, if unable to sleep in 15 to 30 minutes, to get up out of bed. Naps should be eliminated if not part of the individual's routine schedule, and if naps are taken, they should be limited to 20 minutes or less a day. Television can stimulate and disrupt sleep patterns

12. The nurse is caring for an adolescent who is complaining of difficulty falling asleep. Which intervention would be most appropriate? a. Adjust the temperature in the patient's room to 21° C (70° F). b. Ensure that the night light in the patient's room is working. c. Encourage the discontinuation of soda and chocolate nightly snack. d. Close the door to decrease noise from unit activities.

ANS: C Discontinuing the soda and chocolate nightly snack will be most beneficial for this patient since it has two factors that will cause difficulty falling asleep. Coffee, tea, colas, and chocolate act as stimulants, causing a person to stay awake or to awaken throughout the night. Personal preference influences the temperature of the room, as well as the lighting of the room. Noise can be a factor in the unit and can awaken the patient, but caffeine can make it difficult to fall asleep.

13. Which of the following would be most important for the nurse to monitor in a patient who has obstructive sleep apnea? a. Gastrointestinal function b. Circulatory status c. Respiratory status d. Neurological function

ANS: C In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing nasal airflow or stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status takes priority over gastrointestinal, circulatory, and neurologic functioning.

18. The nurse assigns a nursing diagnosis of ineffective breathing pattern. Which of the following sleep conditions would support this diagnosis? a. Insomnia b. Narcolepsy c. Obstructive sleep apnea d. Sleep deprivation

ANS: C Obstructive sleep apnea (OSA) occurs when the muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing airflow or stopping it for as long as 30 seconds. The person still attempts to breathe because chest and abdominal movements continue, resulting in snoring or snorting sounds. With narcolepsy, the person feels an overwhelming wave of sleepiness and falls asleep. Insomnia is characterized by chronic difficulty falling asleep. Sleep deprivation is a condition caused by dyssomnia. OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe.

4. The nurse is caring for a patient in the sleep lab. The nurse recognizes that the patient is in stage 4 NREM from which of the following assessments? a. The patient awakens easily. b. Body functions slow. c. The patient is difficult to awaken. d. Eyes rapidly move.

ANS: C Stage 4 NREM is the deepest stage of sleep. The patient is difficult to arouse, vital signs are significantly lower, and this stage lasts about 15 to 30 minutes. Sleep walking and enuresis sometimes occur. Lighter sleep is seen in stages 1 and 2, where the patient awakens easily. In stage 2, body functions slow and REM sleep is characterized by rapid eye movement.

14. The patient has just been diagnosed with narcolepsy. The nurse provides an educational session and teaches the patient to avoid a. Antidepressant medications. b. Naps shorter than 20 minutes. c. Sitting in hot, stuffy rooms. d. Chewing gum

ANS: C The nurse will intervene about sitting in a hot, stuffy room as this will make the narcolepsy worse so this needs to be corrected. 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). Patients are treated with antidepressants, and management techniques involve scheduling naps no longer than 20 minutes and chewing gum. Additional management techniques include exercise, light high-protein meals, deep breathing, and taking vitamins.

26. The older patient is visiting the clinic after a fall during the night. Which of the following data points obtained most likely would contribute to this fall? a. The patient has been taking glucosamine. b. The patient has been taking a fish oil. c. The patient has been taking Benadryl (diphenhydramine). d. The patient has been taking vitamin C.

ANS: C When older adults are using Benadryl (diphenhydramine), an over-the-counter medication for sleep, caution them that they may experience dizziness, drowsiness, confusion, constipation, and urinary retention because of the long duration of action of the medication. This can contribute to a fall in an older adult. Fish oil given for the treatment of cholesterol, although an issue after a fall with potential bleeding, is not a cause for the fall, nor is glucosamine, which is used in the treatment of joint issues. Neither of these substances are utilized for sleep. Vitamin C is used to support the immune system; it is not used for sleep and does not cause falls.

The nurse is caring for a young adult patient on the medical-surgical unit. When doing midnight checks, she sees that the patient is awake and is doing a puzzle. What is the best explanation for the patient being awake? A. The patient was waiting to talk with the nurse B. The patient misses his family and is lonely C. The patients sleep-wake cycle preference is late evening D. The patient has been kept up by the noise on the unit

ANS: C All persons have biological clocks that synchronize their sleep-wake cycle. This explains why some individuals fall asleep in the early evening and some late evening or early morning. This patient is awake and alert enough to do a puzzle. The individual's sleep-wake preference is probably late evening. Waiting to talk with the nurse, being lonely, and noise on the unit may contribute to lack of sleep, but the best explanation for the patient being awake is the biological clock.

Question: A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep? Select all that apply. a. A patient who is taking iron supplements for anemia b. A patient with Parkinson disease who is taking dopamine c. An elderly patient taking diuretics for congestive heart failure d. A patient who is taking antibiotics for an ear infection e. A patient who is prescribed antidepressants f. A patient who is taking low-dose aspirin prophylactically

Answer: b, c, e. Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems.

23. A young mother has been hospitalized for an irregular heartbeat (arrhythmia). The night nurse comes in to see the patient awake. What would be the most appropriate nursing intervention? a. Inform the patient that it is late and time to go to sleep. b. Ask the patient if she would like medication to help her sleep. c. Recommend the great movie that is on television tonight. d. Take time to sit and talk with the patient about her inability to sleep.

ANS: D Assessment is the first step of the nursing process; therefore assessment needs to be done first and involves ascertaining the cause of the patient's inability to sleep. Patients who are admitted to the hospital for uncertain diagnoses can be stressed and worried about the testing and outcomes. In addition, a young mother can be worried about the care of the children and those caring for the children. This uncertainty and change in routine can cause difficulty in resting or falling asleep. Take the time to talk with the patient to determine the cause of the inability to sleep. A distraction such as a television may or may not work for the patient. After assessment is completed, a sedative may or may not be in order. Telling the patient that it is late and time to go to sleep is not a therapeutic response for an adult who is under stress.

20. The patient presents to the clinic with reports of irritability, being sleepy during the day, not being able to fall asleep, and being tired. Select the most appropriate nursing diagnosis. a. Anxiety b. Fatigue c. Sleep deprivation d. Insomnia

ANS: D Insomnia is experienced when the patient has difficulty falling asleep, frequent awakenings from sleep, and/or short sleep or nonrestorative sleep. It is the most common sleep-related complaint and includes symptoms such as irritability, excessive daytime sleepiness, not being able to fall asleep, and fatigue. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fatigue is an overwhelming sustained sense of exhaustion with decreased capacity for physical and mental work at a usual level. Sleep deprivation is a condition caused by dyssomnia and includes symptoms caused by illness, emotional distress, or medications.

9. A single dad is discussing with the nurse the sleep needs of a preschooler. Which of the following directions would be most helpful to the parent? a. "It is important that the 5-year-old get a nap every day." b. "Preschoolers sleep soundly all night long." c. "On average, the preschooler needs to sleep 10 hours a night." d. "The preschooler may have trouble settling down after a busy day."

ANS: D The preschooler usually has difficulty relaxing or settling down after long, active days. By the age of 5, naps are rare for children, except those for whom a siesta is a custom. Preschoolers frequently partially awaken during the night. On average, a preschooler needs 12 hours of sleep.

19. The nurse is caring for a postpartum patient. The patient's labor has lasted over 28 hours within the hospital; the patient has not slept and is disoriented to date and time. What is the most appropriate nursing diagnosis? a. Impaired parenting b. Insomnia c. Ineffective coping d. Sleep deprivation

ANS: D This patient has been deprived of sleep by staying awake during a 28-hour labor. Disorientation is one potential sign of sleep deprivation. In this scenario, we have a clear cause for the patient's lack of sleep, and it is a one-time episode. Insomnia, on the other hand, is a chronic disorder whereby patients have difficulty falling asleep, awaken frequently, or sleep only for a short time. This scenario does not indicate that this has been a chronic problem for this patient. Although ineffective coping can manifest as a sleep disturbance, we have clear evidence that it was labor that deprived this patient of sleep, not an inability to cope. It could be difficult to care for an infant when sleep deprived; however, this scenario gives no evidence that this mother displays impaired parenting and is not caring adequately for her child or lacks the skills to do so.

5. The patient shares with the nurse the vivid, full color dreams experienced by the patient last night. These data would indicate that the patient has reached what stage of sleep? a. Stage 1 NREM b. Stage 2 NREM c. Stage 3 NREM d. REM

ANS: D Vivid, full color dreaming occurs during REM sleep. This stage usually begins about 90 minutes after sleep has begun. The eyes move rapidly, and heart rate, respiratory rate, and blood pressure fluctuate; loss of skeletal muscle tone occurs. The patient has an increase in gastric secretions and is difficult to arouse.

What is the hormone that promotes sleep? 1) Melatonin 2) L-tryptophan 3) Progesterone 4) Oxytocin

Answer: 1) Melatonin Rationale: The levels of melatonin, which is the natural hormone that promotes sleep, decline in the latter decades of life. It is produced at night by the pineal gland in the brain.

The nurse in the hospital has a prescription to administer medication at 0400 to Mrs. Giovanni. Mrs. Giovanni is asleep when the nurse enters the room. She is difficult to arouse and confused. Identify the stage of sleep Mrs. Giovanni was likely in when the nurse awakened her. 1) Stage II 2) Stage III 3) Stage IV 4) REM

Answer: 3) Stage IV Rationale: Stage IV is the deepest sleep and the most restorative. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage IV sleep, and if awakened, the person may appear confused and react slowly.

How would the nurse be able to identify the person with narcolepsy from one with seizures? 1) Episodes are short in duration. 2) Episodes come on suddenly. 3) The patient can be aroused from the episode. 4) The patient loses voluntary control of his muscles.

Answer: 3) The patient can be aroused from the episode. Rationale: The patient with narcolepsy can be aroused from the sleep episode. A person with seizure activity is unresponsive to stimulus and does not resolve in relationship to arousing. Narcolepsy and seizures are triggered suddenly. Both involve involuntary control of motor function with paralysis and cataplexy. Typical seizures last less than 8 minutes. Most narcoleptic episodes are also brief with microactivity lasting only a few minutes. Infrequently, the uncontrollable urge to sleep goes on for up to an hour.

Question: A nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? Select all that apply. a. A patient who has uncontrolled hypothyroidism b. A patient with coronary artery disease c. A patient who has gastroesophageal reflux (GERD) d. A patient who is HIV positive e. A patient who is taking corticosteroids for arthritis f. A patient with a urinary tract infection

Answer: a, b, c. A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has gastroesophageal reflux (GERD) may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.

Depression, hyperthyroidism, hypothyroidism, pain, and sleep apnea are examples of: 1) disorders that are provoked by sleep. 2) conditions known as parasomnias. 3) conditions that cause secondary sleep disorders. 4) disorders associated with narcolepsy.

Answer: 3) conditions that cause secondary sleep disorders. Rationale: Secondary sleep disorders occur when a disease causes alterations in sleep stages or in quantity of sleep. Depressed people may spend more time in bed; however, in general, they have difficulty falling asleep, experience less slow-wave (deep) sleep, spend less time in REM sleep, awaken early, and have less total sleep time. An increase in thyroid secretion causes an increase in stage III and IV sleep. Hypothyroidism causes a decrease in those stages. Hyperthyroidism creates increased metabolic rate, making it difficult to fall asleep. Acute pain and chronic pain interfere with sleep. They inhibit sleep, increase arousals during sleep, and cause longer awake intervals during the night. During periods of sleep apnea, O2 level in the blood drops, and the CO2 level rises, causing the person to wake up frequently.

The duration of sleep is regulated by the: 1) electrical impulses transmitted to the cerebellum. 2) person's innate biorhythms. 3) amount of sleep a person usually requires. 4) reticular activating system.

Answer: 4) reticular activating system. Rationale: In the morning, with an increase in environmental light, the hypothalamus is signaled to induce gradual arousal from sleep. The reticular formation is then activated by the stimuli from the cerebral cortex. The reticular formation is responsible for maintaining wakefulness. Together, the reticular formation and cortical neurons are called the reticular activating system (RAS). The RAS regulates the duration of sleep.

Question: A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? Select all that apply. a. Daily mental activities b. Daily physical activities c. Morning and evening body temperature d. Daily measurement of fluid intake and output e. Presence of anxiety or worries affecting sleep f. Morning and evening blood pressure readings

Answer: a, b, e. A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is not usually kept in a sleep diary.

Question: A nurse caring for patients in a long-term care facility is implementing interventions to help promote sleep in elderly patients. Which action is recommended for these patients? a. Increase physical activities during the day. b. Encourage short periods of napping during the day. c. Increase fluids during the evening. d. Dispense diuretics during the afternoon hours.

Answer: a. In order to promote sleep in the elderly patient, the nurse should encourage daily physical activity such as walking or water aerobics, discourage napping during the day, decrease fluids at night, and dispense diuretics in the morning or early evening.

Question: A nurse observes some involuntary muscle jerking in a sleeping patient. The nurse determines that the patient is most likely in which stage of sleep? a. Stage I NREM sleep b. Stage II NREM sleep c. Stage IV NREM sleep d. REM sleep

Answer: a. Involuntary muscle jerking occurs in stage I NREM sleep. In the other stages, the muscles proceed from a relaxed state to large muscle immobility.

Question: To promote sleep in a patient, a nurse suggests what intervention? a. Follow the usual bedtime routine if possible. b. Drink two or three glasses of water at bedtime. c. Have a large snack at bedtime. d. Take a sedative-hypnotic every night at bedtime.

Answer: a. Keeping the same bedtime schedule helps promote sleep. Drinking two or three glasses of water at bedtime will probably cause the patient to awaken during the night to void. A large snack may be uncomfortable right before bedtime; instead, a small protein and carbohydrate snack is recommended. Taking a sedative-hypnotic every night disturbs REM and NREM sleep, and sedatives also lose their effectiveness quickly.

Question: A nurse caring for patients in a busy hospital environment should implement which recommendation to promote sleep? a. Keep the room light dimmed during the day. b. Keep the room cool. c .Keep the door of the room open. d. Offer a sleep aid medication to patients on a regular basis.

Answer: b. The nurse should keep the room cool and provide earplugs and eye masks. The nurse should also maintain a brighter room environment during daylight hours and dim lights in the evening, and keep the door of the room closed. Sleep aid medications should only be offered as prescribed.

Question: A nurse observes a slight increase in a patient's vital signs while he is sleeping during the night. According to the patient's stage of sleep, the nurse expects what conditions to be true? Select all that apply. a. He is aware of his surroundings at this point. b. He is in delta sleep at this time. c. It would be most difficult to awaken him at this time. d. This is most likely an NREM stage. e. This stage constitutes around 20% to 25% of total sleep. f. The muscles are relaxed in this stage.

Answer: c, e. This scenario describes REM sleep. During REM sleep, it is difficult to arouse a person, and the vital signs increase. REM sleep constitutes about 20% to 25% of sleep. In stage I NREM sleep, the person is somewhat aware of surroundings. Delta sleep is NREM stages III and IV sleep. In stage IV NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.

Question: A nurse working the night shift at a hospital observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply. a. REM sleep constitutes much of the sleep cycle of a preschool child. b. By the age of 8 years, most children no longer take naps. c. Sleep needs usually decrease when physical growth peaks. d. Many adolescents do not get enough sleep. e. Total sleep decreases in adults with a decrease in stage IV sleep. f. Sleep is less sound in older adults and stage IV sleep may be absent.

Answer: d, e, f. Many adolescents do not get enough sleep due to the stresses of school, activities, and part-time employment causing restless sleep. Total sleep time decreases during adult years, with a decrease in stage IV sleep. Sleep is less sound in older adults, and stage IV sleep is absent or considerably decreased. REM sleep constitutes much of the sleep cycle of a young infant, and by the age of 5 years, most children no longer nap. Sleep needs usually increase when physical growth peaks.

Question: A nurse is performing a sleep assessment on a patient being treated for a sleep disorder. During the assessment, the patient falls asleep in the middle of a conversation. The nurse would suspect which disorder? a. REM behavior disorder b. Narcolepsy c. Enuresis d. Sleep apnea

Answer: b. Narcolepsy is an uncontrollable desire to sleep; the person may fall asleep in the middle of a conversation. Circadian rhythm sleep-wake disorders are characterized by a chronic or recurrent pattern of sleep-wake rhythm disruption primarily caused by an alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep-wake schedule desired or required; a sleep-wake disturbance (e.g., insomnia or excessive sleepiness); and associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder) (Sateia, 2014). Enuresis is urinating during sleep or bedwetting. Sleep apnea is a condition in which breathing ceases for a period of time between snoring.

Question: A nurse is caring for a patient who states he has had trouble sleeping ever since his job at a factory changed from the day shift to the night shift. Which diagnosis would be most appropriate for this patient? a. Ineffective Coping: Multiple Stressors of New Job b. Sleep Deprivation: Difficulty Falling Asleep c. Disturbed Sleep Pattern: Altered Sleep-Wake Pattern d. Risk for Injury: Activity Intolerance/Sleep Deprivation

Answer: c. Rationale: Chronotherapy requires a commitment on the part of the patient to act over a period of weeks to progressively advance or delay the time of sleep for 1 to 2 hours per day. Over time, this results in a shift of the sleep-wake cycle. The use of a central nervous system stimulant is recommended for narcolepsy. Continuous positive airway pressure machine (CPAP) is used for OSA, and the application of heat or cold therapy to the legs is used to treat RLS.

Question: A nurse is discussing with an older female patient the factors that affect sleep. What fact does the nurse teach her? a. Drinking a cup of regular tea at night induces sleep. b. Using alcohol moderately promotes a deep sleep. c. Aging decreases the amount of REM sleep a person experiences. d. Exercising decreases REM and NREM sleep.

Answer: c. The nurse would teach the patient that the amount of REM sleep decreases with age. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity increases both REM and NREM sleep.

Question: A nurse working the night shift in a pediatric unit observes a 10-year-old male patient walking the hallway in a sleep state. The child is unaware of his environment and doesn't recall the incident in the morning. Which sleep disorder would the nurse expect? a. Bruxism b. Cataplexy c. Restless leg syndrome d. Somnambulism

Answer: d. Somnambulism (sleepwalking) may range from sitting up in bed to walking around the room or the house to walking outside the house. The sleepwalker is unaware of the environment. Bruxism is grinding of one's teeth and frequently is an indicator of stress. Cataplexy is a sudden loss of motor tone that may cause the person to fall asleep; it is usually experienced during a period of strong emotion. People with restless leg syndrome (RLS) cannot lie still and report unpleasant creeping, crawling, or tingling sensations in the legs.

Question: A nurse formulates the following diagnosis for an elderly patient who is having trouble getting to sleep at night: Disturbed Sleep Pattern: Initiation of Sleep. Which of the following nursing interventions would the nurse perform related to this diagnosis? Select all that apply. a. Arrange for assessment for depression and treatment. b. Discourage napping during the day. c. Decrease fluids during the evening. d. Administer diuretics in the morning. e. Encourage patient to engage in some type of physical activity. f. Assess medication for side effects of sleep pattern disturbances.

Answer: a, b, e, f. For patients who are having trouble initiating sleep, the nurse should arrange for assessment for depression and treatment, discourage napping, promote activity, and assess medications for sleep disturbance side effects. Limiting fluids and administering diuretics in the morning are appropriate interventions for Disturbed Sleep Pattern: Maintaining Sleep.

A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which condition is a manifestation of depression in an older client? a) Insomnia b) Somnambulism c) Nocturnal enuresis d) Nightmares

a) Insomnia Insomnia and hypersomnia are often manifestations of depression in older clients. Nightmares, somnambulism (sleepwalking), and nocturnal enuresis are examples of parasomnias. These are conditions associated with activities that cause arousal, or partial arousal, usually during transitions in NREM periods of sleep. However, these are not manifestations of depression in an older adult client.

For the last 3 weeks, a nurse in a long-term care facility has administered a sedative-hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation? a) Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration. b) The client's daily activity is interfering with the drug. c) The client is eating carbohydrates prior to bedtime. d) The nurse needs to administer another drug such as diphenhydramine for effectiveness.

a) Most sedative-hypnotics lose their effect after 1 or 2 two weeks of administration. Although most sedative-hypnotic drugs provide several nights of excellent sleep, the medication often loses its effects after 1 or 2 weeks. Alcohol and diphenhydramine should not be administered with a sedative-hypnotic drug. Increased activity assists the client in sleeping. Foods such as protein and carbohydrates have been shown to help a client sleep.

A nurse is caring for a client with restless leg syndrome who complains of sleeplessness. Which nursing diagnosis is most appropriate for this client? a) Sleep Deprivation b) Impaired Bed Mobility c) Relocation Stress Syndrome d) Risk for Injury

a) Sleep Deprivation Sleep deprivation is the most appropriate nursing diagnosis for this client because the symptoms of restless legs syndrome keep the person awake and prevent continuous sleep. Eventually, sleep deprivation affects the person's life, damaging work productivity and personal relationships. Relocation Stress Syndrome would not be an appropriate diagnosis because the symptoms are not due to relocation to a new place. Impaired Bed Mobility is an inappropriate diagnosis because the client is not confined to a bed. The client does not have a risk for injury; therefore, the diagnosis of Risk for Injury would be incorrect.

Which factor necessitates the need for more sleep in the adolescent population? a) rapid growth b) part-time employment c) increased nutritional needs d) increased life stresses

a) rapid growth Rationale: The growth spurt that occurs during adolescence may necessitate the need for more sleep. However, the stresses of school, activities, and part-time employment may cause adolescents to have restless sleep, and many adolescents do not get enough sleep.

A nurse is caring for a client with insomnia. The nurse is explaining the importance of sleep to the client. Which role is sleep supposed to play? a) reduce fatigue b) decrease pain tolerance c) reduce protein synthesis d) eliminate fat accumulation

a) reduce fatigue Sleep is believed to play an important role in reducing fatigue, stabilizing mood, and improving blood flow to the brain, among other things. Sleep increases, not reduces, protein synthesis. Sleep does not eliminate accumulation of fat in a person's body. Regular exercise or physical activity reduces fat accumulation. Sleep increases pain tolerance in a person, whereas sleep deprivation decreases pain tolerance.

A nurse is caring for a client who has been diagnosed with a disturbed sleep pattern. What measures should the nurse implement to promote sleep? Select all that apply. a) Assisting with progressive relaxation b) Administration of diuretics c) Increasing the intake of stimulating chemicals d) Promoting daytime exercises e) Providing a back massage

a, d, e In order to promote sleep in a client, the nurse could use the following measures: promoting daytime exercise, providing a back massage, and assisting the client with progressive relaxation. However, the nurse should reduce the intake of stimulating chemicals to promote sleep in a client. Diuretics may awaken those who take them with a need to empty the bladder. For this reason, diuretics generally are administered early in the morning so that the peak effect has diminished by bedtime.

The nurse is providing client education for the parents of an obese child diagnosed with obstructive sleep apnea. What treatment measures would the nurse explain during the education session? Select all that apply. a) use of a mandibular advancement device (MAD) b) treatment with intranasal antibiotics c) counseling for depression d) treatment with sleeping pills e) a weight loss plan f) use of a continuous passive airway pressure (CPAP) machine

a, e, f A weight loss plan, use of a continuous passive airway pressure (CPAP) machine, and the use of a mandibular advancement device (MAD) are treatment measures that the nurse would explain during the education session on obstructive sleep apnea. The use of antibiotics and sleeping pills would not be included. Counseling for depression is not necessary as the question is written.

The nurse knows that a client understands the purpose of a sleep diary when the client states: a) "I will write down all my morning activities." b) "I will record the time I go to bed and how long it takes me to fall asleep." c) "I will keep track of my sleep information for 2 months." d) "I will only keep track of my sleep habits at home, not when I am traveling out of town."

b) "I will record the time I go to bed and how long it takes me to fall asleep." Rationale:Keeping notes of times of sleep and waking are important details to record in a sleep diary. The notes are usually maintained for 14 days and include specifics such as all wakeful activities and sleep patterns in strange environments.

Parents tell the nurse that their 5-year-old is only sleeping 10 hours now and is refusing to take an afternoon nap. The nurse should teach the parents: a) "It might be a problem. You should discuss this with your pediatrician." b) "This is normal development for children in this age group." c) "Five-year-olds sleep only 10 to 12 hours at night, but napping is very important at this stage." d) "Don't let your child eat any candy or chocolate after dinner."

b) "This is normal development for children in this age group." Preschoolers typically sleep 10-16 hours but become less dependent on napping as they approach school age. By 5 years, they usually do not need routine naps. Telling them to call their pediatrician is passing off responsibility. Sweets are not recommended before bedtime, and this child has normal sleep habits. Which

A nurse is visiting the home of a first-time mother and her newborn. The nurse is teaching the mother about the newborn's sleep needs. The nurse would inform the mother that newborns sleep approximately how many hours per day? OR A new mother calls the pediatric nurse to talk about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep? a) 10 to 12 hours b) 14 to 20 hours c) 18 to 22 hours d) 8 to 10 hours

b) 14 to 20 hours Rationale:The pediatric nurse informs the new parent that on average, infants require 14 to 20 hours of sleep each day.

A nurse is caring for a client diagnosed with sleep apnea. Which nursing diagnosis should the nurse include in her nursing care plan? a) Impaired Bed Mobility b) Impaired Gas Exchange c) Risk For Injury d) Relocation Stress Syndrome

b) Impaired Gas Exchange Rationale:The nurse should include the nursing diagnosis of Impaired Gas Exchange in her nursing care plan. During the apneic or hypopneic periods, ventilation decreases, and blood oxygenation drops. The accumulation of carbon dioxide and the fall in oxygen cause brief periods of awakening throughout the night. Relocation Stress Syndrome, Impaired Bed Mobility, and Risk For Injury are not appropriate diagnoses because the client's loss of sleep is not due to a new place; there is also no immobility or injury risk involved with sleep apnea.is

The client is scheduled for a polysomnography to determine if the client has obstructive sleep apnea (OSA). The nurse instructs the client to: a) take prescribed sedative before trying to sleep. b) anticipate sleeping overnight at a health care center. c) insert an oral appliance prior to attempting sleep. d) apply facial mask that will deliver positive air pressure.

b) anticipate sleeping overnight at a health care center. Polysomnography is a sleep study. The client will be scheduled for the study at a health care center and sleep overnight as part of the study. The client should avoid sedatives as this will aggravate OSA. Interventions for OSA include inserting an oral appliance or applying a facial mask for continuous positive airway pressure.

Which activity for rest break should not be incorporated into care planning for clients to aid in healing and recovery? a) stretching exercises b) drinking an 8 oz cup of a caffeinated beverage c) going for a short walk d) focusing thoughts on a pleasant scene away from work e) taking a short 15- to 30-minute nap

b) drinking an 8 oz cup of a caffeinated beverage Drinking a caffeinated beverage is not as energizing as a short 15- to 30-minute nap, stretching exercises, or taking a short walk.

The nurse is completing a sleep history on a client who reports sleeping problems. Which of the client's regular behaviors will cause the client to have difficulty with sleep? a) drinking 2 cups of coffee every morning b) taking a diuretic at 9 a.m. and 5 p.m. daily c) exercising immediately after getting off work at 5 p.m. d) using a white noise machine to mask outside noise

b) taking a diuretic at 9 a.m. and 5 p.m. daily Explanation:Various factors may affect sleep. Taking a diuretic, particularly late in the day, is a common cause for sleep problems. The diuretic may still affect the client at hours of sleep. The other behaviors are acceptable in promoting sleep: exercising more than 2 hours before sleep, ingesting caffeine early in the day, and using a white noise machine to keep the environment quiet.

The mother reports her 4-year-old child wakes up frequently at night screaming. She also reports this occurs shortly after her son has fallen asleep. The nurse determines that the child takes a tub bath and the mother reads a story to her son prior to bedtime at 8 p.m. The nurse intervenes by stating what to the mother? Select all that apply. a) "Put the child in your bed to sleep when this occurs." b) "It is common for this to occur in this age group." c) "Comforting your child when this occurs may help." d) "You may find a nightlight in his room is helpful." e) "You will need to change your child's bedtime routine."

b, c, d The description is a preschooler experiencing nightmares or night terrors, which is common in this age group. Nursing interventions include teaching the parents to comfort the child and provide a nightlight. The preschooler should not be placed in the parents' bed when this occurs as this will become a regular routine. The preschooler's bedtime routine appears satisfactory, and this should be continued.

Which activity would be appropriate to suggest to the client who reports having difficulty falling asleep every evening? a) Smoke a cigarette to relax and calm down at bedtime. b) Exercise vigorously for 30 minutes before bedtime. c) Eat some crackers with peanut butter at bedtime. d) Eat a bar of a favorite chocolate before bedtime.

c) Eat some crackers with peanut butter at bedtime. Rationale:Carbohydrates make tryptophan more available to the brain, thereby promoting sleep. Therefore, a small protein- and carbohydrate-containing snack such as peanut butter on toast or cheese and crackers are effective. Nicotine contained in cigarettes has a stimulating effect, and smokers usually have a more difficult time falling asleep. The client must be encouraged to quit smoking or to eliminate cigarette smoking after the evening meal. Exercise that occurs within a 3-hour interval before normal bedtime can hinder sleep. Caffeinated products, such as chocolate, coffee, and tea are considered stimulants and can interfere with sleep.

An older adult client with mild hypothermia has been admitted to the health care facility. What should the nurse do to provide an appropriate environment to an older adult client? a) Use a bright light at night for safety. b) Keep an attendant with the client. c) Ensure that the environment is warmer. d) Raise the side rails of the bed.

c) Ensure that the environment is warmer.

The nurse is completing an admission assessment for a client scheduled for back surgery after a construction accident. The nurse notes the client is having slowed speech and focus, irritability, yawning, and that he reports severe lumbar and right leg pain. The nurse suspects a nursing diagnosis of: a) Anxiety related to hospitalization. b) Mobility, Impaired Physical related to Restless Leg Syndrome (RLS). c) Sleep Pattern Disturbance related to acute pain. d) Role Performance, Ineffective related to inability to work at occupation.

c) Sleep Pattern Disturbance related to acute pain. Rationale:The client is demonstrating classic signs of sleep disturbance from the acute back and leg pain he is experiencing. Anxiety may be present but that is a symptom of his problem rather than the nursing diagnosis. He may have impaired mobility, but it is not due to RLS. Also, his role of construction worker may be disrupted by the injury/treatment, but it is not the cause of this assessment data.

A maternity nurse is instructing new parents on the proper sleeping position for their newborn child. In what position does the nurse instruct the parents to place the infant? a) Side-lying position b) Prone position c) Supine position d) High-Fowler's position

c) Supine position Explanation:The nurse will teach the parents to position the infant on the back (supine). Sleeping in the prone position increases the risk for sudden infant death syndrome (SIDS). In a high Fowler's position, the client is placed with the head of the bed elevated as high as possible. The side-lying position is a position for breast-feeding but not for sleeping.

The nurse is assessing a client for sleep disorders. The initial step in sleep assessment is: a) auscultate the lung fields and perform neuro checks. b) measure the client's weight and assess visual acuity. c) observe client's hours of sleep and review client's sleep diary. d) measure neck circumference and auscultate the abdomen.

c) observe client's hours of sleep and review client's sleep diary. Observing the sleeping patterns and checking the client's sleep diary can lead the nurse to clues about the quality of the client's sleep. Neck circumference can be a factor in obstructive sleep apnea, but it is not routinely measured during assessment. Being overweight is a common finding in sleep disorder clients, but visual acuity issues are not. Auscultation of the lungs and abdomen are not pertinent to the potential disorder. A sleep diary kept for 2 weeks will provide a more detailed history of the client's sleep-wakefulness pattern than having the client identify foods that impact sleep, or having the client recall the number of hours of sleep each day for the past week. Client recall may be inaccurate. The client should describe the sleep problem, not the client's bed partner.

A client who previously was a smoker has recently stopped smoking but reports having much trouble sleeping at night. How would the nurse respond? a) "Since you were a smoker, this will always be a problem." b) "If you are sleep deprived, it might be better to smoke." c) "You have to decide what is more important: smoking or sleep." d) "Sleep problems from stopping smoking are temporary."

d) "Sleep problems from stopping smoking are temporary." -Total withdrawal from smoking may be associated with temporary sleep disturbances-The nicotine from cigarettes causes stimulation and the absence of the nicotine can cause daytime sleepiness and more restless at night-This is temporary and the client should be told it will go away

Which is not a lifespan consideration for sleep cycles? a) Newborns can sleep up to 16 to 18 hours per day. b) Getting the toddler and preschooler to fall asleep is a common problem. c) In adolescents, there is a shift to late evening bedtime and late morning rise time. d) By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases.

d) By middle age, the frequency of nocturnal awakenings decreases, and satisfaction with sleep quality increases. By middle age, the frequency of nocturnal awakenings increases, and satisfaction with sleep quality decreases. Situational variables such as job-related stress, pregnancy, parenting, family caregiving responsibilities, and illness may explain these changes in sleep patterns.

A nurse notes that a client admitted to a long-term care facility sleeps for an abnormally long time. After researching sleep disorders, the nurse learns that which area of this client's brain may have suffered damage? a) Midbrain b) Medulla c) Cerebral cortex d) Hypothalamus

d) Hypothalamus The hypothalamus has control centers for several involuntary activities of the body, one of which concerns sleeping and waking. Injury to the hypothalamus may cause a person to sleep for abnormally long periods. The medulla and midbrain are part of the reticular activating system (RAS), which plays a part in the cyclic nature of sleep. The cerebral cortex does not have any role in the sleep process.

The nurse has entered the room of a newly admitted client and observed a continuous positive airway pressure (CPAP) on the client's bedside table. The nurse would recognize that this client likely has a history of what condition? a) Somnambulism b) Narcolepsy c) Insomnia d) Obstructive sleep apnea

d) Obstructive sleep apnea CPAP is a common treatment for sleep apnea that helps to maintain the patency of the client's airway. It does not address the signs and symptoms of insomnia, narcolepsy, or somnambulism (sleepwalking).

A new client in the medical-surgical unit complains of difficulty sleeping and is scheduled for an exploratory laparotomy in the morning. The nursing diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which step is most appropriate in planning care for this diagnosis? a) Help the client maintain normal bedtime routine and time for sleep. b) Bring the client a warm glass of milk at bedtime. c) Use tactile relaxation techniques, such as a back massage. d) Provide an opportunity for the client to talk about concerns.

d) Provide an opportunity for the client to talk about concerns. Stress and anxiety interfere with a person's ability to relax, rest, and sleep. The client is scheduled for a surgical procedure in the morning. The nursing diagnosis addresses this particular concern. Providing an opportunity for the client to talk about concerns and issues would be beneficial. The other options are incorrect because the options do not address the situation at hand, or the nursing diagnosis that is noted.

In Stage 4 sleep, the: a) respirations are irregular b) blood pressure is elevated c) temperature increases d) pulse rate is slow

d) pulse rate is slow During slow-wave sleep, the muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle all decrease.

A client calls a sleep clinic "helpline" and describes her 46-year-old husband's sleep patterns: snoring loudly, then becoming startled and waking up 5 or 6 times a night. The wife is asking how to improve his sleep patterns. The nurse concludes: a) the husband should only eat a small carbohydrate snack before bed. b) the wife should consider wearing ear plugs to bed. c) the wife needs interventions to promote Stage II sleep for herself. d) the husband may be exhibiting signs of sleep apnea.

d) the husband may be exhibiting signs of sleep apnea.

When evaluating a client's sleep plan success, the nurse would expect the client to: a) explain the direct actions of the hypnotic he has been prescribed. b) identify how many NREM cycles he progressed through. c) describe the dreams he had. d) verbalize feeling rested.

d) verbalize feeling rested.