Chapter 43 NCLEX: Sleep

Which of the following guidelines does the nurse apply to the discussion of sleep patterns with elderly patients? A) Circadian rhythms become more prominent as patients age B) The amount of stage 4 sleep increases as patients age C) Total sleep time decreases as the patients age D) Older patients fall asleep more quickly than younger

C Feedback: As people age, the amount of stage 4 sleep decreases significantly. Sleeping patterns may become polyphasic, with a shorter nocturnal period plus daytime naps.

REM sleep in a toddler is about A) 10% B) 20% C) 30% D) 40%

C Feedback: REM sleep in the toddler and preschooler drops to about 30%, which is still higher than adults.

The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? A. "I feel refreshed when I wake up in the morning." B. "I use soft music at night to help me relax." C. "It takes me about 45 to 60 minutes to fall asleep." D. "I take the pain medication for my leg pain about 30 minutes before I go to bed."

C Good sleep-hygiene practices indicate that individuals should fall asleep within 30 minutes of going to bed. Taking 45 to 60 minutes to fall asleep indicates a potential sleep problem and requires follow-up on sleep-hygiene practices. If an individual does not fall asleep within 30 minutes, encourage him or her to get out of bed and do a quiet activity until he or she feels sleepy.

A nurse is caring for a patient who is sleeping for abnormally long periods of time. This condition may be caused by injury to which of the following body structures? A) spinal cord B) pancreas C) hypothalamus D) thyroid

C

A patient is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder? A) waking during sleep B) restless leg syndrome C) uncontrollable desire to sleep D) decrease in the amount or quality of sleep

C

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

C

Which of the following expected outcomes demonstrates the effectiveness of a plan of care to promote rest and sleep? A) verbalizes inability to sleep without medications B) continues to read in bed for hours each night C) identifies factors that interfere with normal sleep pattern D) reports minimal improvement in quality of rest and sleep

C

An individual awakens from a sound sleep in the middle of the night because of abdominal pain. Why does this happen? A) stimuli from peripheral organs to the RAS B) stimuli to the wake center in the cerebral cortex C) messages from chemoreceptors to the brain D) messages from baroreceptors to the spinal cord

A

What condition have studies confirmed to occur when adults and children do not get recommended hours of sleep at night? A) Obesity B) Anxiety C) Diabetes D) Hypertension

A

What is the rationale for using CPAP to treat sleep apnea? A) positive air pressure holds the airway open B) negative air pressure holds the airway closed C) delivery of oxygen facilitates respiratory effort D) alternating waves of air stimulate breathing

A

Which statement made by the parent of a school-age child requires follow-up by the nurse? A. "I encourage evening exercise about an hour before bedtime." B. "I offer my daughter a glass of warm milk before bedtime." C. "I make sure that the room is dark and quiet at bedtime." D. "We use quiet activities such as reading a book before bedtime."

A Best evidence related to sleep hygiene recommends avoiding exercise within 2 hours of bedtime. Exercise should be in the morning or afternoon. Encourage the parent to use quiet activities before bedtime to promote sleep.

Nurses who experience no difficulty working a variety of shifts are generally viewed as which type of person? A) Evening B) Afternoon C) Morning D) Nighttime

A Feedback: Evening people find they function best late in the day and are usually wide awake and ready for activity in the evening.

Which of the following statements about the sleep patterns of toddlers should the nurse incorporate into a teaching plan for parents? A) Getting the child to sleep can be difficult B) Most toddlers fall asleep easily C) Nightmares are rare in toddlers D) Slow-wave sleep is less than in adults

A Feedback: Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.

When the nurse attempts to wake a patient who has just closed his eyes and appears asleep, the patient states he is not asleep. The stage of sleep the patient is in is A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

A Feedback: Stage 1 is the transitional stage between drowsiness and sleep, indicated by a shift from alpha waves to low-voltage, fast theta on the EEG. This stage usually lasts only a few minutes, and, if awakened, the person may say he or she was not asleep.

During stage 3 sleep, the patient may experience A) Enuresis B) Anxiety C) Diaphoresis D) Shortness of breath

A Feedback: Stages 3 and 4 are the stages during which snoring, sleepwalking (somnambulism), and bed-wetting (enuresis) are most likely to occur.

Which sleep-hygiene actions at bedtime can the nurse delegate to the nursing assistant? Select all that apply. A. Giving the patient a backrub B. Turning on quiet music C. Dimming the lights in the patient's room D. Giving a patient a cup of coffee E. Monitoring for the effect of the sleeping medication that was given

A, B, C Giving the patient a backrub, turning on quiet music, and dimming the lights are all appropriate sleep-hygiene measures. These activities are within the scope of practice for the nursing assistant. Coffee, tea, cola, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night and should not be ingested before bedtime. Monitoring medication effect is a registered nurse activity.

The school nurse is teaching health-promoting behaviors that improve sleep to a group of high-school students. Which points should be included in the education? Select all that apply. A. Go to bed at the same time each night. B. Study in your bedroom to have a quiet place. C. Turn on the television to help you fall asleep. D. Avoid drinking coffee or soda before bedtime. E. Turn off your cell phone at bedtime.

A, D, E Going to bed at the same time each night, avoiding drinking coffee and soda before bedtime, and turning off electronic devices are effective sleep-hygiene practices for adolescents. Use of electronic devices is a main cause of sleep disruption in adolescents.

The nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? Select all that apply. A. Take brief, 20-minute naps during the day. B. Drink a glass of wine with dinner. C. Eat the large meal at lunch rather than dinner. D. Establish a regular exercise program. E. Teach the patient about the side effects of modafinil (Provigil).

A, D, E Taking short naps, no longer than 20 minutes, during the day and regular exercise are management strategies that help reduce the feeling of sleepiness. Modafinil is a stimulant used to treat narcolepsy; therefore it is important for patients to understand its side effects.

An 11-year-old child in middle school is currently experiencing sleep-related fatigue during classes. Which of the following is the most appropriate response by the school nurse when counseling the childs parents regarding this assessment? a. What are the childs usual sleep patterns? b. Establish bedtimes for the child and withhold his allowance whenever those times are not adhered to. c. We need to explore other health-related problems, as sleep problems are not likely the cause of his fatigue. d. The bulbar synchronizing region of the childs central nervous system is causing these insomniac problems.

ANS: a a. A school-age child will be tired the following day if allowed to stay up later than usual. The nurse should ask a question to assess the childs usual sleep patterns. b. The nurse should first assess the childs usual sleep pattern. This response is not appropriate because the nurse is assuming the child is not adhering to a bedtime. c. The nurse should first assess the childs usual sleep pattern. A sleep problem is often the cause of fatigue. d. The nurse is assuming the child is experiencing insomnia. The nurse should first determine the childs sleep pattern.

For a client who is currently taking a diuretic, the nurse should inform the client that he or she may experience: a. Nocturia b. Nightmares c. Increased daytime sleepiness d. Reduced REM sleep

ANS: a a. For the client who is currently taking a diuretic, the nurse should inform the client that he or she might experience nighttime awakening because of nocturia. b. Diuretic use does not cause nightmares. c. Diuretics do not cause increased daytime sleepiness. d. Diuretics do not reduce REM sleep.

In teaching methods to promote positive sleep habits at home, the nurse instructs the client to: a. Use the bedroom only for sleep or sexual activity b. Eat a large meal 1 to 2 hours before bedtime c. Exercise vigorously before bedtime d. Stay in bed if sleep does not come after 1/2 hour

ANS: a a. The nurse should explain that if possible, the bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity, besides sex. b. The nurse should instruct the client to avoid heavy meals for 3 hours before bedtime; a light snack may help. c. The nurse should instruct the client to try to exercise daily, preferably in morning or afternoon, and to avoid vigorous exercise in the evening within 2 hours of bedtime. d. The nurse should advise the client to get out of bed and do some quiet activity until feeling sleepy enough to go back to bed if the client does not fall asleep within 30 minutes of going to bed.

A 74-year-old client has been having sleeping difficulties. To have a better idea of the clients problem the nurse should respond: a. What do you do just prior to going to bed? b. Lets make sure that your bedroom is completely darkened at night. c. Why dont you try napping more during the daytime? d. You should always eat something just before bedtime.

ANS: a a. To assess the clients sleeping problem, the nurse should inquire about predisposing factors, such as by asking, What do you do just before going to bed? Assessment is aimed at understanding the characteristics of any sleep problem and the clients usual sleep habits so that ways for promoting sleep can be incorporated into nursing care. b. Older adults sleep best in softly lit rooms. c. Napping more during the daytime is often not the best solution. The nurse should first assess the clients sleeping problem. d. The client does not always have to eat something before going to bed. The nurse should first assess the clients sleeping problem. It may not be difficulty falling asleep.

The nurse is discussing sleep habits with the client in the sleep-assessment clinic. Of the following activities performed before sleeping, the nurse is alert to the one that may be interfering with the clients sleep, which is: a. Listening to classical music b. Finishing office work c. Reading novels d. Drinking warm milk

ANS: b b. At home a client should not try to finish office work or resolve family problems before bedtime. a. Noise should be kept to a minimum. Soft music may be used to mask noise if necessary. c. Reading a light novel, watching an enjoyable television program, or listening to music helps a person to relax. Relaxation exercises can be useful at bedtime. d. A dairy-product snack such as warm milk or cocoa that contains L-tryptophan may be helpful in promoting sleep.

When a client is deprived of sleep, the nurse might assess such symptoms as: a. Elevated blood pressure and confusion b. Confusion and irritability c. Inappropriateness and rapid respirations d. Decreased temperature and talkativeness

ANS: b b. Psychological symptoms of sleep deprivation include confusion and irritability. a. Elevated blood pressure is not a symptom of sleep deprivation. c. Rapid respirations are not a symptom of sleep deprivation. A decreased ability of reasoning and judgment could lead to inappropriateness. d. Decreased temperature is not a symptom of sleep deprivation. The client with sleep deprivation is often withdrawn, not talkative.

As a result of recent studies regarding infant safety during sleep, the nurse instructs the parents to: a. Provide a stuffed toy for comfort b. Cover the infant loosely with a blanket c. Place the infant on its back d. Use small pillows in the crib

ANS: c c. Infants are usually placed on their backs to prevent suffocation or on their sides to prevent aspiration of stomach contents. a. To reduce the chance of suffocation, pillows, stuffed toys, or the ends of loose blankets should not be placed in cribs. b. An infants should not be covered loosely with a blanket, because the infant might pull it over the faces and suffocate. d. To reduce the chance of suffocation, pillows should not be placed in cribs.

The parents of a newborn wonder when she should start to sleep through the night. The nurses response should be that in infants, a nighttime pattern of sleep usually develops by: a. 1 month b. 2 months c. 3 months d. 6 months

ANS: c c. Infants usually develop a nighttime pattern of sleep by age 3 months. a. This is not when infants usually develop a nighttime pattern of sleep. b. This is not when infants usually develop a nighttime pattern of sleep. d. This is not when infants usually develop a nighttime pattern of sleep.

The nurse is alert to clients who may be predisposed to obstructive sleep apnea, including those individuals with: a. Heart disease b. Respiratory infections c. Nasal polyps d. Obesity

ANS: c c. Structural abnormalities such as a deviated septum, nasal polyps, certain jaw configurations, or enlarged tonsils predispose a client to obstructive apnea. a. Individuals with mixed apnea often have signs and symptoms of right-sided heart failure. b. Respiratory infections do not predispose a client to obstructive sleep apnea. d. Clients with obstructive apnea are often middle-aged, obese men. Obesity itself does not predispose a client to obstructive sleep apnea.

The physiology of sleep is complex. Which of the following is the most appropriate statement in regard to this process? a. Ultradian rhythms occur in a cycle longer than 24 hours. b. Nonrapid eye movement (NREM) refers to the cycle that most clients experience when in a high-stimulus environment. c. The reticular activating system is partly responsible for the level of consciousness of a person. d. The bulbar synchronizing region causes the rapid eye movement (REM) sleep in most normal adults.

ANS: c c. The ascending reticular activating system (RAS) located in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness. a. Infradian rhythms, not ultradian rhythms, occur in a cycle longer than 24 hours. b. Nonrapid eye movement refers to the sleep cycle that most clients experience in a low-stimulus environment. d. The bulbar synchronizing region is the area of the brain where serotonin is released to produce sleep. It is not responsible for REM sleep.

It is determined that the client will need pharmacologic treatment to assist with his sleep patterns. The nurse anticipates that treatment with an anxiety-reducing, relaxation-promoting medication will include the use of: a. Barbiturates b. Amphetamines c. Benzodiazepines d. Tricyclic antidepressants

ANS: c c. The benzodiazepines cause relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the CNS that suppress responsiveness to stimulation, therefore decreasing levels of arousal. a. Withdrawal from CNS depressants such as barbiturates can cause insomnia and must be managed carefully. Barbiturates can cause tolerance and dependence. b. CNS stimulants, such as amphetamines, should be used sparingly and under medical management. Amphetamine sulfate may be used to treat narcolepsy. Prolonged use may cause drug dependence. d. Tricyclic antidepressants can cause insomnia when discontinued, and should be managed carefully. They are used primarily to treat depression.

Older adults at the community center are having a discussion on health issues, led by a nurse volunteer. One of the participants asks the nurse what to do about not being able to sleep well at night. The nurse informs the participants that sleep in the evening may be enhanced by: a. Drinking an alcoholic beverage before bedtime b. Using an over-the-counter sleeping agent c. Eliminating naps during the day d. Going to bed at a consistent time even if not feeling sleepy

ANS: c c. To promote sleep, daytime naps should be eliminated. If naps are used, they should be limited to 20 minutes or less twice a day. a. Alcohol should be limited in the late afternoon and evening because it has an insomnia-producing effect. b. The use of nonprescription sleeping medications is not advisable. Over the long term, these drugs can lead to further sleep disruption, even when they initially seemed to be effective. d. Following a bedtime routine should be consistent, not necessarily going to bed. The client should engage in quiet activities that promote relaxation, and then may go to bed. If the client hasnt fallen asleep in 30 minutes, the client should get up out of bed and do some quiet activity until they feel sleepy enough to go back to bed.

In describing the sleep patterns of older adults, the nurse recognizes that they: a. Are more difficult to arouse b. Require more sleep than middle-aged adults c. Take less time to fall asleep d. Have a decline in stage 4 sleep.

ANS: d d. As people age, a progressive decrease occurs in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep sleep. a. As people age, they do not become more difficult to arouse. b. The older adult does not require more sleep than the middle-aged adult. c. An older adult awakens more often during the night, and it may take more time for an older adult to fall asleep.

Which of the following information provided by the clients bed partner is most associated with sleep apnea? a. Restlessness b. Talking during sleep c. Somnambulism d. Excessive snoring

ANS: d d. Partners of clients with sleep apnea often complain that the clients snoring disturbs their sleep. a. Restlessness is not most associated with sleep apnea. b. Sleeptalking is associated with sleep-wake transition disorders, not sleep apnea. c. Somnambulism is associated with parasomnias (specifically arousal disorders and sleep-wake transition disorders).

The mother of a 2-year-old tells the nurse that the child has started crying and resisting going to sleep at the scheduled bedtime. The nurse should advise the parent to: a. Offer the child a bedtime snack b. Eliminate one of the naps during the day c. Allow the child to sleep longer in the mornings d. Maintain consistency in the same bedtime ritual

ANS: d d. The nurse should advise the parent to maintain a regular bedtime and wake-up schedule and to reinforce patterns of preparing for bedtime. A bedtime routine (e.g., same hour for bedtime, quiet activity) used consistently helps young children avoid delaying sleep. a. It is most important that the parent maintain a consistent bedtime routine. If a bedtime snack is already part of that routine, then this is allowable. If it is not, then the child may use having a snack only as a measure of procrastination. b. After age 3 years, the child may give up daytime naps. A bedtime routine used consistently will be more effective in helping the child resist going to sleep. c. The same regular bedtime and wake-up schedule should be maintained.

The nurse is completing an assessment on the clients sleep patterns. A specific question that the nurse should ask to determine the potential presence of sleep apnea is: a. How easily do you fall asleep? b. Do you have vivid, lifelike dreams? c. Do you ever experience loss of muscle control or falling? d. Do you snore loudly or experience headaches?

ANS: d d. To assess for sleep apnea, the nurse may ask, Do you snore loudly? and, Do you experience headaches after awakening? A positive response may indicate that the client experiences sleep apnea. a. This question is directed at assessing the potential presence of insomnia. b. This question is directed at determining the potential presence of narcolepsy. c. This question is directed at determining the potential presence of narcolepsy.

A nurse instructor is instructing her students on the role of hormones in sleep patterns. Which statement would indicate to the nursing instructor that the student needs additional teaching? A) A hyperactive thyroid can make the patient sleepy all the time. B) Women often experience fatigue due to loss of estrogen. C) Estrogen has been shown to decrease sleep latency. D) Hypothyroidism may contribute to a lack of slow-wave sleep.

Ans: A Feedback: Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow-wave sleep.

The student nurse is providing an education program for preschool parents. The nursing student should include which of the following interventions to improve the childs sleep? A) Have the child limit fluids after supper B) The child should drink milk at bedtime C) The parents should keep the child up until 10 PM D) The child should sleep with the parents

Ans: A Feedback: Parents and other caregivers can assist children in establishing the habit of voiding as part of preparing for bedtime. Drinking milk at bedtime, keeping the child up until 10 PM and sleeping with the parents will not improve the childs sleep.

Which of the following problems is associated with obesity, heavy snoring, and shallow breathing? A) Sleep apnea B) Narcolepsy C) Hypersomnia D) Hyperpnea

Ans: A Feedback: Sleep apnea refers to recurrent periods of absence of breathing for 10 seconds or longer, occurring at least five times per hour.

A student nurse is preparing a presentation on sleep hygiene practices. What information should the nurse include? Select all that apply. A) Eliminate caffeine intake 6 hours prior to bedtime. B) Do not watch television in bed. C) Use blackout or other types of curtains/blinds to keep the room as dark as possible. D) Take a warm bath prior to bedtime. E) Do 15 to 30 minutes of exercise prior to bedtime.

Ans: A, B, C Feedback: Caffeine is a stimulant and can interfere with sleeping. Establishing a routine of only sleeping, not reading or watching television, in bed and keeping the room as dark as possible may help decrease insomnia. Taking a warm bath or doing exercise prior to bedtime may increase the time it takes to fall asleep. These activities should be done at least 1 to 2 hours prior to bedtime.

A patient has voiced concerns about her inability to fall asleep. When reviewing her history, what information would the nurse expect to find? Select all that apply. A) Smokes 1 pack of cigarettes daily B) Drinks coffee with all meals C) History of hyperthyroidism D) Exercises 30 to 60 minutes daily E) Works 30 hours per week

Ans: A, B, C Feedback: Insomnia is associated with the consumption of stimulants (e.g., caffeine, nicotine, methamphetamine, and other drugs of abuse). Insomnia is also a side effect of hyperthyroidism . Exercising 30 to 60 minutes daily can help a patient fall asleep faster.

A school nurse is speaking to a group of parents regarding the sleep needs of adolescents. Which statement by a parent indicates a need for further education? A) Adolescents naturally develop an owl like sleep pattern in which they go to bed later and sleep later in the morning. B) Academic performance in adolescents is good when they sleep about 7 hours per night. C) Adolescents catch up on sleep on the weekends, when they typically sleep later. D) Adolescent girls are more likely to develop insomnia than boys.

Ans: B Feedback: Adolescents need about 9 hours of sleep per night. Academic performance is negatively impacted when adolescents get less sleep. Due to irregular sleep patterns, adolescents typically sleep later on weekends in an attempt to catch up on sleep. Adolescent sleep patterns change to a more owl-like pattern in which they rise later and go to sleep later. Adolescent girls have a higher risk of developing insomnia than adolescent boys.

When a nurse notes that the patient appears to be sleeping, is demonstrating irregular respirations, and is showing eye movement, the nurse identifies the stage of sleep the patient is experiencing as A) Transitional B) Rapid eye movement (REM) C) Light sleep D) Slow wave

Ans: B Feedback: In REM sleep, respirations are irregular and oxygen consumption increases.

When a patient tells the clinic nurse that he has irresistible sleep attacks throughout the day lasting from 10 to 15 minutes, the nurse suspects that the patient may be experiencing A) Cataplexy B) Narcolepsy C) Insomnia D) Prolonged latency

Ans: B Feedback: Narcolepsy is a disorder of excessive daytime sleepiness characterized by short, almost irresistible daytime sleep attacks, usually lasting 10 to 15 minutes, and abnormal manifestations of REM sleep.

The nurse is preparing a care plan for a patient with insomnia. Which of the following would be an appropriate outcome criteria for the goal that the patient will report fewer problems falling asleep. A) The patient will fall asleep faster. B) The patient will report a decrease in sleep latency to 10 to 15 minutes within 30 days. C) The nurse will administer the patients hypnotic at bedtime each night. D) The nurse will give the patient a backrub at bedtime each night.

Ans: B Feedback: Outcome criteria for the goal should be patient focused, measurable and with a specific time frame.

A student nurse is preparing a presentation regarding hypnotic medications. What information should the student nurse include? Select all that apply. A) Hypnotics induce a normal sleep pattern. B) Hypnotics may impair waking in a patient. C) Hypnotics are safe for long-term use. D) Hypnotics may be addictive. E) Tapering of doses may be required after long-term use.

Ans: B, D, E Feedback: Hypnotics do not induce a normal sleep pattern and are not indicated for long-term use. Hypnotics may impair waking functions, which can cause daytime sleepiness. Due to the potentially addictive qualities of hypnotics, tapering of doses may be required after long-term use.

The nurse is preparing a care plan for a patient recently diagnosed with obstructive sleep apnea. The patient complains of daytime sleepiness, fatigue and excessive snoring that wakes me up. What nursing diagnosis would be appropriate for this patient? A) Disturbed Sleep Pattern as evidenced by complaints of daytime sleepiness B) Disturbed Sleep Pattern related to obstructive sleep apnea as evidenced by excessive snoring C) Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring D) Disturbed Sleep Pattern related to obstructive sleep apnea

Ans: C Feedback: Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring is the correct nursing diagnosis. The medical diagnosis of obstructive sleep apnea should not be used in the nursing diagnosis.

Which of the following drugs normalizes sleep cycles by enabling the bodys supply of melatonin to naturally promote sleep? A) flurazepam (Dalmane) B) temazepam (Restoril) C) eszopiclone (Lunesta) D) ramelton (Rozerem)

D

A nursing instructor is speaking to a group of students regarding the effects of shift work on sleep patterns. Which pattern of work shifts has been shown to enhance work production? A) Working multiple night shifts in a row B) Working one week of day shifts then one week of night shifts C) Clockwise rotation of shifts D) Rotating between day and night shifts each week.

Ans: C Feedback: Research has shown that clockwise rotation of shifts is preferable and that short naps during breaks enhance work performance. Recent studies have shown a negative relation between the number of consecutive night shifts worked and urinary levels of melatonin metabolites.

When the newly admitted patient with chronic obstructive pulmonary disease informs the nurse that she frequently awakens during the night, the nurse may notify the physician for which of the following interventions? A) A hypnotic medication B) A narcotic medication C) Low-flow oxygen D) Warm milk

Ans: C Feedback: The pattern of frequent arousals seen in people with chronic obstructive lung disease may result from the bodys adaptation to maintain adequate oxygenation. Usually, these patients require low doses of oxygen at night.

While instructing young adults about the need for adequate sleep, the nurse instructs the group that to improve sleep quality, individuals should A) Take an afternoon nap whenever possible B) Catch up on sleep on days off from work C) Stay awake until midnight consistently D) Have a consistent time for arising

Ans: D Feedback: A regular time of rising is one of the most effective means of improving sleep quality and synchronizing circadian rhythms with clock time.

Which of the following individuals is likely to require more hours of sleep? A) a 75 year old B) a 43 year old C) a 25 year old D) a 15 year old

D

Which of the following medications is least likely to affect sleep quality? A) diuretic B) steroid C) antidepressant D) Ambien

D

A middle-aged adult man has just started an exercise program. What would the nurse teach him about timing of exercise and sleep? A) exercise immediately before bedtime enhances ability to sleep B) exercise within 2 hours of bedtime can hinder ability to sleep C) the time of day does not matter; exercise facilitates sleep D) the fatigue from exercise may be a hindrance to sleep

B

The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? A. Have patient follow hospital routines. B. Avoid waking patient for nonessential tasks. C. Give prescribed sleeping medications at dinner. D. Turn television on low to late-night programming.

B Avoiding awakening patient for nonessential tasks promoted sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as laboratory draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits. The other tasks do not promote sleep.

In Stage 4 sleep, the A) Blood pressure is elevated B) Pulse rate is slow C) Respirations are irregular D) Temperature increases

B Feedback: 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 decreases.

Which of the following activities would be appropriate to suggest to the patient who states that she has difficulty falling asleep every evening? A) Take a warm shower before bedtime B) Drink a glass of milk with a turkey sandwich C) Exercise vigorously for 30 minutes before sleep D) Clean the bedroom prior to falling asleep

B Feedback: Hunger disturbs sleep of some people, whereas others have difficulty sleeping after large meals. Ingestion of L-tryptophan, a precursor of serotonin found in foods such as milk, beef, eggs, wheat flour, turkey, and corn, has been found to decrease sleep latency and increase stage 4 sleep. The bodys temperature drops during sleep; therefore taking a warm shower prior to bedtime may increase the time it takes to fall asleep.

The parents of a newborn ask when they can expect the baby to sleep through the night. The nurse responds that the baby will most likely sleep through the night by A) 6 weeks of age B) 3 months of age C) 6 months of age D) 1 year of age

B Feedback: Most infants sleep through the night by 3 months of age, but nocturnal awakenings continue to be frequent during the latter half of the first year.

When a newly admitted patient informs the nurse that he averages 6 hours of sleep per night, the nurse determines that this patient is most likely A) In need of sleeping pills B) Sleep deprived C) Getting efficient sleep D) In need of a sleep clinic visit

B Feedback: Optimum daytime performance with minimal sleepiness and no accumulation of sleep debt in adults is related to obtaining 8 hours of sleep each night. Sleeping less than 6 hours and more than 9 hours per night has been linked to an increase in morbidity and early mortality.

A patient begins snoring and is sleeping lightly. The stage of sleep is A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

B Feedback: Stage 2 is relatively light sleep from which the patient is easily awakened. Rolling eye movements continue, and snoring may occur.

During the first cycle of sleep, the patient will be in REM sleep for A) 1 hour B) 3 minutes C) 15 minutes D) 6 minutes

B Feedback: The time spent in REM sleep in the first cycle may only be 3 to 4 minutes.

A 72-year-old patient asks the nurse about using an over-the-counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse's best response? A. "Antihistamines are better than prescription medications because these can cause a lot of problems." B. "Antihistamines should not be used because they can cause confusion and increase your risk of falls." C. "Antihistamines are effective sleep aids because they do not have many side effects." D. "Over-the-counter medications when combined with sleep-hygiene measures are a good plan for sleep."

B Older adults should avoid the use of over-the-counter antihistamines. These medications have a long duration of action in older adults and can cause confusion, constipation, urinary retention, and increased risk of falls.

Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices? A. "I'll give the baby a bottle to help her fall asleep." B. "We'll place the baby on her back to sleep." C. "We put the baby's stuffed animals in the crib to make her feel safe." D. "I know the baby will not need to be fed until morning."

B This is based on the current evidence that shows that parents need to place an infant on his or her back to prevent suffocation. Bottles, stuffed animals, and pillows should not be placed in the bed with an infant.

The nurse is providing health teaching for a patient using herbal compounds such as kava for sleep. Which points need to be included? Select all that apply. A. Can cause urinary retention B. Should not be used indefinitely C. May have toxic effects on the liver D. May cause diarrhea and anxiety E. Are not regulated by the U.S. Food and Drug Administration (FDA)

B, C, E Herbal products help promote sleep. These products need to be used cautiously because they are not regulated by the U.S. Food and Drug Administration. They should not be used long term and can interact with prescribed medications. Kava needs to be used cautiously because it can be toxic to the liver.

The nurse is developing a plan of care for a patient experiencing obstructive sleep apnea (OSA). Which intervention is appropriate to include on the plan? A. Instruct the patient to sleep in a supine position. B. Have patient limit fluid intake 2 hours before bedtime. C. Elevate the head of the bed to sleep. D. Encourage patient to take an over-the-counter sleep aid.

C Lifestyle changes and modifications of sleep habits should be included on a plan of care for a patient with OSA. Individuals should sleep with the head of the bed elevated and use a side or prone position. Other modifications include good sleep-hygiene practices, alcohol modification, smoking cessation, and weight reduction.

The nurse is contacting the health care provider about a patient's sleep problem. What is the correct order for the steps for SBAR? 1. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep. 2. "Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I'm calling because Mrs. Dodd is having difficulty sleeping." 3. "I'm calling to ask if you would order a hypnotic such as zolpidem (Ambien) to use on a prn basis." 4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can't fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1° C (98.8° F). A. 2, 1, 3, 4 B. 1, 2, 3, 4 C. 2, 1, 4, 3 D. 1, 2, 4, 3

C SBAR is Situation, Background, Assessment, and Recommendation. This is the correct sequence of steps in SBAR for the patient and sleep problem.

The patient reports episodes of sleepwalking to the nurse. Through understanding of the sleep cycle, the nurse recognizes that sleepwalking occurs during which sleep phase? A. Rapid eye movement (REM) sleep B. Stage 1 non rapid eye movement (NREM) sleep C. Stage 4 NREM sleep D. Transition period from NREM to REM sleep

C Stage 4 NREM sleep is the deepest stage of sleep. It is difficult to rouse the sleeper in this stage. During this stage sleepwalking and enuresis (bed-wetting) sometimes occur.

Which statement made by an older adult best demonstrates understanding of taking a sleep medication? A. "I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear." B. "Sleep medicines won't cause any sleep problems once I stop taking them." C. "I'll talk to my health care provider before I use an over-the-counter sleep medication." D. "I'll contact my health care provider if I feel extremely sleepy in the mornings."

C The statement, "I'll talk to my health care provider before I use an over-the-counter sleep medication" shows an understanding of the risks of over-the-counter sleep medications. The use of nonprescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption even when they initially seemed effective. Caution older adults about using over-the-counter antihistamines because of their long duration of action that can cause confusion, constipation, urinary retention, and increased risk of falls.

The nurse is administering a benzodiazepine sleep aid to an older adult. What should be the priority assessment for the patient? A. Incontinence B. Nausea and vomiting C. Bradycardia D. Respiratory depression

D Benzodiazepines in older adults should be used on a short-term, limited basis. Respiratory depression is an adverse effect of benzodiazepines in older adults. Other adverse effects for which to assess include next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination.

What factor has been hypothesized by researchers regarding current thoughts on sleep? A) The current population requires less sleep B) More sleep is obtained through napping C) Population is healthier due to sleep D) Chronic sleep deprivation is present

D Feedback: Most recently, researchers have hypothesized that much of the population in industrialized nations may be chronically sleep deprived.

The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborns sleep patterns. Newborns A) Have shorter periods of REM sleep B) Are inactive when awake C) Will nap two times per day D) Sleep 16 to 17 hours per day

D Feedback: Newborns sleep an average of 16 to 17 hours per 24 hours a day, divided into about seven sleep periods distributed fairly evenly throughout the day and night.

A patient states to the nurse during a sleep assessment that it takes her more than 30 minutes to fall asleep. The patient states it increases her anxiety. This is considered A) Sleeplessness B) Sleep anxiety C) Sleep disturbance D) Sleep latency

D Feedback: The range of normality with respect to sleep patterns is also broad. Most people require 10 to 30 minutes to fall asleep; this period is called sleep latency.

A nurse working the night shift understands the importance of enhancing the sleep patterns of his patients. In order to do so, he should A) Only wake them for the 12:00 AM and 4:00 AM vital signs B) Allow the patient time to sit at the desk to enhance better rest C) Evaluate the sleep response of the patient with a polysomnogram D) Cluster activities to allow 90 to 120 minutes of sleep

D Feedback: When possible, the nurse should cluster activities at night to provide periods of 90 to 120 minutes of uninterrupted sleep.

Which statement made by the patient indicates a need for further teaching on sleep hygiene? A. "I'm going to do my exercises before I eat dinner." B. "I'm going to go to bed every night at about the same time." C. "I set my alarm to get up at the same time every morning." D. "I moved my computer to the bedroom so I could work before I go to sleep."

D This statement requires further teaching. Good sleep-hygiene practices state that the bedroom should only be used for sleeping. Work and study should not be done in the bedroom.

Which of the following symptoms should the nurse assess with a client who is deprived of sleep? 1. Elevated blood pressure and confusion 2. Confusion and irritability 3. Inappropriateness and rapid respirations 4. Decreased temperature and talkativeness

2 Psychological symptoms of sleep deprivation include confusion and irritability. Elevated blood pressure is not a symptom of sleep deprivation. Rapid respirations are not a symptom of sleep deprivation. There may be a decreased ability of reasoning and judgment that could lead to inappropriateness. Decreased temperature is not a symptom of sleep deprivation. The client with sleep deprivation is often withdrawn, not talkative.

A client is discussing his recent restlessness and increased irritability. Which of the following assessment questions is likely to be most helping in determining the cause of these complaints? 1. When did you start noticing these changes? 2. Has anything caused you to change your usual routine lately? 3. Do you have any idea what might be causing these problems? 4. What makes you think that you are more irritable than is normal for you?

2 When the sleep-wake cycle becomes disrupted (e.g., by working rotating shifts), other physiological functions usually change as well. For example, the person experiences a decreased appetite and loses weight. Anxiety, restlessness, irritability, and impaired judgment are other common symptoms of sleep cycle disturbances. Failure to maintain the individuals usual sleep-wake cycle negatively influences the clients overall health. Although the other options are not inappropriate, they are not as directly aimed at determining the cause of the changes.

Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing which of the following chemicals? A) neonephrine B) seratonin C) melatonin D) dopamine

C

A client hospitalized for a myocardial infarction in a cardiac critical care unit (CCU) is most likely to experience sleep deprivation as a result of: 1. A drug-disrupted circadian sleep pattern 2. Generally diminished cardiac output 3. Unfamiliar environmental stimuli 4. Increased emotional stressors

3 Hospitalization, especially in intensive care units, makes clients particularly vulnerable to the extrinsic and circadian sleep disorders that cause the ICU syndrome of sleep deprivation. Constant environmental stimuli within the intensive care unit (ICU), such as strange noises from equipment, the frequent monitoring and care given by nurses, and ever-present lights, confuse clients and lead to sleep deprivation. Although the other options may be contributing factors, they are not as directly responsible.

The physiology of sleep is complex. Which of the following is the most appropriate statement in regard to this process? 1. Ultradian rhythms occur in a cycle longer than 24 hours. 2. Nonrapid eye movement (NREM) refers to the cycle that most clients experience when in a high-stimulus environment. 3. The reticular activating system is partly responsible for the level of consciousness of a person. 4. The bulbar synchronizing region (BSR) causes the rapid eye movement (REM) sleep in most normal adults.

3 The ascending reticular activating system (RAS) located in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness. Infradian rhythms, not ultradian rhythms, occur in a cycle longer than 24 hours. Nonrapid eye movement refers to the sleep cycle that most clients experience in a low-stimulus environment. The bulbar synchronizing region is the area of the brain where serotonin is released to produce sleep. It is not responsible for REM sleep.

Which of the following may improve the sleep of an older adult client? 1. Drinking an alcoholic beverage before bedtime 2. Using an over-the-counter sleeping agent 3. Eliminating naps during the day 4. Going to bed at a consistent time even if not feeling sleepy

3 To promote sleep, daytime naps should be eliminated. If naps are used, they should be limited to 20 minutes or less twice a day. Alcohol should be limited in the late afternoon and evening because it has an insomnia-producing effect. The use of nonprescription sleeping medications is not advisable. Over the long term, these drugs can lead to further sleep disruption even when they initially seemed to be effective. Following a bedtime routine should be consistent, not necessarily going to bed. The client should engage in quiet activities that promote relaxation and then may go to bed. If the client has not fallen asleep in 30 minutes, the client should get up out of bed and do some quiet activity until feeling sleepy enough to go back to bed.

The nurse recognizes that the sleep patterns of older adults differ and older adults generally: 1. Are more difficult to arouse 2. Require more sleep than middle-age adults 3. Take less time to fall asleep 4. Have a decline in stage 4 sleep

4 As people age, there is a progressive decrease in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep, sleep. Older people do not become more difficult to arouse, not do they require more sleep than the middle-age adult. An older adult awakens more often during the night, and it may take more time for an older adult to fall asleep.

A client shares with the nurse that My wife complains about my snoring, and I never really feel rested. Which of the following responses best attempts to explain the cause of the problem to the client? 1. Sleep disturbances can really affect all aspects of your life. How long have you been experiencing this problem? 2. You need to get help to breathe more effortlessly at night so both you and your wife can get sufficient deep stage sleep. 3. Something is interfering with your ability to breathe while you are asleep. Have you talked with your health care provider about the problem? 4. Your upper airway is blocked, and that is making it difficult for you to breathe effectively, so you are spending most of the night in the light sleep stage.

4 The upper airway becomes partially or completely blocked, and diminished nasal airflow (hypopnea) can result for as long as 30 seconds. The person attempts to breathe, which often results in loud snoring and snorting sounds. The effort to breathe during sleep results in arousals from deep sleep, often to the stage 2 cycle, causing interference with deep sleep and thus the clients not feeling rested. The remaining options are not inappropriate, but they are not as directed at explaining the problem to the client.

What name is given to the rhythmic biologic clock that exists in humans? A) sleep-wake cycle B) alert-unaware process C) circadian rhythm D) yo-yo theory

C

Which of the following is the most common sleep disorder? A) hypersomnia B) parasomnia C) insomnia D) dyssomnia

C

A nurse teaches a young couple to put their newborn on his back to sleep. What is the rationale for this information? A) prone position increases the risk for sudden infant death syndrome B) prone position decreases the risk for sudden infant death syndrome C) supine position may alter the size and shape of the infants head D) supine position makes changing diapers and feeding difficult

A

A nurse working the night shift assesses a patients vital signs at 4 a.m. (0340). What would be the expected findings, based on knowledge of NREM sleep? A) decreased TPR and BP B) increased TPR and BP C) no change from daytime readings D) highly individualized, cannot predict

A

A patient who has a sleep disorder is trying stimulus control to improve amount and quality of sleep. What is recommended in this type of therapy? A) use the bedroom for sleep and sex only B) use the bedroom for reading and eating C) go to bed at the same time every night D) sleep alone with minimal coverings

A

A 63-year-old client is discussing the recent problem the client is experiencing with falling asleep. The nurse is discussing strategies to minimize this problem. Which of the following bedtime snacks would be the most likely to induce sleep? 1. One slice of cheese on four wheat crackers and a glass of skim milk 2. Two cups of air-popped popcorn and a glass of fruit juice 3. Two fig cookies and a cup of decaffeinated tea 4. One small pear and a glass of soymilk

ANS: 1 One substance that promotes sleep in many people is L-tryptophan, a natural protein found in foods such as milk, cheese, and meats.

The assistive nursing personnel reports that the heart rate of the sleeping 23-year-old athlete, who is hospitalized following complications of a tonsillectomy, is 56. The assistive nursing personnel states that this is 10 beats per minute slower than when she took it earlier in the evening. The nurse knows that this is considered: 1. Normal, and they will continue to monitor the vital signs as ordered 2. Abnormally slow, and the health care provider should be notified immediately 3. Abnormally slow, and the nurse will recheck the heart rate before taking any action 4. Abnormally slow, signaling that the client may be hemorrhaging

ANS: 1 A healthy adults normal heart rate throughout the day averages 70 to 80 beats per minute or less if the individual is in excellent physical condition. However, during sleep the heart rate falls to 60 beats per minute or less. This means that the heart beats 10 to 20 fewer times in each minute during sleep or 60 to 120 fewer times in each hour. If the client were hemorrhaging, the heart rate would initially be tachycardic as the body attempts to compensate for the lost blood volume.

An 11-year-old boy in middle school is currently experiencing sleep-related fatigue during classes. Which of the following is the most appropriate response by the school nurse when counseling the childs parents regarding this assessment? 1. What are the childs usual sleep patterns? 2. Establish bedtimes for the child, and withhold his allowance whenever those times are not adhered to. 3. We need to explore other health-related problems, because sleep problems are not likely the cause of his fatigue. 4. The bulbar synchronizing region of the childs central nervous system is causing these insomniac problems.

ANS: 1 A school-age child will be tired the following day if allowed to stay up later than usual. The nurse should ask a question to assess the childs usual sleep patterns. The nurse should first assess the childs usual sleep pattern to determine if the child is adhering to a bedtime. A sleep problem is often the cause of fatigue.

A 44-year-old female client shares with the nurse that she is having difficulty falling asleep at night, even though she is exhausted. The nurse knows that which of the following could be causing the sleeplessness? 1. Two cups of hot cocoa every evening 2. Vegetarian diet 3. Afternoon exercise program 4. Hot bath in the evening

ANS: 1 Caffeine is a stimulant and can cause difficulty in falling asleep. There is about 30 mg of caffeine in two cups of hot cocoa.

Teaching for a client who is currently taking a diuretic should include information that he or she may experience: 1. Nocturia 2. Nightmares 3. Increased daytime sleepiness 4. Reduced REM sleep

ANS: 1 For the client who is currently taking a diuretic, the nurse should inform the client that he or she might experience nighttime awakening caused by nocturia. Diuretic use does not cause nightmares or daytime sleepiness or reduce REM sleep.

Which of the following clients is most likely to experience difficulty returning to sleep? 1. A 60-year-old with benign hypertropic prostatic disease 2.A 15-year-old with type 1 diabetes 3. A 35-year-old diagnosed with hypothyroidism 4. A 55-year-old diagnosed with hypertension

ANS: 1 Nocturia, or urination during the night, disrupts sleep and the sleep cycle. This condition is most common in older people with reduced bladder tone or persons with cardiac disease, diabetes, urethritis, or prostatic disease. After a person awakens repeatedly to urinate, returning to sleep is difficult. Although all the clients may have difficulty falling back to sleep when awakened, the answer represents the client with the greatest tendency to be awakened during the night.

The night nurse goes quietly into the sleeping clients room to assess him. The client wakes up as soon as the nurse is in the room. The nurse knows that the client was most likely in which stage of sleep? 1. Stage 1: NREM 2. Stage 2: NREM 3. Stage 3: NREM 4. Stage 4: NREM

ANS: 1 Stage 1 NREM includes the lightest level of sleep. Sensory stimuli such as noise easily arouses the person. The stage lasts a few minutes. Decreased physiological activity begins with gradual fall in vital signs and metabolism. Awakened, person feels as though daydreaming has occurred. Stage 2 NREM is a period of sound sleep. Stage 3 NREM involves initial stages of deep sleep. Stage 4 NREM is the deepest stage of sleep. It is very difficult to arouse the sleeper.

The nurse should instruct the client to do which of the following to promote good sleep hygiene at home? 1. Use the bedroom only for sleep or sexual activity. 2. Eat a large meal 1 to 2 hours before bedtime. 3. Exercise vigorously before bedtime. 4. Stay in bed if sleep does not come after hour.

ANS: 1 The nurse should explain that, if possible, the bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity, besides sex. The nurse should instruct the client to avoid heavy meals for 3 hours before bedtime; a light snack may help. The nurse should also instruct the client to try to exercise daily, preferably in morning or afternoon, and to avoid vigorous exercise in the evening within 2 hours of bedtime. Getting out of bed and doing some quiet activity until feeling sleepy enough to go back to bed if the client does not fall asleep within 30 minutes of going to bed may also help.

A 22-year-old male client shares with the nurse that he is always tired. In assessing the clients sleep pattern to determine the quantity of sleep the client is getting, the nurse should ask: 1. On a scale from 0 to 10, how much sleep to you think you get each night? 2. What time do you usually go to bed? 3. What time do you usually get up? 4. Do you have a bedtime ritual?

ANS: 1 This question helps quantify the length of sleep that the client receives. A brief subjective method to assess sleep is a numeric scale with a 0 to 10 sleep rating. Ask individuals to separately rate their quantity and quality of sleep on the scale. Instruct clients to indicate with a number between 0 and 10 their sleep quantity then their quality of sleep with 0 being the worst sleep and 10 being the best sleep

A 74-year-old client has been having sleeping difficulties. To have a better idea of the clients problem, the nurse should respond: 1. What do you do just before going to bed? 2. Lets make sure that your bedroom is completely darkened at night. 3. Why dont you try napping more during the daytime? 4. Do you eat a small snack before going to bed?

ANS: 1 To assess the clients sleeping problem, the nurse should inquire about predisposing factors, such as by asking What do you do just before going to bed? Assessment is aimed at understanding the characteristics of any sleep problem and the clients usual sleep habits so that ways for promoting sleep can be incorporated into nursing care. Older adults sleep best in softly lit rooms. Napping more during the daytime is often not the best solution. The nurse should first assess the clients sleeping problem. The client does not always have to eat something before going to bed.

An older adult client diagnosed as being in the early stage of Alzheimers disease shares with the nurse that her sleep is interrupted by the noises I hear all through the night. The nurse explains that the most likely reason for this problem is: 1. The clients age 2. A lack of presleep relaxation 3. The amount of noise entering into the clients environment 4. A manifestation of the disease process causing the brain disorder

ANS: 1 With aging, sleep becomes more fragmented, and a person spends more time in lighter stages that are easily disturbed by noise. The remaining options may be a factor but not to the degree of normal aging.

Although the most common effect of obstructive sleep apnea is a disrupted sleep pattern, the condition can cause a serious decline in arterial oxygen levels that may result in: (Select all that apply.) 1. Hypertension 2. Angina attacks 3. Alzheimers disease 4. Cardiac dysrhythmias 5. Cerebral vascular accidents 6. Type 2 diabetes

ANS: 1, 2, 4, 5 Obstructive apnea causes a serious decline in arterial oxygen saturation level. Clients are at risk for cardiac dysrhythmias, right-sided heart failure, pulmonary hypertension, angina attacks, stroke, and hypertension. The other options are not directly related to a diminished supply of arterial oxygen.

Which of the following client statements made by young adults suggest a risk factor for sleep disturbance problems? (Select all that apply.) 1. I have a job that requires my attention 110% of the time. 2. I really enjoy fishing; I wish we lived closer to a river or pond. 3. My wife just found out she is pregnant for the third time in 5 years. 4. My father recently suffered a heart attack, and Mom is so very worried about him. 5. The kids are so active in after-school things that we never have an evening at home. 6. Gardening always gave me such a sense of accomplishment, but I dont have much free time now.

ANS: 1, 3, 4, 5 It is common for the stresses of jobs, family relationships, and social activities to lead frequently to insomnia and the use of medication for sleep. The remaining options reflect a sense of loss but not necessarily of stress.

The nurse and a client are discussing possible behaviors that might be interfering with the clients ability to fall asleep. Which of the following assessment questions is most likely to identify possible problems with the clients sleep routine that possibly are contributing to the difficulty? 1. When do you usually retire for the night? 2. What do you do to help yourself fall asleep? 3. How much time does it usually take for you to fall asleep? 4. Have you changed anything about your presleep ritual lately?

ANS: 2 As people try to fall asleep, they close their eyes and assume relaxed positions. Stimuli to the RAS decline. If the room is dark and quiet, activation of the RAS further declines. At some point the BSR takes over, causing sleep. If the client engages in activities such as reading or watching television as a means of falling asleep, this could be causing the problem. Although the other questions are not inappropriate, they are not as directed toward the cause of the problem.

The nurse knows that which of the following habits may interfere with a clients sleep? 1. Listening to classical music 2. Finishing office work 3. Reading novels 4. Drinking warm milk

ANS: 2 At home a client should not try to finish office work or resolve family problems before bedtime. Noise should be kept to a minimum. Soft music may be used to mask noise if necessary. Reading a light novel, watching an enjoyable television program, or listening to music helps a person to relax. Relaxation exercises can be useful at bedtime. A dairy product snack such as warm milk or cocoa that contains L-tryptophan may be helpful in promoting sleep.

The nurse is caring for a 35-year-old father of three young children who has experienced a compound fractured femur as a result of a work-related incident. He has expressed great concern over both his physical recovery and his long-term ability to work again. This has affected both his emotional status and his sleeping patterns. The nurses most immediate concern is that: 1. The client needs medication to prevent depression 2. The lack of appropriate rest will affect his healing process 3. An occupational therapy consult should be ordered to help him regain his ability to return to his job 4. A psychiatric consult should be ordered to help the client deal with his various emotional concerns

ANS: 2 You must always be aware of the clients need for rest. A lack of rest for long periods causes illness or worsening of existing illness. Although the other options are appropriate concerns, they are not as immediate in nature as is the sleep problem.

The nurse and a client are discussing the importance of an effective 24-hour sleep cycle. Which of the following responses by the client may be a direct result of an inadequate sleep pattern? (Select all that apply.) 1. Gaining weight 2. Usually feeling cold 3. Always feeling tired 4. A heart that beats really fast 5. Often feeling blue or depressed 6. Feeling dizzy when getting up from a chair

ANS: 2, 3, 4, 5, 6 The predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood depend on the maintenance of the 24-hour circadian cycle. Weight gain is not typically a result of poor sleep patterns.

On a 2-week follow-up visit to the health care provider, a 64-year-old female postoperative client shares with the nurse that she is having difficulty sleeping and has never had a history of sleeping problems. The nurse shares with the client that: 1. Because of her age, the client should expect to begin having some problems sleeping 2. It may take a while to get used to sleeping in her bed at home after getting used to sleeping on a hospital bed 3. The medications used for anesthesia can disturb sleep cycles for several weeks following surgery 4. She may not be sleeping as well with her partner after being in a bed by herself while being hospitalized

ANS: 3 If the client has recently had surgery, expect the client to experience some disturbance in sleep. Clients usually awaken frequently during the first night after surgery and receive little deep or REM sleep. Depending on the type of surgery, it takes several days to months for a normal sleep cycle to return.

New research indicates that to increase safety the nurse should instruct parents to do which of the following? 1. Provide a stuffed toy for comfort. 2. Cover the infant loosely with a blanket. 3. Place the infant on his or her back. 4. Use small pillows in the crib.

ANS: 3 Infants are usually placed on their backs to prevent suffocation or on their sides to prevent aspiration of stomach contents. To reduce the chance of suffocation, pillows, stuffed toys, or the ends of loose blankets should not be placed in cribs. Infants should not be covered loosely with a blanket because infants might pull them over their faces and suffocate. To reduce the chance of suffocation, pillows should not be placed in cribs.

A new mother is concerned that her 2-week-old daughter is not sleeping through the night. The nurse should respond that infants usually develop a nighttime pattern of sleep by: 1. 1 month 2. 2 months 3. 3 months 4. 6 months

ANS: 3 Infants usually develop a nighttime pattern of sleep by 3 months of age.

A female client describes the most elaborate dreams to the nurse. She states that she could see colors, hear music, and even had the sensation of flying. The nurse replies to the client that her dreams indicate that she must be: 1. Depressed 2. Pragmatic 3. Creative 4. Mentally ill

ANS: 3 Personality influences the quality of dreams; for example, a creative person has elaborate and complex dreams, whereas a depressed person dreams of helplessness. Most people dream about immediate concerns such as an argument with a spouse or worries over work. Sometimes a person is unaware of fears represented in bizarre dreams.

The nurse is discussing child care strategies with a mother of a newborn. The mother asks the nurse, What causes sudden infant death syndrome (SIDS)? Which of the following responses is most likely to answer the mothers question therapeutically? 1. SIDS is a common fear for new mothers. The best advice is to put your baby to sleep on her back. 2. We arent sure exactly, but it may have something to do with undetected cardiac or oxygen problems. 3. Research is inconclusive, but its thought to be a result of a nervous system problem that occurs when the baby is asleep. 4. Your pediatrician wants you to put your baby to sleep on her back because research has shown that more stomach sleepers are victims.

ANS: 3 Some have hypothesized that sudden infant death syndrome (SIDS) is caused by abnormalities in the autonomic nervous system that are manifested during sleep, resulting in apnea, hypoxia, and/or cardiac dysrhythmias. This answer provides the most thorough answer to the mothers question, whereas the remaining options stress preventive measures.

A 25-year-old clients wife complains to the nurse that he sleepwalks during the night. The nurse knows that this behavior normally occurs in which stage of sleep? 1. Stage 2: NREM 2. Stage 3: NREM 3. Stage 4: NREM 4. REM

ANS: 3 Stage 4 NREM sleep is the deepest stage of sleep. It is very difficult to arouse the sleeper. If sleep loss has occurred, the sleeper will spend a considerable portion of the night in this stage. Vital signs are significantly lower than during waking hours. The stage lasts approximately 15 to 30 minutes. Sleepwalking and enuresis (bed-wetting) sometimes occur. Stage 2 NREM is a period of sound sleep. Stage 3 NREM involves initial stages of deep sleep. REM sleep involves vivid, full-color dreaming. Loss of skeletal muscle tone occurs. It is very difficult to arouse the sleeper. Less vivid dreaming occurs in other stages. The stage is typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates, and increased or fluctuating blood pressure.

It is determined that the client will need pharmacological treatment to assist with the clients sleep patterns. The nurse anticipates that treatment with an anxiety-reducing, relaxation-promoting medication will include the use of: 1. Barbiturates 2. Amphetamines 3. Benzodiazepines 4. Tricyclic antidepressants

ANS: 3 The benzodiazepines cause relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal. Withdrawal from CNS depressants, such as barbiturates, can cause insomnia and must be managed carefully. Barbiturates can cause tolerance and dependence. Central nervous system stimulants, such as amphetamines, should be used sparingly and under medical management. Amphetamine sulfate may be used to treat narcolepsy. Prolonged use may cause drug dependence. Tricyclic antidepressants can cause insomnia when withdrawn and should be managed carefully. They are used primarily to treat depression.

The client asks the nurse, How will I know if Im really rested? The nurses most therapeutic response is: 1. Everyones definition of rested is different. How would you define rested? 2. When you arent tired when you get up in the morning or after an afternoon nap. 3. When you are mentally, physically, and emotionally ready to go about your daily activities. 4. You are rested if you fall asleep easily and sleep uninterruptedly for at least 6 to 8 hours.

ANS: 3 When people are at rest they are in a state of mental, physical, and spiritual activity that leaves them feeling refreshed, rejuvenated, and ready to resume the activities of the day. The remaining options ask questions or provide a limited view on what rested means.

A nurse caring for a patient prior to surgery should recognize which of the following factors place a client at risk for obstructive sleep apnea? (Select all that apply.) 1. Heart disease 2. Respiratory tract infections 3. Nasal polyps 4. Obesity

ANS: 3, 4 Structural abnormalities, such as a deviated septum, nasal polyps, certain jaw configurations, or enlarged tonsils predispose a client to obstructive apnea. Individuals with mixed apnea often have signs and symptoms of right-sided heart failure. Respiratory tract infections do not predispose a client to obstructive sleep apnea. Clients with obstructive apnea are often middle-age, obese men. Obesity itself does not predispose a client to obstructive sleep apnea.

The nurse is preparing to discuss the management of the sleeping disorder narcolepsy. In addition to the prescription of stimulants and antidepressants, which of the following nonpharmaceutical strategies should be included and shared with the client? (Select all that apply.) 1. Wine with meals 2. Regular use of a sauna 3. Light but high-protein meals 4. Regular use of chewing gum 5. Adoption of a regular exercise routine 6. Brief daytime naps of 20 minutes or less

ANS: 3, 4, 5, 6 Narcoleptics may be helped by brief daytime naps no longer than 20 minutes, a regular exercise program, avoiding shifts in sleep, eating light meals high in protein, practicing deep breathing, chewing gum, and taking vitamins. Clients 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).

A client has reported to the nurse that his sprained ankle resulted from a careless accident. I seem so clumsy and unfocused lately. Which of the following assessment questions is most likely to reveal information regarding the cause of these symptoms? 1. How many accidents have you had lately? 2. Have the accidents resulted in serious injuries? 3. Have there been any changes in your daily routine lately? 4. Do you have any idea what is responsible for this lack of focus?

ANS: 4 A loss of REM sleep leads to feelings of confusion and suspicion. Various body functions (e.g., mood, motor performance, memory, and equilibrium) are altered when prolonged sleep loss occurs. Research estimates that traffic, home, and work-related accidents caused by falling asleep are often a result of sleep loss. This answer is the best question because it directly opens up the opportunity for the client to discuss possible sleep problems if they exist. The other questions are not inappropriate but are less likely to reveal the possible cause of the accidents.

A client is concerned that her habit of sleeping during the day and being awake at night is not healthy or normal. The nurses most therapeutic response to the clients concern is: 1. What makes you think that sleeping during the day and being up at night is unhealthy or abnormal? 2. Many people share your sleep habits. As long as you feel all right, I dont think there is anything to worry about. 3. Are you interested in changing your sleep habits for any particular reason? Is sleeping during the day a problem for you? 4. Everyone has a different biological clock that controls his or her sleep cycle. As long as you are sleeping and functioning well, your habit isnt abnormal or unhealthy.

ANS: 4 All persons have biological clocks that synchronize their sleep cycles. If the sleep pattern does not adversely affect the clients health or ability to function, it is not problematic.

A 70-year-old client is reporting to the nurse a concern over taking longer to fall asleep and waking up three to four times during the night. The most therapeutic nursing response to the clients concern is: 1. I think you need to mention your concerns to your health care provider. 2. Older adults seem to need less sleep. Do you still feel rested in the morning? 3. I suggest that you plan for a nap in the afternoon to make up for that missed sleep. 4. As we age, those kinds of problems seem more common. Does this disruption in your sleep cause you to be tired or irritable?

ANS: 4 An older adult awakens more often during the night, and it takes more time for an older adult to fall asleep. The answer provides an opportunity for a discussion about the effect this problem may be creating.

A 73-year-old male client who normally sleeps on his right side recently underwent a right-side hip replacement surgery and now has trouble sleeping. One of the interventions that the nurse might try with this client is to: 1. Request medication to help the client sleep while in the hospital 2. Carefully prop the client on his operative side using pillows to support the hip 3. Schedule therapy for the evening to help the client become tired so he can sleep 4. Question the client to learn more about his normal sleep pattern

ANS: 4 Knowing a clients usual, preferred sleep pattern allows a nurse to try to match sleeping conditions in a health care setting with those in the home.

Which of the following clients experiencing disrupted sleep patterns is most at risk for obstructive sleep apnea (OSA)? 1. A 15-year-old boy with type 1 diabetes 2. A 22-year-old diagnosed with Crohns disease 3. A 49-year-old man who is an avid cross-county runner 4. A 58-year-old woman diagnosed with chronic depression

ANS: 4 Many think OSA affects middle-age men more frequently, particularly when they are obese. However, obstructive sleep apnea is also common in postmenopausal women, younger women, and children. Although the clients in all of the options may experience OSA, the postmenopausal woman has the greatest risk.

Which of the following information provided by the clients bed partner is most associated with sleep apnea? 1. Restlessness 2. Talking during sleep 3. Somnambulism 4. Excessive snoring

ANS: 4 Partners of clients with sleep apnea often complain that the clients snoring disturbs their sleep. Restlessness is not most associated with sleep apnea. Sleep talking is associated with sleep-wake transition disorders; somnambulism is associated with parasomnias (specifically, arousal disorders and sleep-wake transition disorders).

A 9-year-old client asks the nurse, Why do I need to sleep? The nurses most age-appropriate, informative response is: 1. Everyone needs to sleep to feel rested. 2. It gives your body a chance to really rest. 3. Youll be able to do so much better in school if youre rested. 4. Your body needs to rest in order to grow and be really healthy.

ANS: 4 Sleep contributes to physiological and psychological restoration, maintenance, and growth of the body at any age. The remaining options are not as effective at providing a thorough answer to the childs question. The body needs sleep to routinely restore biological processes.

The mother of a 2-year-old child is frustrated because the child does not want to go to bed at the scheduled bedtime. The nurse should suggest that the parent: 1. Offer the child a bedtime snack 2. Eliminate one of the naps during the day 3. Allow the child to sleep longer in the mornings 4. Maintain consistency in the same bedtime ritual

ANS: 4 The nurse should advise the parent to maintain a regular bedtime and wake-up schedule and to reinforce patterns of preparing for bedtime. A bedtime routine (e.g., same hour for bedtime, quiet activity) used consistently helps young children avoid delaying sleep. It is most important that the parent maintains a consistent bedtime routine. If a bedtime snack is already part of that routine, then this is allowable. If it is not, then the child may only use having a snack as a measure of procrastination. After 3 years of age the child may give up daytime naps. A bedtime routine used consistently will be more effective in helping the child who resists going to sleep. The same regular bedtime and wake-up schedule should be maintained.

The nurse and the parents of a 3-year-old are discussing their childs sleep habits. They share a concern over the childs tendency to wake up several times during the night crying out loudly but not really being awake. The nurse addresses the parents concern most therapeutically by responding: 1. Have you ever tried reading a bedtime story before putting her to bed? 2. If she does that only a few times a week, I wouldnt be too overly concerned. 3. Children her age often become poor sleepers. Have you discussed this with her pediatrician? 4. It is common for children to have trouble relaxing, and this behavior is the result. Its usually temporary.

ANS: 4 The preschooler usually has difficulty relaxing or quieting down after long, active days and has problems with bedtime fears, waking during the night, or nightmares. Partial wakening followed by normal return to sleep is frequent. In the waking period, the child exhibits brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting. The other options either ask questions or provide possible tactics for preventing the problems.

The nurse is completing an assessment of the clients sleep patterns. A specific question that the nurse should ask to determine the potential presence of sleep apnea is: 1. How easily do you fall asleep? 2. Do you have vivid, lifelike dreams? 3. Do you ever experience loss of muscle control or falling? 4. Do you snore loudly or experience headaches?

ANS: 4 To assess for sleep apnea (unlike assessing for narcolepsy or insomnia), the nurse may ask, Do you snore loudly? and Do you experience headaches after awakening? A positive response may indicate the client experiences sleep apnea.

Which nursing observation of the patient in intensive care indicates that the patient is sleeping comfortably? 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 per minute or less. The patient experiences decreased respirations, blood pressure, and muscle tone.

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.

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-Fowlers 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 physicians 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.

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, increased total bed time, feelings of sleeping poorly, and early awakening. Smoking (nicotine) decreases the total sleep time and REM and causes awakening or difficulty staying asleep. Alcohol speeds the onset of sleep. A person who is moderately fatigued usually achieves restful 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 persons ability to sleep, but the best answer is the central nervous system.

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 Analogue Scale is utilized for assessing sleep quality. The OUCHER and FACES scales are used to measure pain, and the Glasgow Coma Scale is used to measure level of consciousness.

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.

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 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 may or may not need to be adjusted. Observations do provide needed data, but in the case of insomnia, the patient is the source for evaluating the restfulness of sleep. Sometimes, the nurse has to work with the patient to redefine sleep expectations associated with medical conditions.

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.

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.

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.

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.

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.

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 adolescents 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.

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. 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.

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 neonates sleeping pattern? a. I cant 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 wont be able to nap during the day because the baby will be awake.

ANS: B The neonate averages about 16 hours of sleep. During the first week of life, the child sleeps almost constantly.

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 individuals 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.

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 with 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 individuals 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.

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 patients room to 21 C (70 F). b. Ensure that the night light in the patients 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 Cola and chocolate contain caffeine, which interferes with the ability to fall asleep. 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 airflow and 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 take priority.

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.

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 Patients with narcolepsy need to avoid factors that increase drowsiness such as 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.

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.

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.

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 patients 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.

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.

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

ANS: D One group of medications that are relatively safe are the benzodiazepines such as lorazepam. These medications cause relaxation and antianxiety and hypnotic effects. 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.

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.

The nurse is caring for a postpartum patient. The patients 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 patients 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.

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.

A nurse assessing a patient with a sleep disorder documents cataplexy as a finding. Which of the following is a feature of this condition? A) irresistible urge to sleep, regardless of the type of activity in which the patient is engaged B) sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion C) nightmare or vivid hallucinations experienced during sleep time D) skeletal paralysis that occurs during the transition from wakefulness to sleep

B

A nurse teaches the parents of a toddler about normal sleep patterns for this age group. How many hours of sleep per night is normal near the end of this stage? A) 7 8 hours B) 8 10 hours C) 10 12 hours D) 12 15 hours

B

A patient has been instructed to increase fluid intake but as a result has lost sleep to get up to void several times a night. What can the nurse recommend to decrease the interruption of sleep? A) Drink most of the liquids during the night. B) Drink most of the liquids before 5 p.m. C) Try drinking coffee instead of water. D) Drink the total amount of liquids before noon.

B

What is the most common method for ordering sleep medications? A) stat B) p.r.n C) single order D) daily dose

B

Which of the following groups of terms best describes sleep? A) decreased state of activity, refreshed B) altered consciousness, relative inactivity C) comatose, immobility D) alert, responsive

B

A patients bed partner reports the patient often has irregular snoring and silence followed by a snort. Does this warrant further assessment? A) no, snoring has varied patterns B) no, this is a description of normal snoring C) yes, this is an indicator of obstructive apnea D) yes, the bed partner is unable to sleep at night

C

A sedative-hypnotic has been prescribed to help a patient sleep. What should the nurse teach the patient about this medication? A) it should be taken every night for several months B) it is useful for sleep but is better taken with alcohol C) it loses its effectiveness after 1 or 2 weeks D) it should be taken in the morning for long-term effects

C

A nurse is explaining the use of sleep hygiene to a patient experiencing insomnia. Which of the following statements accurately describe recommended guidelines for the use of this technique? Select all that apply. A) drink an alcoholic drink before bedtime B) take frequent naps during the day C) eat a light meal before bedtime D) sleep in a warm, dark room E) take a warm bath before bedtime F) eliminate the use of a clock in the bedroom

C,E,F

A nurse is discussing sleep problems with a patient. What type of foods would she recommend to promote sleep? A) one cup of hot chocolate B) three glasses of red wine C) a high-protein snack D) a carbohydrate snack

D

The parents of a 10-year-old son are worried about his sleepwalking (somnambulism). What topic should the nurse discuss with the parents? A) sleep deprivation B) privacy C) schoolwork D) safety

D

What independent nursing action can be used to facilitate sleep in hospitalized patients who are on bedrest? A) administering prescribed sleep medications B) changing the bed with fresh linens C) encouraging naps during the daytime D) giving a back massage

D