FA DAVIS Sleeping Quiz

How many hours of sleep per day does a newborn need? 1. 16 to 20 2. 10 to 11 3. 8 to 9 4. 7 to 8

ANS: 1 Rationales Option 1: A newborn infant needs 16 to 20 hours of sleep each day. Option 2: During middle and late childhood, kids need 10 to 11 hours of sleep each day. Option 3: Adolescents need 8 to 9 hours of sleep each day. Option 4: Young adults need 7 to 8 hours of sleep each day.

The physician wants to monitor a client who has been having difficulty falling and staying asleep and feels unrested during the day. What intervention could be used to do this? 1. Have the client complete a sleep diary for 14 days. 2. Plan, implement, and evaluate nursing care related to the specific nursing diagnoses addressing sleep problems. 3. Have the client remain in the hospital to undergo sleep studies. 4. Work with the client to establish goals and outcomes regarding sleep hygiene.

ANS: 1 Rationales Option 1: A sleep diary provides specific information on a client's patterns of sleep and allows for identification of trends in sleep/wakefulness and associated behaviors interfering with sleep. Option 2: Planning and implementing a nursing care plan may be needed at a later date, but when monitoring the client, the client should be involved. Option 3: Sleep studies may or may not need to be completed and would be determined by the initial assessment of sleep disturbances. Option 4: Goals and outcomes should be established to improve sleep patterns based on the intervention.

Breakfast is brought to a client who has been experiencing severe pain and thus little sleep. He or she is finally able to sleep due to analgesic therapy and is asleep when the tray is brought into the room. What should the nurse do in this situation? 1. Allow the client to sleep and have the breakfast tray brought later in the morning. 2. Leave the breakfast tray on the side table for when the client wakes up. 3. Awaken the client briefly to ask if he or she would like to go ahead and have breakfast while it is hot. 4. Wake the client to eat to keep him or her on a regular sleep cycle and provide an opportunity to rest or nap after the meal.

ANS: 1 Rationales Option 1: Allowing clients to sleep through their full sleep cycle is the best option, as meals can be brought at any time. Option 2: Leaving food out to consume at a later time is never a good idea, especially if the amount of time cannot be determined. Option 3: It is best to not interrupt the client if at all possible so he or she can get a full sleep cycle to restore both physical and mental function. Option 4: In situations where the client is in the hospital and out of his or her normal routine, it is best to keep sleep interruptions to a minimum.

The nurse is reviewing electroencephalograph results for a client who reports sleep difficulty. Which waves would the nurse expect to disappear when the client is asleep? 1. Alpha 2. Delta 3. Theta 4. Spindle

ANS: 1 Rationales Option 1: Alpha waves disappear when a client falls asleep. Option 2: Delta waves are more prominent during wakefulness. Option 3: Theta waves slow down when the client sleeps. Option 4: Spindle fibers become slower during sleep.

A 38-year-old healthy woman is being seen for her physical examination and Pap smear. During assessment, she states she lies in bed awake for hours before falling asleep and often wakes in the middle of the night and can't go back to sleep. She also states she feels exhausted in the morning and is tired all the time. She admits to feelings of irritability toward others and lack of desire to engage in social activities because she's "just too tired." What would an appropriate nursing diagnosis be for this client? 1. Insomnia 2. Sleep Deprivation 3. Altered Sleep Patterns 4. Sleep Pattern Disturbance

ANS: 1 Rationales Option 1: Insomnia is often a symptom of a medical cause of inability to sleep; however, it can be used as a nursing diagnosis when it is the issue being addressed for intervention. Option 2: Sleep deprivation is the result of the insomnia and not the nursing diagnosis itself. Option 3: A diagnosis involving sleep patterns is typically due to a change in the environment, discomfort, fear, anxiety, and so on. Option 4: Disturbances in sleep patterns are typically due to unfamiliar environments, stress, and other factors that cause temporary changes in sleep patterns.

What is the hormone that naturally controls sleep? 1. Melatonin 2. L-tryptophan 3. Progesterone 4. Testosterone

ANS: 1 Rationales Option 1: Melatonin is a natural hormone found in the body and is responsible for sleep and wake cycles. Option 2: L-tryptophan is an amino acid that converts to serotonin, which controls moods and sleep. Option 3: Progesterone is a hormone found in females but is not responsible for controlling sleep. Option 4: Testosterone is a naturally occurring hormone that is responsible for libido.

The nurse is working with a client newly diagnosed with narcolepsy. Which treatment regimen would the nurse expect to be prescribed for this client? 1. Methylphenidate (Ritalin) 2. Bilevel positive airway pressure 3. Continuous positive airway pressure 4. Set bedtime and waking time each day

ANS: 1 Rationales Option 1: Methylphenidate (Ritalin) is a central nervous system stimulant that is prescribed in the treatment of narcolepsy. Option 2: Bilevel positive airway pressure is a device used to force air into the lungs as well as expel air. This is used to treat sleep apnea. Option 3: Continuous positive airway pressure is a treatment for sleep apnea that forces air into the lungs. It is not used for narcolepsy. Option 4: A client with narcolepsy would not benefit from getting up the same time every morning and going to bed the same time every night.

A client who has depression with secondary insomnia is requesting "some kind of relief" to improve his or her quality of life. What type of medication would most likely be prescribed for this client? 1. Tricyclic antidepressant 2. Selective melatonin agonist 3. Benzodiazepine 4. Barbiturate

ANS: 1 Rationales Option 1: Primary care providers may prescribe antidepressants to promote sleep even though not approved for this purpose, as they have shown benefits for some individuals who suffer both depression and insomnia. Option 2: This class of medications regulates the sleep-wake cycle by targeting melatonin receptors and is not used for depression. Option 3: This class of medications is sedative/hypnotics and is the first-line treatment for insomnia, and they can be either long- or short-acting. Option 4: These sedative/hypnotics and anticonvulsants are rarely prescribed for insomnia because of the risk of addiction, abuse, and overdose.

What is the benefit of the nurse providing a back massage instead of delegating it to a NAP? 1. It allows fostering of the nurse-client relationship while assessing client needs. 2. The nurse can ensure the client is responsive to treatment. 3. The identity of the client can be confirmed without question. 4. Clients are more apt to relax with the nurse than with a NAP.

ANS: 1 Rationales Option 1: Providing the back rub provides an excellent opportunity to assess the client, develop rapport, and provide emotional support. Option 2: The NAP can also determine if the client is responsive to treatment if trained correctly, so this is not a full benefit. Option 3: The NAP is trained to identify clients, so this is not a benefit. Option 4: While relaxation may be a consideration in some cases, this is not a full benefit for all cases.

What priority nursing intervention does the nurse incorporate into a plan of care to promote sleep for a hospitalized client? 1. Schedule nursing care to avoid interrupting sleep. 2. Promote good body alignment to facilitate relaxation. 3. Control the temperature of the room and provide good ventilation. 4. Offer cool cloths or a back massage.

ANS: 1 Rationales Option 1: Scheduling nursing care around sleep-wake cycles as much as possible can prevent interruption of deep sleep cycles. Option 2: Good body alignment helps with relaxation, which is a component of providing a restful atmosphere, but not a priority nursing intervention that addresses immediate need of sleep deprivation. Option 3: Temperature control and ventilation aid in creating a restful atmosphere, but these do not address the immediate need of disturbed sleep patterns. Option 4: Offering cool cloths or a back massage works to make a client comfortable and thus helps the client to relax. Although relaxation may lead to sleep, this is not the priority intervention of those given.

A client who has just changed to working third shift is concerned about getting enough sleep. What is the probable cause for this? 1. Interrupted circadian rhythm 2. Stress-related insomnia 3. Asynchronous sleeping habits 4. Insufficient melatonin production

ANS: 1 Rationales Option 1: Switching to working at night and sleeping during the day has altered the circadian rhythm. Option 2: While the client may be experiencing some stress due to changing jobs, this is not the most likely cause of the inability to sleep. Option 3: Asynchronous sleeping habits (altering sleeping habits) may be contributing to the issue, but this is not the primary cause of not getting enough quality sleep. Option 4: Melatonin is secreted as the sun disappears and is associated with the biorhythms of the body. While melatonin may not be produced at the time needed for this change in sleep patterns, it is not the predominant cause of sleep disruption.

Which changes can be noted during the deepest stage of non-REM sleep? Select all that apply. 1. Muscles relax. 2. Heart rate lowers. 3. Respirations decrease. 4. Blood pressure increases. 5. Body temperature increases.

ANS: 1, 2, 3 Rationales Option 1: Muscles relax during the deepest stage of non-REM sleep. Option 2: The parasympathetic nervous system stimulation causes the heart rate to decrease. Option 3: Respirations decrease due to parasympathetic nervous system stimulation. Option 4: Blood pressure decreases. It does not increase. Option 5: Body temperature will fall during non-REM sleep. It does not rise.

A preoperative client has not been sleeping well for years but is having even more difficulty lately due to worry about the procedure and concern about being able to receive Ambien while in the hospital. The client states, "I really can't sleep at all without it," and has been taking the medication for several years. Even though the client will receive opioid analgesics postoperatively, the physician still prescribes Ambien. What could be the reason behind this decision? 1. Pain can cause sleep disturbances. 2. The client needs as much sleep as possible to recover from surgery. 3. The medications will have differing effects on the client. 4. The client's age is a factor in sleep patterns that should not be disrupted during hospitalization

ANS: 1 Rationales Option 1: The client is dependent on the medication and adding pain-induced sleep disruption would cause more stress to the client, which is not beneficial at this time. Option 2: While sleep and rest are important in the recovery phase, nurses should monitor clients who are receiving both sleep and analgesic medications for continued sleep-wake patterns. Option 3: While sleep medication and opioid analgesics are in separate categories, opioid medications are linked to drowsiness, and inducing sleep should be monitored closely. Option 4: Age plays a factor in sleep patterns and disturbances; however, this is not a specific factor in this client's special needs.

Which is the restful phase of sleep in which physiological function is slow? 1. NREM 2. REM 3. RAS 4. CSA

ANS: 1 Rationales Option 1: The non-rapid eye movement stage is typically the restful phase of sleep where physiological function slows. Option 2: The rapid eye movement stage involves sleep that is needed for mental and emotional restoration, and brain waves during this stage resemble those of a person who is fully awake. Option 3: The reticular activating system is a collection of nerve cell bodies within the brainstem that is responsible for maintaining wakefulness. Option 4: Central sleep apnea is a complete suspension of breathing caused by dysfunction of central respiratory control, resulting in a tendency to awaken during sleep and, therefore, experience daytime sleepiness.

Which intervention can the nurse include in the plan of care for a client in the hospital to promote sleep and rest? 1. Clustering activities 2. Preventing daytime naps 3. Turning lights on for safety 4. Keeping visitors from staying the night

ANS: 1 Rationales Option 1: The nurse should cluster activities to prevent multiple interruptions during sleep. Option 2: It is impossible to prevent daytime naps when a client is hospitalized, as the client does need to take frequent rest periods. Option 3: Lights should be dimmed or turned off to promote sleep. Option 4: Allowing a client to have a family member stay the night can improve comfort and promote sleep.

When assessing a client for sleep disturbances, what is an appropriate question to address the sleeping environment? 1. What room temperature do you prefer? 2. Do you have a regular sleep schedule? 3. What do you do to help you fall asleep? 4. Do you sleepwalk?

ANS: 1 Rationales Option 1: The temperature of the room, lighting, and noise are all related to the sleeping environment. Option 2: Asking about sleep schedules helps determine sleeping patterns. Option 3: Determining what a client does to help fall asleep is assessing bedtime rituals and practices. Option 4: Asking about sleepwalking, dreaming, and other disturbances during the night help to assess changes in sleep patterns or problems.

What is a nursing consideration for arousing a client during the (NREM) stage of sleep? 1. Temperature, heart rate, and blood pressure are slightly decreased. 2. Skeletal muscles are very relaxed. 3. Metabolism, temperature, pulse, and blood pressure increase. 4. If awakened, the client will react normally.

ANS: 1 Rationales Option 1: While easily aroused during this stage, temperature, heart rate, and blood pressure are slightly decreased and should be monitored until the client is fully alert. Option 2: Skeletal muscle relaxation is seen in the NIII (NREM) cycle. Option 3: During the REM cycle, metabolism, temperature, pulse, and blood pressure increase. Option 4: A client who is awakened during the REM cycle will react normally, as it is a less restful phase of the sleep cycle.

The nurse is assessing the sleep-wake pattern of a client admitted to the hospital with a gastrointestinal bleed. Which findings would require a more in-depth sleep evaluation? Select all that apply. 1. Lasts for longer than 30 days 2. Wakes up four times per night 3. Snores about one night per week 4. Smokes one pack of cigarettes daily 5. Takes more than 15 minutes to fall asleep

ANS: 1, 2 Rationales Option 1: A client who has had sleep problems for greater than 30 days requires health-care provider follow-up. Option 2: A client who wakes up more than three times per night needs follow-up by the health-care provider. Option 3: Occasional snoring does not require follow-up. Option 4: Smoking is a risk factor for insomnia. It is known and does not require follow-up. Option 5: A client who takes 30 minutes to fall asleep, not 15 minutes, needs follow-up.

A 36-year-old male has been admitted to the medical-surgical floor for 24-hour observation due to exhaustion. The client reports difficultly falling asleep and then staying asleep for the past 5 months when he started a new job working nights. In addition, he states that since his 5th child was born, it is loud in his house, causing him to not get restful sleep when he gets home from work. He states he often works 12- to 14-hour shifts and only gets about 4 hours of sleep before having to return to work, and frequently dozes off on the job. He came to the hospital because he thinks he has "narcolepsy or something." Upon further assessment, he reports being very agitated at the slightest things and that he and his wife have been fighting a lot, and the nurse notices he looks very tired with dark circles underneath his eyes. What is the objective data in this scenario that help form the nursing care plan? Select all that apply. 1. Admitted for exhaustion 2. Looks tired with dark circles under the eyes 3. Reports being very agitated 4. Works 12 to 14 hours with only 4 hours of sleep 5. Difficulty falling asleep

ANS: 1, 2 Rationales Option 1: Client is being admitted, which is objective, as it is information not from the client. Option 2: The appearance of the client is observable, so it is objective. Option 3: When the client states or reports something, this is information that is subjective. Option 4: When the client states or reports something, this information cannot be measured or observed and is subjective. Option 5: The client states difficulty falling asleep, which would be considered subjective information.

What questions would best address sleep changes and problems when assessing a client's sleep history? Select all that apply. 1. How often do you experience difficulty falling asleep? 2. Do you ever experience an unpleasant creeping feeling, crawling, or tingling, relieved only by moving the legs at night? 3. Do you snore? 4. Do you grind your teeth while you sleep? 5. Do you take any sleep medications or other drugs?

ANS: 1, 2, 3, 4

A client is concerned about having narcolepsy, as he or she has sudden involuntary episodes of sleep occurring at random times during the day. What questions should the nurse ask to further investigate the client's concern? Select all that apply. 1. How have your sleeping patterns been lately? 2. Have you experienced any slurred speech or changes in your facial muscles prior to these episodes? 3. Do you feel numbness, weakness, or unusual feelings in your knees or legs? 4. Have you recently changed shifts at work? 5. Has anyone told you that you snore or grunt while you are asleep?

ANS: 1, 2, 3, 4 Rationales Option 1: Asking about sleeping patterns can determine what type of sleep disturbance the client is experiencing. Option 2: Narcolepsy is typically seen with altered speech and facial muscles prior to the episode. Option 3: Feelings of numbness, weakness, and odd feelings in the knees and legs have been seen in clients with narcolepsy. Option 4: Changing sleep patterns can be attributed to certain sleep disturbances and may contribute to randomly falling asleep. Option 5: Grunting, snoring, or thrashing during sleep usually is the manifestation of obstructive sleep apnea, not narcolepsy.

hich factors can affect geriatric clients' ability to obtain adequate sleep at night? Select all that apply. 1. Frequent daytime naps 2. Taking longer to fall asleep 3. Awakening for longer periods during the night 4. Nocturia interfering with sleep 5. Loneliness causing restless sleep

ANS: 1, 2, 3, 4 Rationales Option 1: Frequent daytime naps do not interfere with obtaining adequate sleep at night. Option 2: Older adults tend to take longer to fall asleep at night. Option 3: When older clients wake up during the night, they tend to be awake for longer periods of time. Option 4: Nocturia, frequent urination, can interfere with getting a full night's sleep. Option 5: Loneliness does not usually interfere with getting a good night's sleep.

A 38-year-old client is asking for medication for trouble falling asleep and staying asleep. The client also feels groggy and unrested during the day. What should the nurse assess for as possible etiologies? Select all that apply. 1. Watching TV while in bed 2. Sleeping with smart phone nearby 3. Caffeine consumption 4. Current medications 5. Exercise/activities

ANS: 1, 2, 3, 4 Rationales Option 1: Watching TV in bed, specifically at bedtime, can contribute to disrupted sleep patterns and inability to naturally fall asleep. Option 2: Smart phones emit low-level frequencies as well as project light that can interrupt sleep patterns. Option 3: Excessive caffeine consumption and consuming caffeine late in the day can affect sleep patterns. Option 4: Certain medications, such as bronchodilators or steroids, can cause sleep patterns to be disturbed. Option 5: Exercise has been linked to more restful sleep; however, other issues can override activity level, and full sleep patterns and hyperactivity can have a negative effect on REM patterns.

When educating student nurses on self-care and sleep hygiene, what information should be included? Select all that apply. 1. Fatigue can cause impaired judgment and decision making. 2. If possible, take frequent breaks (e.g., every 1 to 2 hours) during the night shift. 3. Be smart about your caffeine use. 4. Use breaks and lunch hours for exercise and cardio activity. 5. Plan rest days in between consecutive work days.

ANS: 1, 2, 3, 5 Rationales Option 1: Fatigue can slow reaction times and create a sense of fogginess, which can impair judgment. Option 2: Taking breaks every couple of hours gives the mind and body a chance to rest and refocus. Option 3: Don't ingest caffeine when you don't need it to stay awake, and avoid caffeine at the end of your shift before sleep. Option 4: Physical movement and activity should be engaged in periodically even if it is just getting up and moving around; however, cardio activity and exercise do not have to be planned for lunch and breaks. Option 5: When working long shifts, rotating shifts, and night shifts, plan rest days in the schedule between consecutive work days.

An adolescent reports constant fatigue and an inability to stay awake in school. Which factors should the nurse assess for that could be interfering with sleep? Select all that apply. 1. Smart phone use 2. Drug and alcohol use 3. Caffeine consumption 4. Hectic work schedules 5. School work and studying 6. Depression, anxiety, and tension

ANS: 1, 2, 3, 5 Rationales Option 1: Smart phone use and the lights associated with it can affect circadian rhythms and cause sleep deprivation. Option 2: Drug and alcohol use can interfere with sleep in teenagers. Option 3: Caffeine is found in many energy drinks that are frequently consumed by teenagers. Option 4: Hectic work schedules affect adults, not adolescents. Option 5: School work and studying can impact sleep for adolescents. Option 6: Depression, anxiety, and tension can affect sleep in middle-aged adults, not adolescents.

The nurse is discussing sleep patterns with a client who reports sleep disturbances. Which questions should the nurse ask the client to determine the cause of the sleep problem? Select all that apply. 1. "What do you do for employment?" 2. "Do you include exercise in your daily life?" 3. "What is a typical 24-hour food intake for you?" 4. "When does your spouse normally go to sleep?" 5. "How many caffeinated beverages do you drink each day?"

ANS: 1, 2, 3, 5, Rationales Option 1: The nurse does not need to know what the person's job is to determine the cause of sleep disturbances. Option 2: Daily exercise, especially within 2 hours of bedtime, produces better sleep. Option 3: A diet high in saturated fat closer to bedtime can interfere with sleep. Option 4: The nurse does not need to know the sleep pattern of others in the family. Option 5: Caffeine blocks adenosine, which interferes with sleep. Therefore, the nurse would ask the client about caffeine consumption.

Which nursing interventions can help promote sleep? Select all that apply. 1. Keep the room dim or dark. 2. Change the linens daily or when soiled. 3. Hold opioid analgesics before bedtime. 4. Position the client to provide good body alignment. 5. Turn on the television set to the client's favorite show.

ANS: 1, 2, 4 Rationales Option 1: It is difficult to sleep in an environment that is brightly lit. Therefore, the nurse should dim or turn off lights. Option 2: Clean, dry linens will help promote sleep. The nurse should change the linens every day or* when they become soiled. Option 3: Pain should be managed and if the client requires opioid pain medications, the nurse should administer these prescribed medications. Option 4: The client should be positioned to maintain good body alignment. This can be done with pillows or extra blankets. Option 5: The nurse should provide a quiet environment for the client. The television set should be turned off.

Which are causes of obstructive sleep apnea? Select all that apply. 1. Being overweight 2. Enlarged tonsils 3. Over 60-years-old 4. Deviated nasal septum 5. History of cigarette smoking

ANS: 1, 2, 4 Rationales Option 1: Overweight clients are at a higher risk for obstructive sleep apnea. Option 2: Enlarged tonsils can cause obstructive sleep apnea. Option 3: Clients over the age of 40 are at an increased risk of obstructive sleep apnea. Option 4: Deviated nasal septums can lead to obstructive sleep apnea. Option 5: Cigarette smoking does not cause obstructive sleep apnea.

In which ways can anxiety interfere with a client having a restful night's sleep? Select all that apply. 1. Tachycardia 2. Increased respirations 3. Decreased norepinephrine 4. Decreased intestinal motility 5. Increased gastric secretions

ANS: 1, 2, 5 Rationales Option 1: Anxiety can increase the heart rate and interfere with sleep. Option 2: Respirations increase when a client is anxious. Option 3: Anxiety increases norepinephrine production through stimulation of the sympathetic nervous system. Option 4: Anxiety increases intestinal motility. It does not decrease motility. Option 5: Anxiety causes an increase in gastric secretions, which can prevent a client from having a restful sleep.

The nurse is educating a client with a new diagnosis of sleep apnea regarding consistent use of the continuous positive airway pressure (CPAP) machine. Which complications should the nurse instruct the client about that can occur with untreated sleep apnea? Select all that apply. 1. Angina 2. Anemia 3. Arrhythmias 4. Hypotension 5. Evening headache

ANS: 1, 3 Rationales Option 1: Angina can occur from untreated sleep apnea. Option 2: A client who does not use the CPAP machine to treat the sleep apnea is at risk for polycythemia, not anemia. Option 3: Cardiac arrhythmias can happen when a client does not use his or her CPAP machine. Option 4: Hypertension is a common finding in a client with untreated sleep apnea. Option 5: Morning headaches are more commonly reported by clients with untreated sleep apnea.

A client with restless leg syndrome reports difficulty sleeping. Which factors may be the cause? Select all that apply. 1. Age 2. Shift work 3. Low iron levels 4. Antidepressants 5. Alcohol consumption

ANS: 1, 3, 4 Rationales Option 1: Older adults have a higher incidence of restless leg syndrome. Option 2: Shift work has been linked to altered circadian rhythms, not restless leg syndrome. Option 3: Low iron levels are found in clients with restless leg syndrome. Option 4: Some antidepressants are known to cause restless leg syndrome. Option 5: Alcohol use can lead to insomnia. It does not cause restless leg syndrome.

Which sleep disorders are considered secondary and are caused by underlying health disorders? Select all that apply. 1. Pain 2. Anemia 3. Asthma 4. Depression 5. Hyperthyroidism

ANS: 1, 4, 5 Rationales Option 1: Uncontrolled pain is a secondary cause of sleep disorders. Option 2: Anemia can result from untreated sleep apnea, but it is not a secondary cause of sleep disorders. Option 3: Asthma can be exacerbated from not receiving enough sleep; however, it is not a secondary sleep disorder. Option 4: Clients who are depressed may sleep too much or not enough. They frequently have secondary sleep disorders. Option 5: Hyperthyroidism increases metabolism, which prevents a client from obtaining adequate amounts of sleep.

A nurse caring for a client with peripheral neuropathy secondary to uncontrolled diabetes suggests acupuncture because the client has trouble sleeping and is showing signs of daytime drowsiness, irritability, and restlessness. The client does not want to take medication for pain but is willing to try alternative therapies. What component of the PICOT model addresses acupuncture in this situation? 1. P 2. I 3. C 4. O 5. T

ANS: 2 Rationales Option 1: "P" addresses the population/client, and acupuncture does not fit this category. Option 2: "I" is the intervention component of the PICOT model and addresses the acupuncture. Option 3: "C" addresses the compare group, which would be no acupuncture in this situation. Option 4: "O" refers to the outcome, which addresses the ultimate goal of no pain. Option 5: "T" refers to an expected time frame if needed.

In which sleep stage would a client's EEG show beta waves? 1. Drowsy stage 2. In periods of wakefulness 3. Earlier phase of NREM 4. When transitioning to deep sleep

ANS: 2 Rationales Option 1: A client's EEG shows alpha waves during the drowsy stage. Option 2: A client's EEG shows beta waves during periods of wakefulness. Option 3: A client's EEG shows theta waves during the earlier phase of NREM. Option 4: A client's EEG shows delta waves during the transition into deep sleep.

The parents of a toddler report difficulty getting their child to sleep at night. The child wants to play and not go to sleep. Which intervention suggested by the nurse would be most effective? 1. Give the toddler melatonin prior to sleep. 2. Plan sedentary activities the last hour before bed. 3. Punish the child for not listening to the rules for bedtime. 4. Feed the child a large snack 30 minutes prior to going to bed

ANS: 2 Rationales Option 1: Melatonin is a natural product that helps with sleep; however, it is not proven safe for toddler use. Option 2: Toddlers who have difficulty winding down before bed benefit from sedentary activities such as reading a book the last hour before bed. This will help relax the child and promote sleep. Option 3: The child should not be punished for not listening to the rules for bedtime. Option 4: A small snack would be most appropriate before bed, as a large snack would make it more difficult to fall asleep.

A client presents to the clinic requesting medication to help him or her sleep. The health-care provider diagnoses the client with insomnia. Which criteria would the nurse expect to be present related to this diagnosis? Select all that apply. 1. Happens three times a night 2. Happens three days per week 3. Happens for at least three months 4. Happens when unable to sleep for three hours 5. Happens from three causes: caffeine, smoking, or alcohol

ANS: 2, 3 Rationales Option 1: Insomnia does not happen three times per night. It would be just once a night. Option 2: One of the criteria for insomnia is that it happens three days per week. Option 3: Insomnia can be diagnosed if it happens for at least three months. Option 4: There is no time frame as to how long it takes for the person to fall asleep to diagnose insomnia. Option 5: Caffeine, smoking, and alcohol can interfere with sleep, but the presence of these three do not lead to a diagnosis of insomnia.

The nurse is educating a group of teenagers regarding obtaining sufficient amounts of sleep. Which consequences of sleep deprivation should the nurse include in the presentation? Select all that apply. 1. Decreases risk for strokes 2. Increases sensitivity to pain 3. Intensifies insulin resistance 4. Strengthens the immune system 5. Increases the appetite and intake

ANS: 2, 3, 5

Which high-amplitude brain waves found during sleep are common in children but rare in adults? 1. Beta 2. Alpha 3. Theta 4. Delta

ANS: 3 Rationales Option 1: Beta waves are high-frequency, low-amplitude waves during wakefulness. Option 2: Alpha waves are medium-frequency, low-amplitude waves during the drowsy stage. Option 3: Theta waves are high-amplitude waves found in deep sleep and are more common in children than adults. Option 4: Delta waves are low-frequency, high-amplitude regular waves in deep sleep but are not common in children and rare in adults.

Which statement best describes parasomnia? 1. Parasomnia is when a client has difficulty falling asleep. 2. Parasomnias include sleep apnea and narcolepsy. 3. Parasomnia is a pattern of waking behavior that involves sleepwalking. 4. Parasomnia is an umbrella term that includes restless leg syndrome as a cause.

ANS: 3 Rationales Option 1: Dyssomnia, not parasomnia, is when a client reports difficulty falling asleep. Option 2: Sleep apnea and narcolepsy are categorized as parasomnias, not dyssomnias. Option 3: Sleepwalking is a type of parasomnia. Option 4: Restless leg syndrome is a type of dyssomnia where the client cannot sleep due to constant leg movement.

A client is about to engage in a sleep study to determine sleep apnea. At which stage would an EEG show vivid dream activity? 1. NII (NREM) 2. NIII (NREM) 3. REM 4. NI (NREM)

ANS: 3 Rationales Option 1: In this stage of sleep, the client is easily roused, temperature, heart rate, and blood pressure decrease slightly, and there are not vivid dreams, as this is a light sleep. Option 2: This is a deep stage of sleep; there may be dreams, but they are not typically as vivid as those that occur in REM sleep. Option 3: In this stage of sleep, the client's EEG may show vivid dream activity. Option 4: This is a stage of transition between wakefulness and sleep; dreams are not usually remembered from this stage.

The nurse is developing a plan of care for a client in the intensive care unit with fluid volume overload related to congestive heart failure who is receiving diuretics. Which factors can lead to altered sleep patterns for this client? Select all that apply. 1. Uncontrolled pain 2. Diagnosis of congestive heart failure 3. Hospitalization in an intensive care unit 4. Frequent urination related to diuretic use 5. Repeated interruptions throughout the day and night

ANS: 3, 4, 5 Rationales Option 1: A client with congestive heart failure would not necessarily experience uncontrolled pain unless there are other comorbidities that are causing pain. Option 2: The diagnosis of congestive heart failure does not interfere with sleep. There are other factors that could prevent adequate sleep. Option 3: The client may experience many alarms and noises as well as frequent nursing interventions in an intensive care unit. These factors can interfere with the client obtaining sleep. Option 4: Diuretics cause increased urination as the excess fluid is being removed. Frequent urination can interfere with sleep. Option 5: A client in the intensive care unit will have repeated interruptions preventing adequate rest.

Question 2. Which neurotransmitters are related to excitatory and inhibitory sleep mechanisms? Select all that apply. 1. Glycine 2. Aspartate 3. Serotonin 4. Histamine 5. Prostaglandins 6. Acetylcholine

ANS: 3, 4, 5, 6 Rationales Option 1: Glycine is an amino acid that helps break down glycogen and is not responsible for excitatory and inhibitory sleep mechanisms. Option 2: Aspartate combines with other metals and is also an amino acid. It is not related to excitatory and inhibitory sleep mechanisms. Option 3: Serotonin is a neurotransmitter responsible for excitatory and inhibitory sleep mechanisms. Option 4: Histamine is a neurotransmitter that works with excitatory and inhibitory sleep mechanisms. Option 5: Prostaglandins are neurotransmitters that are related to excitatory and inhibitory sleep mechanisms. Option 6: Acetylcholine is a neurotransmitter that has excitatory and inhibitory sleep mechanism responsibilities.

Which sleep disorder involves a person suddenly waking up thrashing about and hallucinating? 1. Insomnia 2. Narcolepsy 3. Sleep apnea 4. Night terrors

ANS: 4 Rationales Option 1: A person with insomnia has difficulty falling asleep at night. Option 2: Narcolepsy is when a person falls asleep suddenly when standing up. This does not cause someone to thrash around and hallucinate. Option 3: Sleep apnea occurs when a person stops breathing during sleep. Option 4: Night terrors usually occur in children when they wake up and thrash about and hallucinate.

Which diagnostic test involves measuring brain wave activity, oxygen and carbon dioxide levels, and vital signs? 1. Actigraph 2. Sleep study 3. Sleep diary 4. Polysomnography

ANS: 4 Rationales Option 1: An actigraph is a device worn on the wrist or a telephone app that measures sleep wake cycles. Option 2: A sleep study is done overnight and measures what happens during sleep. Option 3: A sleep diary is a handwritten journal the client keeps for 14 days documenting sleep-wake patterns. Option 4: Polysomnography measures brain wave activity, oxygen and carbon dioxide levels, eye movement, and vital signs in a sleep lab.

The nurse is caring for a client with uncontrolled type 1 diabetes mellitus and is experiencing varying blood glucose levels. Which nursing intervention should the nurse perform that may prevent sleep and rest for the client? 1. Provide a snack every 3 to 4 hours. 2. Administer insulin as prescribed. 3. Administer 50% dextrose before bed. 4. Monitor blood glucose levels during the night.

ANS: 4 Rationales Option 1: The client would not need to eat a snack every 3 to 4 hours during the night to control blood glucose levels. Option 2: The administration of insulin would occur during waking hours and should not affect sleep and rest. Option 3: The nurse would only administer 50% dextrose when the client is severely hypoglycemic. Option 4: Blood glucose levels may need to be monitored during the night to prevent hypoglycemic events.

Which part of the brain controls circadian rhythms? 1. Thalamus 2. Cerebellum 3. Pituitary gland 4. Hypothalamus

ANS: 4 Rationales Option 1: The thalamus relays information between the cerebral cortex and the subcortical areas. It is not responsible for circadian rhythms. Option 2: The cerebellum controls balance and movement. It does not control circadian rhythms. Option 3: The pituitary gland releases hormones such as growth hormone, but it does not control circadian rhythms. Option 4: The hypothalamus controls circadian rhythms, which synchronizes sleep-wake cycles with light.