Nursing Fund 171.2 Chapter 43 Review Questions

A 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.) 1. Take brief, 20-minute naps no more than twice a day. 2. Drink a glass of wine with dinner. 3. Eat a large meal at lunch rather than dinner. 4. Establish a regular exercise program. 5. Teach the patient about the side effects of modafinil.

Answer: 1, 4, 5. 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

Which sleep-hygiene actions at bedtime can the nurse delegate to assistive personnel? (Select all that apply.) 1. Giving the patient a back rub 2. Turning on quiet music 3. Dimming the lights in the patient's room 4. Giving a patient a cup of coffee 5. Monitoring for the effect of the sleeping medication that was given

Answer: 1, 2, 3. Giving the patient a back rub, turning on quiet music, and dimming the lights are all appropriate sleep-hygiene measures. These activities are within the scope of practice for assistive personnel. 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

Which statements from a patient indicate an understanding of behaviors that will promote sleep? (Select all that apply.) 1. "I will not watch television in bed." 2. "I will not drink caffeine later in the day." 3. "A short nap late in the evening will lead to a more restful night of sleep." 4. "I am going to start eating dinner closer to my bedtime" 5. "I will start to exercise regularly during the day.

Answer: 1, 2, 5. To promote sleep, you should not watch television in bed. The noise of television can be disruptive and adds stimulation that is disruptive to sleep. Caffeine should not be consumed late in the day because it can cause wakefulness at bedtime. A regular exercise program completed in the morning is part of sleep hygiene practices and can help promote sleep. Exercise or eating a meal should not be done right before bed because sleep can be disrupted.

Which nursing intervention(s) best promote(s) effective sleep in an older adult? (Select all that apply.) 1. Limit fluids 2 to 4 hours before sleep. 2. Ensure that the room is completely dark. 3. Ensure that the room temperature is comfortably cool. 4. Provide warm covers. 5. Encourage walking an hour before going to bed.

Answer: 1, 3, 4. Limiting fluids reduces incidence of nocturia. For safety reasons complete darkness should be avoided. A soft nightlight lessens the chance of a fall should the patient require ambulation to the bathroom during the night. Older adults sometimes require extra blankets or covers to achieve a comfortable sleeping temperature. Keeping the bedroom temperature at a cooler, comfortable temperature is conducive to sleep

Which statement made by the patient indicates an understanding of sleep-hygiene practices? 1. "I usually drink a cup of warm milk in the evening to help me sleep." 2. "If I exercise right before bedtime, I will be tired and fall asleep faster." 3. "I know it does not matter what time I go to bed as long as I am tired." 4. "If I use hypnotics for a long time, my insomnia will be cured."

Answer: 1. Drinking a warm beverage such as milk in the evening can help promote sleep. Milk contains l-tryptophan, which helps promote sleep. Other snacks that contain l-tryptophan, such as cereal and cheese and crackers, may also promote sleep. Exercising right before bedtime may prevent sleep. Good sleep hygiene includes going to bed and getting up at the same time daily. Hypnotics can help with insomnia but are not curative.

The nurse is contacting the health care provider about a patient's sleep problem. Place the steps of the SBAR (situation, background, assessment, recommendation) in the correct order. 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 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).

Answer: 2, 1, 4, 3. SBAR is Situation, Background, Assessment, and Recommendation. This is the correct sequence of steps in SBAR for the patient and sleep problem

Which nursing interventions are appropriate to include in a plan of care to promote sleep for patients who are hospitalized? (Select all that apply.) 1. Give patients a cup of coffee 1 hour before bedtime. 2. Plan vital signs to be taken before the patients are asleep. 3. Turn television on 15 minutes before bedtime. 4. Have patients follow at-home bedtime schedule. 5. Close the door to patients' rooms at bedtime.

Answer: 2, 4, 5. Bedtime routines relax patients in preparation for sleep. Patients in the hospital should follow their at-home bedtime routine. Taking vital signs before sleep onset prevents disruption of sleep and improves sleep duration and quality. Closing the door to patients' rooms decreases noise that can disrupt sleep. Noise is one of the main factors contributing to poor sleep in hospitalized patients. Excessive stimulation, such as watching television, should be avoided close to bedtime

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? 1. "Antihistamines are better than prescription medications because prescription medications can cause a lot of problems." 2. "Antihistamines should not be used because they can cause confusion and increase your risk of falls." 3. "Antihistamines are effective sleep aids because they do not have many side effects." 4. "Over-the-counter medications when combined with sleep hygiene measures are a good plan for sleep.

Answer: 2. 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 an 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? 1. "I'll give the baby a bottle to help her fall asleep." 2. "We'll place the baby on her back to sleep." 3. "We put the baby's stuffed animals in the crib to make her feel safe." 4. "I know the baby will not need to be fed until morning."

Answer: 2. 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.

A nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? 1. "I feel refreshed when I wake up in the morning." 2. "I use soft music at night to help me relax." 3. "It takes me about 45 to 60 minutes to fall asleep." 4. "I take the pain medication for my leg pain about 30 minutes before I go to bed."

Answer: 3. 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