Patho Exam 3 Ch 17

c

A client has been taking nonprescription melatonin to help the fall asleep and remain asleep throughout the night. The client states that it worked for a brief period but now requires additional help. Which pharmacologic melatonin receptor agonists should the nurse anticipate being prescribed by the healthcare provider? Diphenhydramine (Benadryl) Zolpidem (Ambien) Ramelteon (Rozerem) Alprazolam (Xanax)

d) Maintaining a regular sleep-wake schedule Pg. 448 Non-24-Hour Sleep-Wake Rhythm Disorder Strengthening the light-dark cycle is a treatment option for both blind and sighted people with FRSD, as the circadian visual pathway remains intact in some blind people. Treatment for blind people also includes maintaining a regular sleep-wake schedule and melatonin. Bright-light exposure and melatonin administration have been shown to be effective treatments for FRSD in sighted people.

A client who is considered legally blind is diagnosed with a free-running sleep disorder (FRSD) after frequent reports of difficulty sleeping. Which scenario would the nurse advise for this client? a) Listening to music while sleeping b) Staying awake as long as possible in the evening c) Wearing a eye mask during daylight hours d) Maintaining a regular sleep-wake schedule

a

A client who is hospitalized in the intensive care unit after having a myocardial infarction (MI) informs the nurse that he needs a sleeping pill because of the inability to sleep in that environment. The client states that he has never had trouble sleeping before. Which type of insomnia does the nurse recognize the client is having? Acute insomnia Chronic insomnia Irregular sleep-wake rhythm Free-running sleep disorder

Try taking a warm bath before bedtime. Stretch or walk to manipulate the leg muscles for relief. Ensure the bedroom is a cool temperature and darkened. Deliberately massage the muscles to provide relief.

A client with mild symptoms of restless leg syndrome (RLS) does not want to take medication. The nurse should educate the client about which activity(ies)/intervention(s) that may be beneficial? Select all that apply. Drink a warm beverage such as tea or cocoa at bedtime. Try taking a warm bath before bedtime. Stretch or walk to manipulate the leg muscles for relief. Ensure the bedroom is a cool temperature and darkened. Deliberately massage the muscles to provide relief.

d) Stage 1 Pg. 444 NREM Sleep Stage 1 consists of low-voltage, mixed-frequency, alpha-wave EEG activity. It occurs at sleep onset and is a brief transitional stage between wakefulness and true sleep. During this stage, people can be easily aroused simply by touching them, calling their name, or quietly closing a door.

A nurse enters a client's room to administer medications and finds the client resting in bed with eyes closed. The nurse checks the client's name bracelet and calls the client by name. The client arouses easily and states, "I must have dozed off." Which stage of sleep does the nurse recognize this client was in? a) Stage 3 b) Stage 4 c) Stage 2 d) Stage 1

Insomnia Daytime sleepiness Decreased alertness and performance

A nurse has just returned to her home on the East Coast of the United States after attending a nursing conference on the West Coast. Which symptoms are related to circadian rhythm and may be experienced by the nurse? Select all that apply. Dependent edema Ear pain Insomnia Daytime sleepiness Decreased alertness and performance

c) Irregular sleep-wake rhythm Pg. 448 Irregular Sleep-Wake Rhythm Irregular sleep-wake syndrome is characterized by a lack of consistent pattern to the sleep-wake cycle. It is most common in older adults with neurological disorders, particularly Alzheimer disease.

A nurse is caring for a client diagnosed with Alzheimer disease who sleeps at irregular intervals, having no consistent sleep-wake cycle. The nurse suspects that the client is experiencing: a) Advanced sleep phase syndrome b) Delayed sleep phase syndrome c) Irregular sleep-wake rhythm d) Free-running sleep disorder

d) 16-20 hours Pg. 455 Sleep Patterns in Children Newborns (0-2 months) usually sleep approximately 16 to 20 hours per day.

A nurse is caring for a client who is 2 days postpartum. The client asks the nurse how many hours of the day she should expect her infant to sleep. What is the most appropriate answer? a) 8-10 hours b) 10-12 hours c) 12-14 hours d) 16-20 hours

c) Sleep paralysis Pg. 451 Narcolepsy Sleep paralysis occurs on falling asleep or awakening, during which people find themselves unable to move, speak, or even breathe deeply. Narcolepsy is a syndrome characterized by abnormal sleep tendencies including excessive daytime sleepiness, disturbed nocturnal sleep, and manifestations related to rapid eye movement sleep such as cataplexy. Cataplexy is characterized by brief periods of muscle weakness brought about by emotional reactions such as laughter, anger, or fear. Hypnagogic hallucinations are vivid hallucinations that occur at the onset of sleep.

A nurse is caring for a client who reports a terrifying experience of being unable to move, speak, or take a deep breath upon awakening. What has the client likely experienced? a) Narcolepsy b) Cataplexy c) Sleep paralysis d) Hypnagogic hallucinations

a) Avoid caffeinated beverages c) Maintain a quiet sleep environment that is neither too cold nor too hot d) Establish a regular wakeup time Pg. 450 Treatment Sleep hygiene refers to a set of rules and information about personal and environmental activities that affect sleep. These rules include establishing a regular wakeup time to help set the circadian clock and regularity of sleep onset, maintaining a practice of sleeping only as long as needed to feel refreshed, providing a quiet environment that is neither too hot nor too cold, and avoiding the use of alcohol and caffeine before going to bed.

A nurse is discussing sleep hygiene with a client who reports having chronic insomnia. Which are appropriate recommendations? Select all that apply. a) Avoid caffeinated beverages b) Drink a glass of wine before bedtime c) Maintain a quiet sleep environment that is neither too cold nor too hot d) Establish a regular wakeup time

a) Methylphenidate b) Modafinil c) Armodafinil Pg. 451 Diagnosis and Treatment Pharmacological treatment of narcolepsy focuses on the use of stimulant medications such as methylphenidate, amphetamines (e.g., Adderall, methamphetamine), modafinil, and armodafinil, which are FDA approved for the treatment of narcolepsy. Phenytoin and carbamazepine are used for clients with seizure activity and other neurologic conditions.

A nurse is instructing a client about the medication that will be needed for the treatment of narcolepsy. Which types of medication may be used to treat this disorder? Select all that apply. a) Methylphenidate b) Modafinil c) Armodafinil d) Carbamazepine e) Phenytoin

a

A nurse is obtaining a client's sleep history. The client asks about obtaining a prescription for melatonin. What is the nurse's best response? "Melatonin is available without a prescription, but speak to your health care provider about it." "Melatonin is a natural sleep aid, so you do not need a prescription." "Melatonin has not been proven to aid in improving sleep." "Melatonin does not require a prescription, but is regulated and considered safe."

b) "Melatonin is thought to be safe for short-term use" Pg. 446 Melatonin For short-term usage, melatonin is though to be safe; however, it is not regulated by the Food and Drug Administration. Although synthetic preparations are available without prescription in health food stores and pharmacies, their potencies, purity, safety, and effectiveness cannot be ensured.

A nurse is obtaining a client's sleep history. The client asks the nurse if taking melatonin is safe. What is the nurse's best response? a) "Melatonin is not safe unless it is prescribed for you" b) "Melatonin is thought to be safe for short-term use" c) "Melatonin is regulated by the Food and Drug Administration; therefore, it is safe to take it" d) "Melatonin is a potent and pure sleep aid"

d

A nurse is obtaining a sleep history from a 19-year-old college student. The student states, "I sleep through my 8 AM class more often than not. I just can't seem to wake up at that early hour." The nurse suspects that the student is experiencing: Chronic insomnia Advanced sleep phase syndrome Obstructive sleep apnea Delayed sleep phase syndrome (DSPS)

a) Alcohol induces sleep initially and disrupts and fragments sleep Pg. 450 Chronic Insomnia Disorder Although alcohol initially may induce sleep, it often causes disrupted and fragmented sleep. Sleep also is disrupted in people undergoing alcohol- or sleep-medication withdrawal. Alcohol also can lead to poor quality sleep and is related to insomnia.

A nurse is performing an intake assessment for a client admitted to the hospital with hypertension. The client informs the nurse that she drinks alcohol in the evening to help her sleep. What does the nurse know about the induction of sleep through alcohol intake? a) Alcohol induces sleep initially and disrupts and fragments sleep b) Alcohol along with the concurrent use of melatonin in moderation will help with acute insomnia c) Alcohol is a stimulant and will cause a delay in the induction of sleep d) Alcohol will help induce a deep sleep that the client will awaken from refreshed in the morning

c

A nurse who works the night shift reports an inability to fall asleep at night when not on duty. This inability is related to which disruption? Estrogen level Diurnal rhythm Circadian rhythm Oxygen level

d) Beginning sleep at noon rather than earlier in the morning e) Darkening the bedroom Pg. 449 Shift Work Disorder Beginning sleep at noon rather than earlier in the morning may produce a more normal sleep period in relation to shift onset. Sleeping in absolute darkness during daytime by using blackout shades or eye masks may benefit the night worker's sleep. Exercise immediately before going to bed is not recommended. Tea contains caffeine which may inhibit sleep. A number of drugs can lead to poor-quality sleep. Drugs commonly related to poor sleep are caffeine, nicotine, stimulating antidepressants, alcohol, and recreational drugs.

A nurse working the night shift is unable to fall asleep when morning comes and the shift is over. Which activities may promote sleep for a night-shift worker? Select all that apply. a) Drinking hot tea b) Ask for a prescription for an antidepressant c) Exercise after work before going to bed d) Beginning sleep at noon rather than earlier in the morning e) Darkening the bedroom

a

A parent brings a 10-year-old child to the clinic because of sleepwalking at least two to three times per week. The parent is very concerned and asks the nurse what should be done when the child is found to be sleepwalking. What is the nurse's best response? "Make sure the environment is safe and place bolts on doors and windows." "Have the child stay up later in the evening so he or she will sleep throughout the night." "Immediately wake the child up so that he or she will not come to harm while wandering." "Administer a sleeping pill to the child so that sleep will be deep enough that he or she will not arise during the night."

a) Delayed sleep phase syndrome (DSPS) Pg. 448-449 Delayed and Advanced Sleep-Wake Phase Disorder The main symptoms of DSPS are extreme difficulty falling asleep at a conventional hour of the night and awakening on time in the morning for school, work, or other responsibilities. In adults, there is evidence of association between some psychopathologic disorders and DSPS. DSPS is most common in adolescents whose frustrated parents cannot wake them up in time for school and have trouble getting them to go to bed at night. FRSD consists of a lack of synchronization between the internal sleep-wake rhythm and the external 24-hour day. ISWR is characterized by a lack of consistent pattern to the sleep-wake cycle.

A parent brings a 15-year-old adolescent into the clinic, stating "I cannot wake him up in the morning. He has been late for school several times and I do not know what to do any longer." Which sleep syndrome is the nurse aware is common in adolescents? a) Delayed sleep phase syndrome (DSPS) b) Acute shifts in the sleep-wake cycle c) Irregular sleep-wake rhythm (ISWR) d) Free-running sleep disorder (FRSD)

b) Sleep terrors Pg. 454 Sleep Walking and Sleep Terrors Sleep terrors are marked by repeated episodes of awakening from sleep. They usually occur during the first third of the night lasting between 30 seconds and 3 minutes. The peak onset is usually between 5 and 7 years of age. In a typical episode, the child sits up abruptly in bed, appears frightened, and demonstrates signs of extreme anxiety, including dilated pupils, excessive perspiration, rapid breathing, and tachycardia.

A parent brings a 6-year-old child in for a wellness checkup and tells the nurse that the child sometimes wakes up screaming at night. When the parent goes to check on the child, the parent observes the child "sitting up in bed, screaming, sweating, and breathing rapidly." The nurse knows that these symptoms may indicate: a) Nightmares b) Sleep terrors c) Hypersomnia d) Sleep walking

d) Injury during an episode of sleepwalking Pg. 454 Sleep Walking and Sleep Terrors Sleepwalking is common in children between the ages of 5 and 12 years. It involves repeated episodes of complex motor movements that lead to leaving the bed and walking without the child being conscious of the episode or remembering that it occurred. As with sleep terrors, it normally occurs in non-rapid-eye movement sleep stages 3 and 4 during the first third of the sleep period. The primary concern is injury during an episode. Children may bump into things, fall down stairs, or even leave their home during an episode. Therefore, gates should be placed across stairs and windows and doors should be locked so the child cannot leave the house.

A parent informs the nurse that their family was on vacation, staying in a hotel, and woke up to the sound of a knock at the door. When they opened the door, their 8-year-old child was standing at the door not knowing where he was. This was not the first occurrence of sleepwalking for this child. Which objective should be the priority concern? a) Finding the cause of the sleepwalking b) Type of medication allergy the child has c) How many episodes a week the child is having d) Injury during an episode of sleepwalking

b) "The onset of puberty often lengthens the circadian rhythm, causing an increase in evening wakefulness" Pg. 446 Circadian Rhythms Circadian rhythms control the sleep-wake patterns; hormonal changes during puberty affect the length of these rhythms, accounting for the changes in sleep patterns. The need for medication is not supported. While teenagers are susceptible to peer pressure and often engage in rebellious behavior, that is not the etiology for the change in adolescent sleep patterns.

A parent of a 14-year-old teen expresses concern over the late hours the teen keeps. Which response by the nurse best explains a possible etiology for the late hours? a) "Your teen needs to be prescribed sleep medications to regulate his sleep patterns" b) "The onset of puberty often lengthens the circadian rhythm, causing an increase in evening wakefulness" c) "Your teenager is likely responding to pressure from his peers to stay up late" d) "Teenagers often rebel against parental rules; his body will assure he gets the sleep he needs"

a) Behavioral therapies, counseling, and education may be of some use for the client Pg. 456 Sleep and Sleep Disorders in Older Adults Behavioral therapies may be beneficial in the treatment of insomnia. Drugs may be of use in the short term and should be used judiciously rather than completely avoided. The efficacy of melatonin is unproven. The client's insomnia would likely be categorized as secondary insomnia, given the obvious contribution of stressors.

A physician is providing care for a 40-year-old client who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The client is requesting a prescription for "sleeping pills." Which statement forms a valid basis for the care provider's plan for treatment? a) Behavioral therapies, counseling, and education may be of some use for the client b) Melatonin supplements will be the safest and most effective long-term pharmacologic treatment c) Sedatives and hypnotic drugs will not provide safe relief of the man's health problem d) The man is suffering from primary insomnia

d) Rapid eye movement sleep Pg. 444 Brain Waves Most dreaming occurs in rapid eye movement (REM sleep). Stages 1, 3, and 4 are parts of non-REM sleep, and dreaming does occur in most stages of sleep.

In which stage of sleep does dreaming occur most frequently? a) Non-rapid eye movement sleep b) Stage I c) Stages 3 and 4 d) Rapid eye movement sleep

c) Symptoms that become worse in the evening Pg. 452 Restless Legs Syndrome Diagnosis of RLS is based on a history of (1) a compelling urge to move the legs, usually associated with paresthesias; (2) motor restlessness, as seen by activities such as pacing, tossing and turning in bed, or rubbing the legs; (3) symptoms that become worse at rest and are relieved by activity; and (4) symptoms that are worse in the evening or at night.

Restless legs syndrome (RLS) is a disorder that has its peak onset in middle age. Diagnosis of RLS is based on a history of what? a) Symptoms that become worse in the afternoon b) Motor relaxation c) Symptoms that become worse in the evening d) Compelling urge to rest legs

d) Measuring the combined activity among neurons to a given stimulus Pg. 444 Brain Waves During the recording of an EEG, the postsynaptic potentials are averaged and filtered to improve the quality of the signal. As such, the EEG does not measure the activity of a single neuron, but instead the combined activity and cross talk among many hundreds of neurons responding to a given stimulus.

The client states having periods of being "unaware of surroundings" and "falling asleep during the day." The client is scheduled for an electroencephalogram (EEG) to determine if there is seizure activity or a sleep disturbance. What will the nurse teach the client about the purpose of the EEG? a) Measuring the activity of a single neuron b) Using low voltage to stimulate the brain into activity to simulate a seizure c) Measuring periods of apnea and hypopnea d) Measuring the combined activity among neurons to a given stimulus

d) Lead the client back to bed Pg. 454 Sleepwalking and Sleep Terrors No attempt should be made to interrupt the sleepwalking event because such efforts may be frightening. Restraints and CPAP mask are not treatments for sleepwalking.

The nurse has a client who appears to be sleepwalking. Which intervention would be most appropriate for the nurse? a) Apply a continuous positive air pressure (CPAP) mask to the client b) Awaken the client and reorient the client to his surroundings c) Apply a vest restraint to maintain the client's safety d) Lead the client back to bed

Inability to concentrate Irritability Anxiety?

The nurse is caring for a client in the intensive care unit who has been unable to sleep well for days. Which symptoms may be associated with sleep deprivation? Select all that apply. Decreased urinary output Inability to concentrate Irritability Anxiety

d) Cataplexy Pg. 451 Narcolepsy Cataplexy is characterized by brief periods of muscle weakness brought about by emotional reactions such as laughter, anger, or fear. Sleep paralysis is a terrifying experience that occurs on falling asleep or on awakening, during which people find themselves unable to move, speak, or even breathe deeply. Hypnagogic hallucinations are vivid hallucinations that occur at the onset of sleep. Hypnopompic hallucinations are hallucinations that may occur on awakening.

The nurse is caring for a client who has been diagnosed with narcolepsy. The client reports that his muscles become extremely weak when he becomes excited. The nurse understands that the client is describing which of the following? a) Hypnagogic hallucinations b) Hypnopompic hallucinations c) Sleep paralysis d) Cataplexy

a) "That must be annoying. Sometimes getting up and walking for a while helps" Pg. 452 Restless Legs Syndrome The client is describing restless legs syndrome (RLS). Symptoms of RLS become worse at rest and are relieved by activity.

The nurse is caring for a client who reports, "My legs just won't rest. I can't stop moving them!" Which statement is an appropriate response by the nurse? a) "That must be annoying. Sometimes getting up and walking for a while helps" b) "Tell me how that makes you feel" c) "Let me get you some orange juice. The potassium will help" d) "Let me message your legs for you"

a

The nurse quietly enters a client's room and checks the client's intravenous infusion using a flashlight. In spite of the nurse being quiet and not turning on the lights, the client awakens easily. The client was most likely in which of sleep cycle? Stage 1 Stage 4 Stage 3 Stage 2

d

The spouse of a blind client calls the nurse practitioner to ask what is causing the client such a difficult time sleeping and what can be done. What might the client be suffering from, and which would be the most accurate response? Obstructive sleep apnea; administer melatonin daily. Free-running sleep disorder; get a prescription for a sleep aid. Chronic insomnia; use bright light therapy prior to sleep. Non-24 hour sleep-wake syndrome; regulate wake and sleep times.

c) 90-110 minutes Pg. 444 Sleep Stages A complete sleep cycle takes about 90-110 minutes.

What is the length of time a client undergoes a complete sleep cycle? a) 30-60 minutes b) 60-80 minutes c) 90-110 minutes d) 120-160 minutes

c) Risk for injury Pg. 456 Sleepwalking Because sleepwalking can be dangerous, it is important that the environment be safe. Dangerous objects should be removed and bolts should be placed on doors and windows.

What is the priority nursing concern for a client who reports sleepwalking? a) Impaired oxygenation b) Altered level of consciousness c) Risk for injury d) Sensory deprivation

c) Impaired airway Pg. 452 Obstructive Sleep Apnea All of the listed outcomes may be experienced by the client, but the priority is impaired airway.

When caring for a client with diagnosed obstructive sleep apnea, for what priority nursing assessment should the nurse be monitoring? a) Pain b) Fatigue c) Impaired airway d) Sexual dysfunction

a) Alzheimer disease Pg. 456 Sleep and Sleep Disorders in Older Adults Persons with Alzheimer disease often have increased periods of nighttime awakening and daytime napping. The other diseases are not associated with increased periods of nighttime awakening and daytime sleeping.

Which disease often results in more frequent periods of nighttime awakening and daytime sleeping? a) Alzheimer disease b) Parkinson disease c) Amyotrophic lateral sclerosis (ALS) d) Huntington disease

Bronchodilators Decongestants Corticosteroids

Which medications may cause sleep disturbance? Select all that apply. Bronchodilators Decongestants Aspirin Vitamins Corticosteroids

c) REM sleep Pg. 445 REM Sleep Brain activity increases in REM sleep while decreasing in all other stages.

Which sleep stage is characterized by an increase in brain activity? a) Stage 1 b) Stage 3 c) REM sleep d) Stage 4