Prep U Ch. 22 Sleep Disorders
An elderly patient is brought to the clinic by her daughter who informs the nurse that her mother is having terrible nightmares and does not know what to do about them. The patient does not sleep well and is very tired. What does the nurse suspect the diagnostic label to be for this patient? a) Sleep apnea b) Sleep-related movement disorder c) Insomnia d) Parasomnia
Parasomnia Explanation: Parasomnias are primary sleep disorders characterized by unusual or undesirable behaviors during sleep. They interfere with sleep or happen during the threshold between sleep and wakefulness. Examples include nightmares, sleepwalking, and sleep terrors.
Narcolepsy, a disorder characterized by excessive daytime sleepiness and cataplexy (sudden bilateral loss of postural muscle tone), is effectively treated with ... a) SSRIs. b) administration of methylphenidate (Ritalin). c) behavior modification techniques. d) discouraging daytime napping.
b) administration of methylphenidate (Ritalin).
A nursing student correctly identifies which of the following to be true about adolescence and sleep? a) Inadequate sleep does not interfere with daily activities. b) Circadian changes in sleep timing, particularly later bedtimes, may be normal in adolescence. c) Teenagers normally get at least 9 hours of sleep. d) Experts say that teenagers need approximately 12 hours of sleep each night.
Circadian changes in sleep timing, particularly later bedtimes, may be normal in adolescence. Explanation: Circadian changes in sleep timing, particularly later bedtimes, may be normal in adolescence. Experts say teenagers need about 9 hours of sleep but they usually get 7 to 8 hours. Inadequate sleep is a health concern for pediatric populations
A nurse is reading a journal article about sleep-wake disorders. The article mentions a REM disorder. Which of the following would the nurse expect to be discussed? a) Sleep walking b) Nightmare disorder c) Restless leg syndrome d) Sleep terrors
Nightmare disorder Explanation: Nightmare disorder is a rapid eye movement (REM) disorder that generally occurs during the second half of the major sleep episode. Non-rapid eye movement (NREM) sleep arousal disorders, including sleepwalking and sleep terror types, usually occur the first third of the major sleep episode. Restless legs syndrome is considered a sleep disorder and is classified as a parasomnia.
Which of the following parasomnias occur primarily in children in the Non-REM stage and may result in emotional experiences that are frightening? a) Confusional arousals b) Sleep terrors c) Sleepwalking d) Nightmares
Sleep terrors Explanation: Sleep terrors occur primarily in children, and in the non-REM sleep stage resulting in frightening thoughts. Nightmares occur in the REM sleep stage.
A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following recent falls and a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? a) "I try my best to get out for a walk after breakfast or after supper." b) "I make it a rule not to drink any alcohol in the evening." c) "I make sure that I take a long nap each afternoon to compensate for my frequent waking at night." d) "I've got a bottle of diazepam at home, but I only take them once or twice a month."
"I make sure that I take a long nap each afternoon to compensate for my frequent waking at night." Explanation: Daytime sleeping can interfere with the normal sleep-wake cycle. Occasional use of hypnotics is acceptable and moderate exercise that is not performed before bedtime can help with insomnia. Alcohol can inhibit sleep in older adults.
A young adult comes to the sleep clinic and reports not getting enough sleep and rest. The client reports needing a drink of alcohol to fall asleep. What should the nurse tell this client about alcohol's effect on sleep? a) "The short-term effects of alcohol will be beneficial to your sleep." b) "Alcohol should not have any effect on your sleep." c) "Long-term effects of alcohol are arousal and wakefulness." d) "Alcohol causes restful sleep; continue using it."
"Long-term effects of alcohol are arousal and wakefulness." Explanation: Many people use alcohol to self-treat insomnia. Although its acute sedative effects lead to drowsiness and shorten sleep latency, long-term effects include arousal and wakefulness. Once alcohol is metabolized (4-5 hours), withdrawal results in shallow and disturbed sleep as well as other symptoms.
A client asks the nurse, "What causes insomnia?" Which response by the nurse would be most appropriate? a) "No one factor is associated with causing insomnia." b) "It is one of the few disorders caused by a chemical imbalance." c) "Most cases involve some type of posttraumatic stress." d) "Individuals with insomnia have an underlying mental health problem."
"No one factor is associated with causing insomnia." Explanation: Many factors affect sleep, but there is no one factor that causes insomnia. One of the major reasons for insomnia is depression, which accounts for most cases. However, most people with insomnia do not have psychiatric diagnosis
A client asks the nurse, "What causes insomnia?" Which response by the nurse would be most appropriate? a) "No one factor is associated with causing insomnia." b) "Most cases involve some type of posttraumatic stress." c) "It is one of the few disorders caused by a chemical imbalance." d) "Individuals with insomnia have an underlying mental health problem."
"No one factor is associated with causing insomnia." Explanation: Many factors affect sleep, but there is no one factor that causes insomnia. One of the major reasons for insomnia is depression, which accounts for most cases. However, most people with insomnia do not have psychiatric diagnosis.
A nursing instructor is teaching a class on sleep and rest to first year nursing students. The instructor realizes a need for further education when one of the students makes which statement? a) "Changes in sleep patterns may be a sign of other medical conditions." b) "Pain is a cause of sleep disturbance." c) "Sleep disturbance is part of normal aging." d) "Sleep disturbance can be caused by nocturia
"Sleep disturbance is part of normal aging." Explanation: Sleep disturbance is not a normal part of aging; this mistaken belief may be a barrier for clients to seek help for genuine problems. The other statements are true.
A parent of a 14-year-old male expresses concern over the late hours the teen keeps. Which of the following responses by the nurse best explains a possible etiology for the late hours? a) "You are the parent and need to enforce the bed time rules to show who the boss is." b) "The onset of puberty often lengthen the circadian rhythm causing and increase in evening wakefulness." c) "Your teen needs to be prescribed sleep medications." d) "Your teenager is likely being pressured by peers to stay up late and go against your house rules."
"The onset of puberty often lengthen the circadian rhythm causing and increase in evening wakefulness."
A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns? a) "There may be something else going on with your husband such as delirium or a problem with his medications." b) "This is understandably upsetting for you, but as long as the environment is safe it's likely not significant." c) "I'll likely prescribe a benzodiazepine for this when I next see your husband." d) "This is not an uncommon event that often accompanies older age."
"There may be something else going on with your husband such as delirium or a problem with his medications." Explanation: New onset sleepwalking in an older adult is usually a manifestation of another problem such as delirium, drug toxicity or a seizure disorder. It is not a normal age-related change and a benzodiazepine is not a prudent initial treatment.
A nurse is teaching a client with insomnia about stimulus control. Which of the following would the nurse include in the education? a) "You should avoid eating or watching television in your bedroom." b) "You should focus your attention on pleasant images to reduce stress." c) "Let's look at your behavior and thoughts contributing to your problem." d) "Try spending less time in bed along with avoiding any naps."
"You should avoid eating or watching television in your bedroom." Explanation: Stimulus control is a technique used when the bedroom environment no longer provides cues for sleep but has become the cue for wakefulness. Patients are instructed to avoid behaviors in the bedroom incompatible with sleep, including watching television, doing homework, and eating. This allows the bedroom to be reestablished as a stimulus for sleep. Another behavioral intervention is sleep restriction. Clients often increase their time in bed to provide more opportunity for sleep, resulting in fragmented sleep and irregular sleep schedules. Clients are instructed to spend less time in bed and avoid napping. Relaxation training, such as imagery, is used when patients complain of difficulty relaxing, especially if they are physically tense or emotionally distressed. Cognitive behavior therapy helps to identify maladaptive behaviors and cognition that contribute to insomnia
A nurse working in a sleep laboratory is talking to patients about the importance of adequate sleep. The nurse informs them that the timing and patterns of sleep changes as people age. What does the nurse say is the normal amount of sleep needed for INFANTS? a) 10 to 12 hours b) 18 to 20 hours c) 14 to 15 hours d) 8 to 10 hours
14 to 15 hours Explanation: Infants normally spend more time each day asleep than awake. Their 14 to 15 hours of daily sleep usually consists of one or two naps and 10 to 12 hours of nighttime sleep.
After reviewing information about sleep patterns and changes occurring over the lifespan, a group of nursing students demonstrates understanding when they identify that NEWBORNS require how much sleep per day? a) 17 to 18 hours b) 13 to 14 hours c) 8 to 9 hours d) 11 to 12 hours
17 to 18 hours Explanation: Newborns need 17 to 18 hours of sleep each day, which occurs in 3- to 4-hour episodes throughout the day. By age 6 months, 12 hours of sleep at night and two 1- to 2-hour naps each day are needed. After age 5 years, children gradually need less sleep. Preadolescents need about 10 hours of sleep each night, and napping is rare. A teenager's sleep need is only slightly less, at about 9 hours. During young adulthood, about 8 hours of sleep is needed.
A nurse is reading a journal article about sleep. When reviewing the statistics about the average person in the Unites States, which of the following would the nurse most likely find as the average duration of sleep? a) 9 to 9.5 hours b) 6 to 6.5 hours c) 7 to 7.5 hours d) 8 to 8.5 hours
6 to 6.5 hours Explanation: The average sleep duration of adults in the U. S. has plateaued between 6 and 6.5 hours from a high of 8.5 hours in 1960.
Which of the following individuals would be expected to have the highest risk of developing sleep apnea? a) A man with poorly controlled diabetes and hypertension b) A female with chronic insomnia and atrial fibrillation that is treated with warfarin c) A woman with restless leg syndrome and chronic obstructive pulmonary disease d) A male client with a diagnosis of unstable angina and peripheral vascular disease
A man with poorly controlled diabetes and hypertension Explanation: Male gender, diabetes and hypertension are all associated with sleep apnea. COPD, angina, PVD and atrial fibrillation are not noted to be strongly associated with sleep apnea.
Which of the following findings during sleep observations of clients in a sleep lab would be most likely to be considered pathologic? a) A man experiences periods of apnea of 5 to 15 seconds in duration b) A woman's intrinsic clock involves a sleep-wake cycle that is consistently two hours longer than the actual length of a day c) A woman spends the majority of her sleeping hours in REM sleep d) A man's PCO2 is increased and his PO2 decreased during deep sleep
A woman spends the majority of her sleeping hours in REM sleep Explanation: While vital, REM sleep does not normally occupy the majority of sleeping hours. Brief apneic spells are not uncommon and the circadian rhythm often does not match the 24-hour length of day. It is normal for PCO2 to increase and PO2 to decrease during deep sleep.
Which of the following findings during sleep observations of clients in a sleep lab would be most likely to be considered pathologic? a) A man's PCO2 is increased and his PO2 decreased during deep sleep b) A man experiences periods of apnea of 5 to 15 seconds in duration c) A woman spends the majority of her sleeping hours in REM sleep d) A woman's intrinsic clock involves a sleep-wake cycle that is consistently two hours longer than the actual length of a day
A woman spends the majority of her sleeping hours in REM sleep Explanation: While vital, REM sleep does not normally occupy the majority of sleeping hours. Brief apneic spells are not uncommon and the circadian rhythm often does not match the 24-hour length of day. It is normal for PCO2 to increase and PO2 to decrease during deep sleep.
A physician is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for "sleeping pills" to help him through this time. Which of the following statements forms a valid basis for the physician's plan for treatment? a) Melatonin supplements will be the safest and most effective long term pharmacological treatment b) Behavioral therapies, counseling and education may be of some use for the client c) Sedatives and hypnotic drugs will not provide safe relief of the man's health problem d) The man is suffering from primary insomnia
Behavioral therapies, counseling and education may be of some use for the client Explanation: 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 and his insomnia would likely be categorized as secondary insomnia, given the obvious contribution of stressors.
Problems that nurses who work the night shift may encounter more than those who work day shift include ... a) hyperalertness. b) poor concentration. c) lower alcohol tolerance. d) increased risk of errors.
Daily use of caffeine Explanation: Caffeine is a stimulant that results in delayed sleep onset, decreased total sleep time, increased wake after sleep onset, and decreased REM and slow-wave sleep. Caffeine-containing beverages include coffee, tea, cola, chocolate, and some non-cola soft drinks. Caffeine is also found in over-the-counter (OTC) cold preparations and stimulants.
A client comes to the clinic reporting insomnia that began with depression that was diagnosed about 2 months ago. The client informs the nurse that she goes to bed at the same time each night, drinks a glass of warn milk prior to bedtime, and mediates for 20 minutes before turning out the lights. What does the nurse suspect is the cause of this client's insomnia? a) Meditating prior to bedtime b) Not varying bedtime each night c) Drinking milk prior to bedtime d) Depression
Depression Explanation: Many factors affect sleep, but no single factor causes insomnia. One of the major reasons for insomnia is depression, which accounts for many cases.
A client is telling a nurse about a dream that was beautiful, as if the client was actually in a garden with vivid colors and bright flowers. The client was in which stage of sleep during this dream? a) N3 b) N1 c) N2 d) REM
REM Explanation: REM sleep is the stage when dreams have vivid content, full color, and sounds. The person is difficult to wake at this stage.
Which of the following observations of a female client in a sleep lab would indicate to clinicians that she is in REM sleep? a) Her motor movements are suppressed and muscle tone is flaccid. b) Delta waves are evident on her EEG and heart and respiration rates are slowed. c) Rolling eye movements are observed and she has moderate muscle activity. d) She has a low level of cerebral activity and her EEG indicates low voltage and mixed frequencies.
Her motor movements are suppressed and muscle tone is flaccid. Explanation: REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves and low levels of cerebral activity are associated with stages 1 through 4 of sleep.
Which of the following observations of a female client in a sleep lab would indicate to clinicians that she is in REM sleep? a) Rolling eye movements are observed and she has moderate muscle activity. b) Delta waves are evident on her EEG and heart and respiration rates are slowed. c) Her motor movements are suppressed and muscle tone is flaccid. d) She has a low level of cerebral activity and her EEG indicates low voltage and mixed frequencies.
Her motor movements are suppressed and muscle tone is flaccid. Explanation: REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves and low levels of cerebral activity are associated with stages 1 through 4 of sleep.
Which of the following observations of a female client in a sleep lab would indicate to clinicians that she is in REM sleep? a) She has a low level of cerebral activity and her EEG indicates low voltage and mixed frequencies. b) Delta waves are evident on her EEG and heart and respiration rates are slowed. c) Rolling eye movements are observed and she has moderate muscle activity. d) Her motor movements are suppressed and muscle tone is flaccid.
Her motor movements are suppressed and muscle tone is flaccid. Explanation: REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves and low levels of cerebral activity are associated with stages 1 through 4 of sleep.
A client is diagnosed with narcolepsy. During the interview, the client reports vivid dream-like images when he first falls asleep. The nurse documents this as which of the following? a) Hypnagogic hallucinations b) Daytime sleepiness c) Sleep paralysis d) Cataplexy
Hypnagogic hallucinations Explanation: Hypnagogic hallucinations are intense dreamlike images that occur at sleep onset and usually involve the current environment. Hallucinations can be visual or auditory, such as hearing one's name called or a door slammed. Cataplexy is the bilateral loss of muscle tone triggered by a strong emotion, such as anger or laughter. This muscle atonia can range from subtle (drooping eyelids) to dramatic (buckling knees). Respiratory muscles are not affected. Sleep paralysis, the inability to move or speak when falling asleep or waking up, is often described as terrifying and is accompanied by a sensation of struggling to move or speak. Daytime sleepiness refers to the overwhelming urge to sleep.
An instructor is describing the sleep-wake cycle to a group of nursing students. The instructor determines that the education was successful when the group identifies that the body's biological clock is located in which of the following? a) Hypothalamus b) Temporal lobe c) Frontal cortex d) Pituitary gland
Hypothalamus Explanation: The biologic clock that regulates our circadian rhythms is located in the suprachiasmatic nucleus, an area of the hypothalamus that lies on top of the optic chiasm.
A client who comes to the sleep clinic reports being tired in the morning. Upon further assessment, the client discusses difficulty falling asleep at night and waking up in a bad mood in the morning. The client also acknowledges difficulty staying awake during the day. Which of the following diagnoses would the nurse suspect? a) Depression b) Insomnia c) Restless leg syndrome d) Narcolepsy
Insomnia Explanation: Insomnia refers to difficulty falling asleep or maintaining sleep. Dissatisfaction with sleep quantity is also present. Symptoms of insomnia include difficulty falling asleep, experiencing mood alterations, being tired in the morning, and dozing during the day.
A nurse preceptor working in a sleep clinic informs a graduate that the most common sleep disorder in adults is which of the following? a) Sleep-related breathing disorder b) Insomnia c) Parasomnias d) Sleep-related movement disorders
Insomnia Explanation: Insomnia, which is a perception of insufficient sleep or not feeling rested after habitual sleep, is the most common sleep disorder in adults.
After teaching a group of nursing students about sleep-wake disorders, the instructor determines that the education was successful when the students identify which of the following as the most prevalent disorder? a) Insomnia b) Obstructive sleep apnea syndrome c) Parasomnia d) Narcolepsy
Insomnia Explanation: Of all the sleep-wake disorders and sleep-related problems, insomnia is the most prevalent.
Which type of circadian rhythm sleep disorder occurs across time zones? a) Delayed sleep type b) Advanced sleep phase type c) Shift type work d) Jet lag type
Jet lag type Explanation: Jet lag occurs after travel across time zones, particularly in coast-to-coast and international travel. Individuals with delayed sleep phase type or "night owls" tend to be unable to fall asleep between 2 and 6 AM; hence, their whole sleep patterns shift, and they have difficulty rising in the morning. The endogenous sleep-wake cycle is normal but is mismatched to the imposed hours of shift work. In advanced sleep phase type, the opposite of the night owls occurs. These individuals are "larks" or earlier risers. They are unable to stay awake in the evening and consistently wake up early.
A nursing student has learned that the sleep-wake cycle is partially regulated by which of the following hormones? a) Estrogen b) Melatonin c) Cortisol d) Cholecystokinin
Melatonin Explanation: Melatonin, a hormone released from the pineal gland, aids in the regulation of the sleep-wake cycle
A nursing student has learned that the sleep-wake cycle is partially regulated by which of the following hormones? a) Estrogen b) Melatonin c) Cortisol d) Cholecystokinin
Melatonin Explanation: Melatonin, a hormone released from the pineal gland, aids in the regulation of the sleep-wake cycle.
A client is prescribed Ramelteon (Rozerem). The nurse understands that this drug is classified as which of the following? a) Sedating antidepressant b) Benzodiazepine c) Melatonin receptor agonist d) Nonbenzodiazepine
Melatonin receptor agonist Explanation: Ramelteon is classified as a melatonin receptor agonist. Triazolam is an example of a benzodiazepine. Zolpidem is an example of a nonbenzodiazepine. Trazodone is an example of a sedating antidepressant.
A nurse walks into a client's room to administer medications and finds the client sitting up in a chair. He is holding the newspaper but appears to be sleeping and not reading. His wife tells the nurse that he does this all the time and sometimes falls asleep while driving. For what should the nurse assess this client? a) Insomnia b) Sleep apnea c) Restless leg syndrome d) Narcolepsy
Narcolepsy Explanation: Narcolepsy is an overwhelming urge to sleep that can occur at anytime of the day, regardless of the amount of sleep at night.
When performing a nursing history with a client reporting a sleep disturbance, it is important to assess for which potential contributing factor to sleep difficulties? a) Recent cessation of smoking b) Chronic stress c) Use of over-the-counter antihistamines d) Daily use of caffeine
Narcolepsy Explanation: Narcolepsy is an overwhelming urge to sleep that can occur at anytime of the day, regardless of the amount of sleep at night.
A nurse is reading a journal article about sleep-wake disorders. The article mentions a REM disorder. Which of the following would the nurse expect to be discussed? a) Restless leg syndrome b) Nightmare disorder c) Sleep terrors d) Sleep walking
Nightmare disorder Explanation: Nightmare disorder is a rapid eye movement (REM) disorder that generally occurs during the second half of the major sleep episode. Non-rapid eye movement (NREM) sleep arousal disorders, including sleepwalking and sleep terror types, usually occur the first third of the major sleep episode. Restless legs syndrome is considered a sleep disorder and is classified as a parasomnia.
Which of the following motor disorders of sleep can be life threatening? a) Obstructive apnea b) Narcolepsy c) Restless legs syndrome d) Periodic limb movement disorder
Obstructive apnea Explanation: Obstructive apnea causes poor ventilation, poor quality sleep, and daytime sleepiness - at best. At worst, it can contribute to depression, auto- and work-related accidents, cardiac dysrhythmias, and hypertension. Severe apnea can lead to pulmonary hypertension, polycythemia, or cor pulmonale. Periodic limb movement disorder and restless legs syndrome, although distressing and possibly indicative of disease, are not of themselves life threatening. Narcolepsy is not a motor disorder of sleep.
Which of the following motor disorders of sleep can be life threatening? a) Periodic limb movement disorder b) Restless legs syndrome c) Narcolepsy d) Obstructive apnea
Obstructive apnea Explanation: Obstructive apnea causes poor ventilation, poor quality sleep, and daytime sleepiness - at best. At worst, it can contribute to depression, auto- and work-related accidents, cardiac dysrhythmias, and hypertension. Severe apnea can lead to pulmonary hypertension, polycythemia, or cor pulmonale. Periodic limb movement disorder and restless legs syndrome, although distressing and possibly indicative of disease, are not of themselves life threatening. Narcolepsy is not a motor disorder of sleep.
A client comes to the sleep clinic and reports fatigue and daytime sleepiness. Assessment reveals a weight gain of 40 lbs over the last year following smoking cessation and a history of gastroesophageal reflux disease (GERD). The client's wife says that her husband snores so loudly, she cannot remember the last time that she slept well. From what should the nurse suspect this client is suffering? a) Obstructive sleep apnea syndrome b) Narcolepsy c) Restless leg syndrome d) Insomnia
Obstructive sleep apnea syndrome Explanation: Obstructive sleep apnea syndrome is the most commonly diagnosed breathing-related sleep disorder. It is characterized by snoring during sleep and episodes of sleep apnea that can disrupt sleep and contribute to daytime sleepiness.
In which stage of sleep does dreaming occur most frequently? a) Non-Rapid Eye Movement Sleep b) Stage I c) Stage 3 and 4 d) Rapid Eye Movement Sleep
Rapid Eye Movement Sleep Explanation: Most dreaming occurs in REM sleep. Stage 1, 3 and 4 are parts of Non-REM sleep, and dreaming does occur in most stages of sleep.
An elderly patient is brought to the clinic by her daughter who informs the nurse that her mother is having terrible nightmares and does not know what to do about them. The patient does not sleep well and is very tired. What does the nurse suspect the diagnostic label to be for this patient? a) Sleep apnea b) Sleep-related movement disorder c) Parasomnia d) Insomnia
Parasomnia Explanation: Parasomnias are primary sleep disorders characterized by unusual or undesirable behaviors during sleep. They interfere with sleep or happen during the threshold between sleep and wakefulness. Examples include nightmares, sleepwalking, and sleep terrors.
To treat transient insomnia, it is suggested that good sleep hygiene habits be established. What is an example of sleep hygiene? a) Taking a prescribed dosage of sedatives routinely b) Watching television or reading until falling asleep c) Taking a warm bath at night to promote good hygiene d) Setting up a normal bedtime and awakening time
Setting up a normal bedtime and awakening time Explanation: Good sleep hygiene includes setting normal sleep and wake times to help set the circadian clock, sleeping only as long as needed to feel refreshed, and providing a quiet sleep environment. Each of the other options is not recommended to develop good sleep hygiene.
Sleep disturbances may be caused by multiple factors. Which of the following is not a common contributor to sleep disturbances? a) Prolonged periods of wakefulness b) Length of daylight hours between winter and summer months c) Working the occasional night shift d) Rapid geographical relocation across several time zones
Prolonged periods of wakefulness Explanation: Homeostasis is the coordinated physiological processes that maintain most steady states in an organism. The need for sleep increases as the time awake increases. Prolonged periods of wakefulness result in decreased alertness, increased sleepiness, and greater amounts of slow-wave (NREM stage 4) sleep. But once sleep occurs, homeostasis is accomplished and the accumulated "sleep debt" is replenished. The client awakes feeling rested.
Sleep disturbances may be caused by multiple factors. Which of the following is not a common contributor to sleep disturbances? a) Length of daylight hours between winter and summer months b) Working the occasional night shift c) Prolonged periods of wakefulness d) Rapid geographical relocation across several time zones
Prolonged periods of wakefulness Explanation: Homeostasis is the coordinated physiological processes that maintain most steady states in an organism. The need for sleep increases as the time awake increases. Prolonged periods of wakefulness result in decreased alertness, increased sleepiness, and greater amounts of slow-wave (NREM stage 4) sleep. But once sleep occurs, homeostasis is accomplished and the accumulated "sleep debt" is replenished. The client awakes feeling rested.
A client is telling a nurse about a dream that was beautiful, as if the client was actually in a garden with vivid colors and bright flowers. The client was in which stage of sleep during this dream? a) REM b) N3 c) N2 d) N1
REM Explanation: REM sleep is the stage when dreams have vivid content, full color, and sounds. The person is difficult to wake at this stage.
A client visiting the sleep clinic participates in a sleep study and is diagnosed with obstructive sleep apnea. What does the nurse explain as the cause of this disorder? a) Collapse of the lower respiratory tract b) Repetitive episodes of reduced airflow c) Repetitive episodes of extra airflow d) Too much airflow
Repetitive episodes of reduced airflow Explanation: Obstructive sleep apnea is associated with repetitive episodes of reduced airflow or cessation of airflow resulting from collapse of the upper airway.
A client visiting the sleep clinic participates in a sleep study and is diagnosed with obstructive sleep apnea. What does the nurse explain as the cause of this disorder? a) Repetitive episodes of extra airflow b) Too much airflow c) Collapse of the lower respiratory tract d) Repetitive episodes of reduced airflow
Repetitive episodes of reduced airflow Explanation: Obstructive sleep apnea is associated with repetitive episodes of reduced airflow or cessation of airflow resulting from collapse of the upper airway.
Which of the following is a priority when caring for clients diagnosed with insomnia? a) Safety b) Mobility c) Nutrients d) Security
Safety Explanation: Safety is a priority for people with primary insomnia. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Nutrients, mobility, and security are not priorities in this client population.
To treat transient insomnia, it is suggested that good sleep hygiene habits be established. What is an example of sleep hygiene? a) Watching television or reading until falling asleep b) Taking a warm bath at night to promote good hygiene c) Taking a prescribed dosage of sedatives routinely d) Setting up a normal bedtime and awakening time
Setting up a normal bedtime and awakening time Explanation: Good sleep hygiene includes setting normal sleep and wake times to help set the circadian clock, sleeping only as long as needed to feel refreshed, and providing a quiet sleep environment. Each of the other options is not recommended to develop good sleep hygiene.
A client tells the nurse that he goes to bed and turns the lights out at 10 PM, but doesn't fall asleep until around 11 PM. The nurse documents this time as which of the following? a) Sleep architecture b) Circadian rhythm c) Sleep efficiency d) Sleep latency
Sleep latency Explanation: Sleep latency is the time period measured from "lights out," or bedtime, to initiation of sleep. Sleep architecture is the pattern of non-rapid eye movement (NREM) and rapid eye movement (REM) that are in about a 90- to 110-minute cycle. Sleep occurs in stages, and the timing of sleep is regulated by circadian rhythms. Sleep efficiency is the ratio of total sleep time to time in bed. Circadian rhythm refers to the pattern that reflects all physiologic and psychological functions fluctuating and repeating itself in a 24-hour cycle.
A client with narcolepsy tells the nurse that it often feels like he is being suffocated when he is falling asleep. He also says, "I get terrified because I can't seem to move." The nurse identifies this as which of the following? a) Hypersomnolence b) Cataplexy c) Sleep paralysis d) Hypnagogic hallucinations
Sleep paralysis Explanation: Sleep paralysis, the inability to move or speak when falling asleep or waking up, is often described as terrifying and is accompanied by a sensation of struggling to move or speak. Although the diaphragm is not involved, patients may also complain of not being able to breathe or feeling suffocated. These episodes are typically brief in duration and usually terminate spontaneously or when the individual is touched.Cataplexy is the bilateral loss of muscle tone triggered by a strong emotion, such as anger or laughter. This muscle atonia can range from subtle (drooping eyelids) to dramatic (buckling knees). Respiratory muscles are not affected. Hypnagogic hallucinations are intense dreamlike images that occur at sleep onset and usually involve the current environment.Hypersomnolence refers to excessive sleepiness.
Which of the following parasomnias occur primarily in children in the Non-REM stage and may result in emotional experiences that are frightening? a) Sleepwalking b) Sleep terrors c) Nightmares d) Confusional arousals
Sleep terrors Explanation: Sleep terrors occur primarily in children, and in the non-REM sleep stage resulting in frightening thoughts. Nightmares occur in the REM sleep stage.
When describing the stages of sleep, which of the following would the nurse identify as the deepest state of sleep? a) Slow-wave sleep b) NREM sleep stage 2 c) REM sleep d) NREM sleep stage 1
Slow-wave sleep Explanation: Slow-wave sleep, or the deepest state of sleep, characterizes stages 3 and 4 of NREM sleep. Light sleep characterizes NREM sleep stage 1 and 2. REM sleep is a deep sleep but the brain is active.
What body function is responsible for the control of the circadian clock with input of light-dark awareness? a) Suprachiasmatic nucleus (SCN) b) Thalamus c) Visual stimulation d) The rotation of the moon
Suprachiasmatic nucleus (SCN) Explanation: The SCN is responsible for the control of the circadian clock through receiving lights-dark input from the retina. Visual stimulation is involved, but the SCN seems to be the control center. While the suprachiasmatic nucleus is part of the hypothalmus, the thalamus is not involved.
A nursing student overhears a sleep clinic doctor say that a patient is diurnal. The student correctly identifies this to mean which of the following? a) The patient remains awake both day and night. b) The patient sleeps both day and night. c) The patient awakes during the day and sleeps during the night. d) The patient awakes at night and sleeps during the day.
The patient awakes during the day and sleeps during the night. Explanation: Most adults are diurnal, meaning that they are awake during the day and asleep at night.
A person with advanced sleep phase syndrome (ASPS) would experience which symptoms? a) Trouble staying awake in the evening and waking up in the morning feeling rested. b) Difficulty falling asleep at night and awakening in the morning. c) Trouble staying awake and falling asleep at inappropriate times. d) Sleeping 10 to 12 hours per day and awakening with feelings of sadness.
Trouble staying awake in the evening and waking up in the morning feeling rested. Explanation: With ASPS a person has trouble staying awake in the evening, goes to bed early and wakes up in the morning feeling rested. Falling asleep at inappropriate times is more related to narcolepsy, and waking up feeling sadness is most related to depression. Trouble going to sleep and trouble waking in the morning is related to delayed sleep phase syndrome.
A nursing instructor is teaching about the importance of sleep for all body systems. What does the instructor identify as types of sleep deprivation? (Select all that apply.) a) Chronic b) Partial c) Indirect d) Complete e) Acute
• Acute • Chronic • Partial • Complete Explanation: Sleep deprivation may be acute or chronic and partial or complete.
Cory, an 18-year-old high school senior, stays up past midnight every night and has to be at school by 7:30 AM the next day. He often feels sleepy until mid-morning yet refuses to go to bed any earlier. An explanation for Cory's disrupted sleep-wake cycle is a) as people get older they tend to fall asleep later and wake earlier naturally. b) adolescents only need 4 to 6 hours of sleep. c) Cory is not motivated to attend his senior year of high school and dreads going. d) circadian changes may be normal in adolescence.
circadian changes may be normal in adolescence. Explanation: As children move through their school years into their teens, total daily sleep time gradually declines from approximately 10 to 7 to 8 hours. Adolescents tend to stay up late into the night and arise late in the morning. They may be difficult to arouse early in the morning and may suffer from excessive daytime sleepiness. These circadian changes may be normal in adolescence.
The pacemaker that regulates sleep-wake cycles in humans and contributes to sleep disorders is ... a) circadian rhythm. b) hippocampus. c) Medulla. d) caudate nucleus and pineal glands.
circadian rhythm. Explanation: The circadian rhythm is a pacemaker or biological clock that regulates the daily patterning of sleep. In mammals this structure is the suprachiasmic nucleus located in the hypothalamus. The circadian pacemaker stimulates changes in the daily patterns of sleep and wake that are endogenous (stimulated internally) to the organism.
A client complains of sleepiness during the day and occasional slight memory lapses. During the assessment, his wife states she is bothered by his snoring, especially when he is sleeping on his back. She often rolls him over in his sleep. The nurse suspects the client has ... a) narcolepsy b) parasomnia c) sleep deprivation d) obstructive sleep apnea syndrome
obstructive sleep apnea syndrome Explanation: Clients with OSA experience sleep disruption and excessive daytime sleepiness. They typically snore loudly and gasp or choke during sleep, which is more severe when they lie supine. They may be unaware that they have apnea or hypopnea or that they snore during sleep. They are at risk for lapses in memory, slowed reaction time, and falling asleep while working, operating machinery, or driving a motor vehicle.
A client complains of sleepiness during the day and occasional slight memory lapses. During the assessment, his wife states she is bothered by his snoring, especially when he is sleeping on his back. She often rolls him over in his sleep. The nurse suspects the client has ... a) sleep deprivation b) narcolepsy c) obstructive sleep apnea syndrome d) parasomnia
obstructive sleep apnea syndrome Explanation: Clients with OSA experience sleep disruption and excessive daytime sleepiness. They typically snore loudly and gasp or choke during sleep, which is more severe when they lie supine. They may be unaware that they have apnea or hypopnea or that they snore during sleep. They are at risk for lapses in memory, slowed reaction time, and falling asleep while working, operating machinery, or driving a motor vehicle.
A client complains of sleepiness during the day and occasional slight memory lapses. During the assessment, his wife states she is bothered by his snoring, especially when he is sleeping on his back. She often rolls him over in his sleep. The nurse suspects the client has ... a) sleep deprivation b) parasomnia c) narcolepsy d) obstructive sleep apnea syndrome
obstructive sleep apnea syndrome Explanation: Clients with OSA experience sleep disruption and excessive daytime sleepiness. They typically snore loudly and gasp or choke during sleep, which is more severe when they lie supine. They may be unaware that they have apnea or hypopnea or that they snore during sleep. They are at risk for lapses in memory, slowed reaction time, and falling asleep while working, operating machinery, or driving a motor vehicle.
Since the 1960s, benzodiazepines have been prescribed commonly to promote sleep. However, a newer classification of drugs, the nonbenzodiazepine-benzodiazepine agonists, including zolpidem (Ambien) and zaleplon (Sonata), are becoming more commonly used. One major advantage of the nonbenzodiazepine-benzodiazepine agonists is a) their effects may last into the next day. b) they also contain antihistamines, which aid in sedation and drowsiness. c) they are less likely to produce tolerance or hangover effects. d) they also help to reduce general anxiety levels.
they are less likely to produce tolerance or hangover effects. Explanation: These drugs act more selectively on GABA receptors than the benzodiazepines to promote sleep. They are less likely to produce tolerance or hangover effects than the benzodiazepines.
Since the 1960s, benzodiazepines have been prescribed commonly to promote sleep. However, a newer classification of drugs, the nonbenzodiazepine-benzodiazepine agonists, including zolpidem (Ambien) and zaleplon (Sonata), are becoming more commonly used. One major advantage of the nonbenzodiazepine-benzodiazepine agonists is a) they also help to reduce general anxiety levels. b) they are less likely to produce tolerance or hangover effects. c) they also contain antihistamines, which aid in sedation and drowsiness. d) their effects may last into the next day.
they are less likely to produce tolerance or hangover effects. Explanation: These drugs act more selectively on GABA receptors than the benzodiazepines to promote sleep. They are less likely to produce tolerance or hangover effects than the benzodiazepines.
A nursing instructor is teaching about the importance of sleep for all body systems. What does the instructor identify as types of sleep deprivation? (Select all that apply.) a) Partial b) Complete c) Chronic d) Indirect e) Acute
• Acute • Chronic • Partial • Complete Explanation: Sleep deprivation may be acute or chronic and partial or complete.
A client with insomnia is prescribed a melatonin receptor agonist. When teaching the client about this drug, the nurse would incorporate which of the following as an effect of melatonin? Select all that apply. a) Increases alertness b) Maintains reproductive rhythm c) Decreases body temperature d) Shifts circadian rhythm e) Enhances immune function
• Decreases body temperature • Enhances immune function • Shifts circadian rhythm Explanation: Melatonin has been shown to shift circadian rhythm, decrease body temperature, alter reproductive rhythm, enhance immune function, and decrease alertness. Normally, levels of melatonin increase with decreasing exposure to light.
After teaching a class about circadian rhythm disorders, a nursing instructor determines that the teaching was successful when the class identifies which of the following as a subtype? Select all that apply. a) Delayed sleep phase b) Shift work c) Jet lag d) Nightmare e) Sleep terror
• Delayed sleep phase • Jet lag • Shift work Explanation: Subtypes of circadian rhythm disorders include a delayed sleep phase, jet lag type, and shift work type. Nightmare and sleep terror are separate disorders.
A nurse is teaching a client about sleep hygiene and ways to promote sleep. Which of the following would the nurse include in the education plan? Select all that apply. a) Exercising about 2 hours before bedtime b) Avoiding caffeine after mid-afternoon c) Using the bedroom for sleep and sex d) Drinking a glass of wine before bed e) Establishing a regular time for bed
• Establishing a regular time for bed • Avoiding caffeine after mid-afternoon • Using the bedroom for sleep and sex Explanation: Appropriate sleep hygiene measures include setting and maintaining a regular bedtime and rising time, avoiding caffeine after mid-afternoon, avoiding alcohol, exercising regularly but avoiding exercise the 3 hours before bedtime, and using the bedroom for sleep and sex.
A nurse working in a sleep clinic is speaking to a group of young and middle adults. The nurse informs them that research shows which of the following to be known causes that contribute to sleep problems in their age group? (Select all that apply.) a) Minimum noise level b) Family stress c) Academic pressure d) Negative life events e) Positive life events
• Family stress • Positive life events • Negative life events • Academic pressure Explanation: Family stress, positive and negative life events, and academic pressure may contribute to sleep problems in this age group. Minimum noise level is not a factor in this age group.
A nursing instructor is teaching about changes in older adults and lists which of the following seen in relation to their sleep? (Select all that apply.) a) Flattened circadian rhythm b) Insomnia c) Advanced sleep phase syndrome d) Increased total time for sleep e) Absence of naps
• Flattened circadian rhythm • Advanced sleep phase syndrome • Insomnia Explanation: Older adults experience a flattened circadian rhythm and a decrease in total time of sleep. They experience advanced sleep phase syndrome, which involves falling asleep early in the evening and waking early in the morning. Insomnia is very common in older adults. Napping also is common among older adults and may result in decreased nocturnal sleep.
A nursing instructor is teaching about changes in older adults and lists which of the following seen in relation to their sleep? (Select all that apply.) a) Increased total time for sleep b) Advanced sleep phase syndrome c) Insomnia d) Absence of naps e) Flattened circadian rhythm
• Flattened circadian rhythm • Advanced sleep phase syndrome • Insomnia Explanation: Older adults experience a flattened circadian rhythm and a decrease in total time of sleep. They experience advanced sleep phase syndrome, which involves falling asleep early in the evening and waking early in the morning. Insomnia is very common in older adults. Napping also is common among older adults and may result in decreased nocturnal sleep.
A nurse is teaching a client about appropriate sleep measures. During the education session, the nurse cautions the client about consuming caffeine based on the understanding that caffeine can result in which of the following? Select all that apply. a) Decreased total sleep time b) Vivid dreams c) Increased sleep latency d) Increased slow-wave sleep e) Decreased REM sleep
• Increased sleep latency • Decreased total sleep time • Decreased REM sleep Explanation: Caffeine can affect sleep in several ways. It increases sleep latency, decreases total sleep time, and decreases REM sleep. L-dopa causes vivid dreams and nightmares. Increased slow-wave sleep occurs with lithium, phenothiazines, and antidepressants (tricyclics and MAOIs).
When doing a report on sleep apnea to present to a nursing class, a first-year student learns that certain ethnic groups are at increased risk for sleep apnea. Which groups are included? (Select all that apply.) a) American Indian b) Asian American c) African American d) Greek American e) Latino
• Latino • African American • Asian American Explanation: Latino, African, and Asian Americans may all be at a greater risk for certain sleep disorders such as sleep apnea.
A mother brings her 8 year old to the clinic and informs the nurse that he will not go to bed when told. What should the nurse tell this mother that a lack of sleep can cause in this patient besides poor school performance? (Select all that apply.) a) Obesity b) Increased risk for gastrointestinal symptoms c) Decreased blood pressure d) Increased vision problems e) Diabetes
• Obesity • Diabetes Explanation: Sleep deprivation in children has serious implications for learning and for work and school performance. It also is associated with obesity and the development of diabetes.
A patient reporting sleep deprivation has been told to reduce caffeine consumption. Which of the following does the nurse tell the patient contains caffeine? (Select all that apply.) a) Over-the-counter cold preparations b) Cola c) Chocolate d) Coffee e) Fruit juices
• Over-the-counter cold preparations • Cola • Chocolate • Coffee Explanation: Caffeine-containing beverages include coffee, tea, cola, chocolate, and some noncola drinks. OTC cold preparations also contain caffeine.
A nurse working in a sleep laboratory is talking to a patient being evaluated for a sleep disorder. The nurse identifies which of the following as a result of sleep deprivation? (Select all that apply.) a) Development of diabetes b) Enhanced work performance c) Problems with memory d) Problems with decision making e) Injuries
• Problems with memory • Problems with decision making • Injuries • Development of diabetes Explanation: Sleep deprivation has been linked with problems with memory, learning, and decision making; poor work performance; injuries; and other negative consequences. Evidence also suggests that sleep deprivation can lead to diabetes and cardiovascular disorders.
A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply. a) She complains of a powerful urge to move her legs when in bed at night. b) She repeatedly moves her large toe, ankle and knee during sleep. c) She has frequently awakened unable to move or speak. d) She believes that she experiences auditory hallucinations when she awakens e) Her sleep latency is normally around one hour.
• She has frequently awakened unable to move or speak. • She believes that she experiences auditory hallucinations when she awakens Explanation: Sleep paralysis and hypnagogic hallucinations are symptoms of narcolepsy. Repeated toe, ankle and leg movements are associated with periodic limb movement disorder while an urge to move her legs would suggest restless legs syndrome. Narcolepsy is not normally associated with long sleep latency periods
A client with insomnia is prescribed a melatonin receptor agonist. When teaching the client about this drug, the nurse would incorporate which of the following as an effect of melatonin? Select all that apply. a) Shifts circadian rhythm b) Decreases body temperature c) Enhances immune function d) Increases alertness e) Maintains reproductive rhythm
• Shifts circadian rhythm • Decreases body temperature • Enhances immune function Explanation: Melatonin has been shown to shift circadian rhythm, decrease body temperature, alter reproductive rhythm, enhance immune function, and decrease alertness. Normally, levels of melatonin increase with decreasing exposure to light.
A nurse is giving a talk to a local woman's group about sleep and how it needs to be maintained across the lifespan. What does the nurse tell the group about the different sleep disturbances in women? Select all that apply. a) Sleep is tied to hormonal levels. b) Sleep-disordered breathing is more common in women than in men. c) Many women have sleep problems during the premenstrual period. d) Sleep deprivation is associated with menopause. e) Women who are pregnant sleep better due to hormone levels.
• Sleep is tied to hormonal levels. • Many women have sleep problems during the premenstrual period. • Sleep deprivation is associated with menopause. Explanation: Sleep is closely tied to hormonal levels. Approximately one-third of women report sleep disturbance during the premenstrual period. Disrupted sleep is also common during pregnancy, the postpartum period, and menopause. Sleep-disordered breathing is more common among men.
A nursing student is conducting a study group with peers about sleep disorders. The student reports that the most common sleep disorders in children include which of the following? (Select all that apply.) a) Parasomnias b) Sleep apnea c) Sleep-onset insomnia d) Narcolepsy e) Movement disorders
• Sleep-onset insomnia • Parasomnias • Sleep apnea • Movement disorders Explanation: Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. Narcolepsy usually does not begin until between the ages of 15 and 25 years. The other disorders are common sleep disorders found in children.