Sleep Ch.33 Yoost &Crawford
The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? 1 "I always feel tired when I wake up in the morning." 2 "I go to bed at the same time each night." 3 "It takes me about 10 minutes to fall asleep." 4 "Sometimes I have to get up during the night to urinate."
"I always feel tired when I wake up in the morning." This statement indicates that the patient is not experiencing quality sleep and should be followed up with more extensive questions and assessment of the problem. Patients are the best resource for describing sleep problems and how these problems are a change from their usual sleep and waking patterns. A general description of the problem followed by more focused questions usually reveals specific characteristics that are useful in planning therapies. To begin, the nurse needs to understand the nature of the sleep problem, its signs and symptoms, its onset and duration, its severity, any predisposing factors or causes, and the overall effect on the patient. Ask specific questions related to the sleep problem. It is important that people follow a bedtime routine such as going to bed at the same time each night. This action promotes sleep. At night, an adult normally falls asleep with 10 minutes. It is not uncommon for adults to get up in the middle of the night to urinate.
Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching? 1 "I won't put my baby to bed with a bottle." 2 "For the first few weeks we're putting the cradle in our room." 3 "My grandmother told me that babies sleep better on their stomachs." 4 "I know I'll have to get up during the night to feed my baby when he wakes up."
"My grandmother told me that babies sleep better on their stomachs." indicates that the mother needs further teaching. Placing a newborn/infant on the stomach to sleep predisposes the child to sudden infant death syndrome (SIDS). The mother should be educated on the "back to bed" concept for infant sleeping. Infants' beds need to be safe. Parents should place infants on their back to prevent suffocation and decrease the risk of SIDS. A newborn/infant should not be put to bed with a bottle. This practice predisposes the child to ear infections and dental caries. The newborn's cradle should be placed in the parent's room for the first few weeks of life. A new mother should expect to feed her baby every 3 to 4 hours.Test-Taking Tip: For questions about infant sleep, remember that one of the first campaigns for preventing SIDS and promoting babies sleeping on their backs was called "Back to Sleep." Think of how a mother feels when her baby awakens in the middle of the night. She really wants the infant to go back to sleep!
A nurse is explaining the physiology of sleep to student nurses. Which information would the nurse include in the explanation? Select all that apply. 1 During sleep, the core body temperature starts to decrease between 2 and 4 a.m. 2 During sleep, cortisol levels increase around 2 a.m. and peak around 4 a.m. 3 The major sleep center is located in the hypothalamus. 4 The ascending reticular activating system (RAS) regulates sleep. 5 Melatonin is the hormone believed to induce sleep in humans.
1 During sleep, the core body temperature starts to decrease between 2 and 4 a.m. 3 The major sleep center is located in the hypothalamus. 5 Melatonin is the hormone believed to induce sleep in humans. Sleep involves a sequence of physiologic states maintained by central nervous system activity. Core body temperature, which typically is coupled closely with activity rhythm, starts to increase after the minimum core temperature level is reached between 2 and 4 a.m., in anticipation of activity. The major sleep center in the body is located in the hypothalamus. Melatonin is the hormone believed to induce sleep in humans. In anticipation of daytime activity, cortisol levels increase around 4 a.m. and peak around 6 a.m. Sleep is a complex process regulated by the RAS and neurotransmitter interactions. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.
A nurse has a sleep disorder due to working on rotating shifts. Which physiologic symptoms are observed in the nurse? Select all that apply. 1 Fatigue 2 Increased reflexes 3 Difficulty concentrating 4 Decreased neuromuscular coordination 5 Increased visual alertness
1 Fatigue 3 Difficulty concentrating 4 Decreased neuromuscular coordination Sleep deprivation can occur due to rotating shifts, as the human biologic clock becomes maladjusted. It can lead to symptoms of fatigue, headache, nausea, increased sensitivity to pain, decreased neuromuscular coordination, irritability, and difficulty concentrating. Circadian rhythm sleep disorders are common in those who participate in shift work. Reflexes and visual alertness is decreased, not increased. Test-Taking Tip: Sleep deprivation makes people less alert. "Increased reflexes" and "increased visual alertness" can be eliminated when you realize they represent heightened alertness.
Which complications would the nurse expect to find in a patient who is on beta blockers? Select all that apply. 1 Insomnia 2 Irritability 3 Drowsiness 4 Nightmares 5 Restlessness
1 Insomnia 4 Nightmares Beta blockers inhibit the effects of the adrenaline hormone and also inhibit nighttime secretion of melatonin, a hormone involved in regulating both sleep and the body's circadian clock. Reduced secretions of melatonin result in insomnia and nightmares. Irritability occurs due to sleep deprivation. Drowsiness and restlessness occur due to overusage of medications such as barbiturates, amphetamines, and antidepressants.
A patient is hospitalized for insomnia. The nurse learns that the patient has had insomnia for 6 months after starting to work night shifts and is stressed due to his workload. Which sleep deprivation symptoms will the nurse most likely find in the patient? Select all that apply. 1 Irritability 2 Nausea 3 Increased reflexes 4 Decreased sensitivity to pain 5 Decreased alertness
1 Irritability 2 Nausea 5 Decreased alertness The patient may be irritable and nauseous due to sleep deprivation. He may also be experiencing decreased alertness. His reflexes would be decreased and he would experience increased sensitivity to pain.
The nurse is assessing a patient who has sleep apnea. Which symptoms are likely to be found in the patient? Select all that apply. 1 Loud snoring 2 Muscle weakness 3 Pulmonary hypertension 4 Cardiac arrhythmias 5 Excessive urination during the night
1 Loud snoring 3 Pulmonary hypertension 4 Cardiac arrhythmia Sleep apnea is a condition in which a person experiences the absence of breathing (apnea) or diminished breathing during sleep between snoring intervals. It is characterized by the lack of airflow through the mouth and nose for at least 10 seconds, and up to 2 minutes, during sleep. Prolonged sleep apnea can cause an increase in blood pressure, leading to cardiac arrest. Cardiac arrhythmias, pulmonary hypertension, and left-sided heart failure can result from prolonged sleep apnea. Muscle weakness and excessive urination during the night are not symptoms of sleep apnea.
A patient who consumes alcohol on regular basis reports difficulty falling asleep. Which statements describe the effects of alcohol on sleep? Select all that apply. 1 Small amounts of alcohol promote sleep. 2 Small amounts of alcohol prevent the patient from falling asleep. 3 Alcohol causes the patient to remain awake. 4 Alcohol awakens the patient early and causes difficulty returning to sleep. 5 Alcohol limits rapid eye movement (REM) sleep.
1 Small amounts of alcohol promote sleep. 4 Alcohol awakens the patient early and causes difficulty returning to sleep. 5 Alcohol limits rapid eye movement (REM) sleep. Small amounts of alcohol may help some people fall asleep, but alcohol increases wakefulness in the last half of the night. Ingesting large quantities of alcohol creates difficulty falling asleep and limits REM sleep, and this may cause a restless sleep and the sensation of a "hangover" on arising.
The nurse is giving information about different phases of sleep to student nurses. What information should the nurse include? Select all that apply. 1 Stage 3 sleep is decreased in older adults, resulting in less restorative sleep. 2 Dreams occur during rapid eye movement (REM) sleep only. 3 Infants spend half of their sleep in lighter stages. 4 Dreams occur during both non-rapid eye movement (NREM) and REM sleep. 5 There is decreased epinephrine release during REM sleep.
1 Stage 3 sleep is decreased in older adults, resulting in less restorative sleep. 3 Infants spend half of their sleep in lighter stages. 4 Dreams occur during both non-rapid eye movement (NREM) and REM sleep. Normal sleep has two phases: NREM and REM sleep. NREM sleep has three stages. Stage 3 sleep is decreased in older adults, resulting in less restorative sleep. Dreaming is a phenomenon that occurs both in NREM and REM phases of sleep. However, the dreams of REM sleep are more vivid and colorful as compared to NREM. Infants spend half of their sleep in lighter stages. REM sleep is associated with increased epinephrine release. Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures.
A patient has a history of obstructive sleep apnea. Which postoperative care reduces the risk of any complications in the patient? Select all that apply. 1 Using an oral appliance 2 Monitoring the patient's airway 3 Avoiding elevation of the head of the bed 4 Sleeping in the supine position 5 Using a continuous positive airway pressure (CPAP) device
1 Using an oral appliance 2 Monitoring the patient's airway 5 Using a continuous positive airway pressure (CPAP) device Patients with obstructive sleep apnea have a risk of developing postoperative complications. Following surgery, the patient may reach deep levels of rapid eye movement sleep that causes muscle relaxation. This muscle relaxation can worsen obstructive sleep apnea and obstruct the airway. An oral appliance can be used to keep the airway patent by advancing the mandible or tongue to relieve pharyngeal obstruction. The nurse should monitor the patient for an increased risk of respiratory complications. Using a CPAP device helps prevent airway collapse. The patient would be more comfortable if the head of the bed is elevated. The patient should not sleep in the supine position, as it may obstruct the airway.
A nurse is consulting with a patient who is experiencing insomnia. Which lifestyle factors may affect the patient's sleep patterns? Select all that apply. 1 Working a rotating shift 2 Performing unaccustomed heavy work 3 Late-night social activities 4 Changing evening mealtime 5 A small weight gain in a person with a normal BMI
1 Working a rotating shift 2 Performing unaccustomed heavy work 3 Late-night social activities 4 Changing evening mealtime A good sleep pattern depends on many lifestyle factors. Working a rotating shift disrupts the sleep-wake cycle and results in poor sleep. Performing unaccustomed heavy work may cause excessive fatigue and interfere with sleep. Late-night social activities may interfere with sleep by providing too many stimuli. Changing evening mealtime may interfere with sleep. A heavy meal eaten before bedtime may cause indigestion and sleep irregularities. A small weight gain is unlikely to interfere with sleep; however, obesity predisposes individuals to obstructive sleep apnea.STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: Amount of time needed Amount of time available "Best" time to study Time for emergencies and relaxation
A patient reports difficulty falling asleep. The nurse asks questions to assess the symptoms of insomnia and analyzes the different stages of the patient's sleep cycle. Which characteristics are indicative of stage 2 of non-rapid eye movement (NREM) sleep? Select all that apply. 1 Sleepwalking may occur. 2 Body functions become slow. 3 Arousal remains relatively easy. 4 Muscle relaxation increases. 5 Vital signs are significantly lower than during waking hours.
2 Body functions become slow. 3 Arousal remains relatively easy. 4 Muscle relaxation increases. In stage 2 of NREM sleep, the body functions become slow. The sleeper can be relatively easy to arouse in this stage. The muscles continue to relax. A person may sleepwalk during stage 3 of NREM sleep. Also during stage 3, the vital signs are lower than they are during waking hours.
Which complications does the nurse expect to find in a patient who has circadian rhythm sleep disorders? Select all that apply. 1 Tremors 2 Cataplexy 3 Depression 4 Hypertension 5 Sexual dysfunction
3 Depression 4 Hypertension 5 Sexual dysfunction Improper sleep due to circadian rhythm sleep disorders decreases dopamine levels, which causes depression. Increases in stress hormones due to insufficient sleep cause hypertension. The metabolic rate decreases due to improper sleep; this causes an imbalance in sex hormones and results in sexual dysfunction. Tremors occur due to withdrawal of barbiturate-sedative hypnotics. Cataplexy is the loss of muscle tone that occurs in a patient who has narcolepsy.
The patient reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs during which sleep phase? 1 Rapid eye movement (REM) sleep 2 Stage 1 non-rapid eye movement (NREM) sleep 3 Stage 4 NREM sleep 4 Transition period from NREM to REM sleep
Although dreams occur during NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate, and some believe they are functionally important to learning, memory processing, and adaptation to stress. There are 3 stages of NREM sleep; therefore there is not a stage 4 NREM sleep.STUDY TIP: Keep a bedside journal and write down dreams as you awaken, whether you feel rested, and the hours you slept. After a few weeks, reread the sleep chapter in your text to learn what your sleep habits can tell you about yourself. This information may be valuable for planning study times before the exam.
A mother gave birth 2 days ago and is being discharged home from the hospital today. Which parental teaching ensures the infant's safety while sleeping? 1 Place pillows beside the infant. 2 Avoid placing the infant on his or her back. 3 Place blankets with loose ends in the crib. 4 Avoid loose-fitting plastic mattress covers.
An infant's bed needs to be safe to prevent suffocation. Loose-fitting plastic mattress covers should be avoided to reduce chances of suffocation. Placing pillows beside the infant may suffocate him or her. The infant may suffocate if placed on the abdomen while sleeping. Placing blankets with loose ends in the crib may cause suffocation, and it should be avoided.
The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? 1 Have patient follow hospital routines. 2 Avoid awakening patient for nonessential tasks. 3 Give prescribed sleeping medications at dinner. 4 Turn television on low to late-night programming.
Avoiding awakening patient for nonessential tasks promotes sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as laboratory draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits. The nurse should make every effort to allow the patient to follow his or her regular sleep schedule. The prescribed sleeping medications should be administered at the ordered time. Administering a sleeping medication at dinner may cause the patient to go to sleep too soon, thereby disrupting the patient's bedtime routine. All distractions should be eliminated. The television should be turned off.Test-Taking Tip: Look for answers that focus on the patient's safety, comfort, or feelings.
Which intervention is appropriate to include on a care plan for improving sleep in the older adult? 1 Decrease fluids 2 to 4 hours before sleep. 2 Exercise vigorously 1 hour before bedtime to increase fatigue. 3 Allow the patient to sleep as late as possible. 4 Take a nap during the day to make up for lost sleep.
Decreasing fluids 2 to 4 hours before sleep reduces the likelihood that the older adult's sleep will be disrupted during the night by the need to void. Exercise within 2 hours of normal sleep time can hamper sleep and should be avoided. Excessive exercise and exhaustion can hinder normal sleep. Encourage older adults to maintain the usual bedtime and routines as much as possible.Test-Taking Tip: Even if you know decreasing fluids 2 to 4 hours before sleep is the correct choice, be sure to read through the other options in case there is an even better response. That would not have been necessary on this question, but it will be on many others.
The nurse is developing a plan of care for a patient experiencing narcolepsy. Which intervention is appropriate to include in the plan? 1 Instruct the patient to increase carbohydrates in the diet. 2 Have patient limit fluid intake 2 hours before bedtime. 3 Preserve energy by limiting exercise to morning hours. 4 Encourage patient to take one or two 20-minute naps during the day.
Encourage patient to take one or two 20-minute naps during the day. A person with narcolepsy has the problem of falling asleep uncontrollably at inappropriate times. Brief daytime naps no longer than 20 minutes help reduce subjective feelings of sleepiness. Following a regular exercise program, practicing good sleep habits, avoiding shifts in sleep, strategically timing daytime naps if possible, eating light meals high in protein, practicing deep breathing, chewing gum, and taking vitamins are also methods of narcolepsy management. Patients with narcolepsy need to avoid factors that increase drowsiness (e.g., alcohol; heavy meals; exhausting activities; long-distance driving; and long periods of sitting in hot, stuffy rooms). Fluids may be decreased in the evenings if the person often awakens during the night to urinate. Limiting fluids is not related to narcolepsy. Routine exercises help promote sleep. A person with narcolepsy does not have trouble sleeping.Test-Taking Tip: Use this mnemonic or make up one of your own: A person with narcolepsy benefits from a "power nap."
For over a month, a patient has been sleeping nearly 12 hours each night, but still sleeps during the day. On further assessment, the nurse finds that the patient has hypothyroidism. Which sleep disorder does the nurse suspect in this patient? 1 Bruxism 2 Insomnia 3 Hypercapnia 4 Hypersomnia
Hypersomnia is a sleep disorder in which an individual sleeps excessively during the daytime, even after sleeping for 8 to 12 hours at night. This condition persists for at least a month and is common in individuals with hypothyroidism. Low levels of thyroid hormone cause fatigue and exhaustion leading to hypersomnia. Bruxism is the clenching of teeth during sleep; it may occur due to stress. Insomnia is difficulty sleeping. Hypercapnia is an increase in carbon dioxide levels in the blood.Test-Taking Tip: Use your knowledge of Latin and Greek word roots to help you recall meanings of terms. For this question, hyper- means excessive, somn/i indicates sleep, and - ia denotes a condition; so hypersomnia is a condition of excessive sleep!
A patient reports falling asleep suddenly, even in the middle of the day while doing other tasks, and states that she has strong, vivid visions while falling asleep. Which condition do these symptoms indicate? 1 Bruxism 2 Narcolepsy 3 Sleep terrors 4 Somnambulism
Narcolepsy is a chronic neurologic disorder in which a person lacks control over sleep because the brain loses its control over the sleep-wake cycle. Patients with narcolepsy may also have hallucinations. Bruxism is the grinding of teeth during sleep. A person who has sleep terrors suddenly wakes from sleep in an extremely terrified state. Somnambulism is a sleep disorder in which a person walks while sleeping.STUDY TIP: To help you recall that somnambulism means sleepwalking, think of the word ambulate, meaning to walk. Now find part of ambulate in somn ambulism.
The nurse observes that a patient snores loudly while sleeping and repeatedly awakens throughout the night. On further assessment, the nurse finds an increase in the patient's blood pressure. Which disorder does the nurse anticipate in the patient? 1 Hypersomnia 2 Sleep terror disorder 3 Restless leg syndrome 4 Obstructive sleep apnea
Obstructive sleep apnea is a blockage of the upper airways that results in shallow or no breathing during sleep. During sleep, the throat muscles intermittently relax, which blocks the airway and results in snoring. This pattern increases the carbon dioxide levels in the blood and causes the person to awaken. Hypersomnia is a sleep-wake disorder in which a person sleeps excessively during the day, even after a normal 8 to 12 hours of sleep at night. A person with a sleep terror disorder wakes suddenly in a terrified state from deep sleep. Restless leg syndrome is a neurologic disorder characterized by tingling and crawling sensations in the legs and an urge to move them.STUDY TIP: Do you know someone with sleep apnea? Do they use a continuous positive airway pressure (CPAP) machine? Ask them about their symptoms and what has changed since they used the CPAP. Linking a disorder with a specific person can help you remember its presenting signs and symptoms. If you don't know someone personally with sleep apnea, invent such a person and write a paragraph about him or her to help your memory have another link to this information.
The nurse is caring for a patient diagnosed with restless leg syndrome (RLS). Which characteristics are common for this syndrome? Select all that apply. 1 It is usually associated with nocturia. 2 It occurs immediately after waking up. 3 Patients have intense, abnormal, lower-extremity sensations of crawling or tingling feelings. 4 It is more common in those having thrombocytopenia. 5 Patients have recurrent disagreeable leg movements.
Patients have intense, abnormal, lower-extremity sensations of crawling or tingling feelings. AND Patients have recurrent disagreeable leg movements. Restless leg syndrome is a familial sleep disorder characterized by disagreeable leg movements resulting from intense, abnormal, lower-extremity sensations of crawling or tingling feelings. The sensations cause a delay in sleep onset. This disorder leads to constant leg movement during the day and insomnia at night. Restless leg syndrome can occur at any age but is more common in elderly individuals. No association between restless leg syndrome and nocturia has been cited. This syndrome occurs usually before sleep onset rather than waking. RLS is not related to thrombocytopenia; however, its incidence is more common in people with iron deficiency anemia.
A patient with iron deficiency anemia reports rhythmic movements of the feet and legs and an itching sensation in the muscles before sleep. Which condition is likely to be found in the patient? 1 Insomnia 2 Cataplexy 3 Narcolepsy 4 Restless leg syndrome
Rhythmic movements of the feet and legs and an itching sensation in the muscles before sleep are symptoms of restless leg syndrome, which may be caused by iron deficiency anemia. Insomnia refers to difficulty falling asleep. In cataplexy, sudden muscle weakness occurs during intense emotions such as sadness, anger, or laughter. Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states.
A nurse finds that an obese patient snores loudly and has periods of apnea that occur several times during sleep. Which diagnosis may be assigned to this patient? 1 Narcolepsy 2 Sleep apnea 3 Sleep deprivation 4 Paroxysmal nocturnal dyspnea
Sleep apnea is most common in obese patients. Typical symptoms include snoring and periods of apnea. Narcolepsy is a chronic neurologic disorder caused by the brain being unable to regulate the sleep-wake cycle normally. A patient with narcolepsy falls asleep unexpectedly. Sleep deprivation could result from sleep apnea. Paroxysmal nocturnal dyspnea occurs when a patient has shortness of breath during the night.
The nurse is caring for a newborn and instructs the parents, "Place your baby on her back for sleeping." Which condition does the nurse want to prevent in the newborn? 1 Bruxism 2 Narcolepsy 3 Sleep apnea 4 Sudden infant death syndrome
Sudden infant death syndrome is the sudden and unexpected death of a newborn or infant. The newborn may experience breathlessness due to laryngeal chemoreflex stimulation if placed in the prone position. Placing the newborn in the supine position prevents the laryngeal chemoreflex stimulation; thus it may lessen the newborn's risk of sudden infant death syndrome. Bruxism is the clenching of the teeth during sleep and occurs due to stress; it does not occur in newborns. Narcolepsy is a neurologic disorder that affects the sleep cycle and wakefulness; it usually occurs in adolescents. Sleep apnea is the absence of breath for at least 10 seconds and up to 2 minutes during sleep; it mostly occurs in adult men.STUDY TIP: To help you recall that infants should sleep on their backs to prevent SIDS, consider that when they awaken in the middle of the night, you wish they would go BACK to sleep.
The nurse finds that a child is grinding his teeth while sleeping. Which disorder does this behavior indicate? 1 Bruxism 2 Narcolepsy 3 Sleep apnea 4 Sleep terrors
Teeth grinding or teeth clenching during sleep is termed bruxism, which may occur due to stress. This may cause pain, if the clenching is tight. Narcolepsy is an uncontrollable excess sleep disorder and may occur due to the brain's inability to control the sleep-wake cycle. Sleep apnea is the absence of breath between snoring intervals. A person with sleep terrors wakes in a terrified state.STUDY TIP: Draw the face of a person clenching his teeth. Mark X's where the teeth meet and over the jaw muscles that are clenching during bruxism. Now write bruxism all over the teeth and jaw, using the X's that marked the spot.
A patient who recently immigrated to the United States tells the nurse, "I am unable to sleep and concentrate on my work." What might be the reason for this condition? 1 Sleep apnea 2 Hypersomnia 3 Sleep terror disorder 4 Circadian rhythm sleep disorder
When a person travels from one time zone to another, he or she may face difficulty in adjusting to the time changes. This causes difficulty in sleeping, memory problems, depression, weight gain, and impaired concentration levels. This type of sleep disorder is termed circadian rhythm sleep disorder. Sleep apnea is shallow or absent breathing during sleep. Hypersomnia is a sleep-wake disorder in which a person sleeps excessively during the daytime, even after a normal 8 to 12 hours of sleep at night. A patient who has sleep terror disorder wakes suddenly in a terrified state from deep sleep.
