Sleep MASTERY ASSESSMENT
What would the nurse state is true about a toddler's sleep? 1-Total sleep averages 12 hours a day. 2-In the awake period, a toddler exhibits sleepwalking. 3-A toddler normally takes several naps during the day. 4-It is uncommon for toddlers to awaken during the night.
Total sleep averages 12 hours a day--Toddlers sleep 12 hours a day on an average. In the awake period, preschoolers rather than toddlers exhibit brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting. An infant normally takes several naps during the day but usually sleeps an average of 8 to 10 hours during the night. It is common for toddlers to awaken during the night.
A client who has been taking the prescribed dose of zolpidem for 5 days returns to the clinic for a follow-up visit. When interviewing the client, the nurse identifies that the medication has been effective when the client makes which statement? 1-"I have less pain." 2-"I have been sleeping better." 3-"My blood glucose is under control." 4-"My blood pressure is coming down."
"I have been sleeping better."--Zolpidem is a sedative-hypnotic that produces central nervous system depression in the limbic, thalamic, and hypothalamic areas of the brain. Zolpidem is not an analgesic, antidiabetic, or antihypertensive medication.
The nurse is instructing the parents of a 6-month-old infant about sleeping patterns and the best sleeping positions for their child. Which instruction regarding sleep position is most important? 1-"Place the infant in a supine position for sleep." 2-"Avoid positioning the head on alternating sides." 3-"A prone position is more beneficial for sleeping." 4-"If the infant is restless, place it on one side to sleep."
"Place the infant in a supine position for sleep."--The nurse instructs the parent to place the infant in a supine position so the infant does not roll over to a prone position. When the infant is less than 6 months old, the infant is placed in a supine position and the head is positioned on alternating sides to prevent positional plagiocephaly. There is a risk for sudden infant death syndrome (SIDS) if the infant is placed in a prone position. If the infant is restless, it should be assessed, but not put to sleep on one side, because the infant can easily roll over to the prone position if placed on the side.
A client is admitted to a psychiatric hospital after a month of unusual behavior that has included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. Which disorder does the nurse associate with these behaviors? 1-Bipolar disorder, manic phase 2-Antisocial personality disorder 3-Obsessive-compulsive disorder 4-Chronic undifferentiated schizophrenia
Bipolar disorder, manic phase--This kind of hyperactive behavior is typical of the manic flight into reality associated with mood disorders. The behaviors are more indicative of a mood disorder than a personality disorder. Ritualistic, not manic, behavior is indicative of obsessive-compulsive disorder. A flat affect and apathy are more indicative of a schizophrenic disorder.
A client reports disturbed sleep due to itching caused by an allergy. Which medication would be prescribed to help the client sleep well and treat the allergic symptoms? 1-Cetirizine 2-Fexofenadine 3-Desloratadine 4-Chlorpheniramine
Chlorpheniramine--Chlorpheniramine [1] [2] is an antihistamine that helps to manage allergic symptoms by preventing vasodilation and decreasing allergic symptoms. Sedation is a side effect of chlorpheniramine; therefore this drug is prescribed to clients experiencing sleep issues due to allergic symptoms. Cetirizine effectively blocks histamine from binding to receptors and has less sedating potential. Fexofenadine and desloratadine are also less sedating antihistamine drugs.
In a noisy room a sleeping newborn initially startles and exhibits rapid movements; however, the baby soon goes back to sleep. What is the most appropriate nursing action in response to this behavior? 1-Documenting an intact reflex 2-Assessing the infant's vital signs 3-Testing the infant's ability to hear 4-Stimulating the infant's respirations
Documenting an intact reflex--The initial response is a reflection of the startle reflex; when the stimulus is repetitive, the response to the stimulus decreases. This decrease in response is called habituation and is expected. Assessing the infant's vital signs and stimulating the infant's respirations are not necessary because the neonate's response is expected. The infant is responding to noise and therefore hears.
The night nurse reports that a young client with paranoid schizophrenia has been awake for several nights. The day nurse reviews the client's record and finds that this client did not have an interrupted sleep pattern disorder before transfer from a private room to a four-bed room 3 days ago. What factor should the nurse identify as most likely related to the client's sleeplessness? 1-Fear of the other clients 2-Concern about family at home 3-Watching for an opportunity to escape 4-Trying to work out emotional problems
Fear of the other clients--Because the client has paranoid feelings that other people are out to do harm, assignment to a four-bed room may be threatening. Concern about family at home seems unlikely, because the disruption appears to have started with the transfer to a four-bed room. Watching for an opportunity to escape is possible but unlikely; planning an escape is usually not part of a schizophrenic pattern of behavior. Trying to work out emotional problems is possible but not likely; clients with schizophrenia have difficulty solving problems.
At night an older client with dementia sleeps very little and becomes more disoriented. How can the nurse best limit this confusion resulting from sleep deprivation? 1-Shutting the client's door during the night 2-Applying a vest restraint when the client is in bed 3-Leaving a dim light on in the client's room at night 4-Administering the client's prescribed as-needed sedative medication
Leaving a dim light on in the client's room at night--A small light in the room may prevent misinterpretation of shadows, which can heighten fear and alter the client's perception of the environment. A disoriented and confused client should be closely observed, not isolated. Restraints are a last resort; less restrictive interventions should be used first. Sedatives should be used sparingly in older adults, because they may cause further confusion and agitation.
What change is seen when a child enters from a stage of toddlerhood to the stage of preschooler? 1-Preschoolers sleep soundly at night. 2-Preschoolers take frequent naps during the day. 3-Preschoolers get into the habit of extending bedtimes. 4-Preschoolers sleep about nine hours each night.
Preschoolers get into the habit of extending bedtimes--Preschoolers desire to extend their bedtimes. They show hyperactivity during sleeping hours. Preschoolers have sleep disturbances instead of sleeping soundly. Daytime naps are infrequent in preschoolers. Preschoolers sleep around 12 hours each night.
What are physiologic symptoms assessed in a client with sleep deprivation? Select all that apply. 1-Ptosis and blurred vision 2 -Agitation and hyperactivity 3 -Confusion and disorientation 4-Increased sensitivity to pain 5 -Decreased auditory alertness
Ptosis and blurred vision, Decreased auditory alertness--Ptosis may result from a loss of elasticity of the eyelids, which is a physiologic symptom of sleep deprivation. Decreased auditory alertness and blurred vision are also physiologic symptoms of sleep deprivation. Agitation, hyperactivity, confusion, disorientation, and increased sensitivity to pain are psychologic symptoms of sleep deprivation.
A client is experiencing feelings of sadness and is having difficulty concentrating and sleeping. What are additional common signs and symptoms of depression that the nurse should expect when performing an assessment of this client? 1-Rigidity and a narrowing of perception 2-Alternating episodes of fatigue and high energy 3-Diminished pleasure in activities and alteration in appetite 4-Excessive socialization and interest in activities of daily living
Diminished pleasure in activities and alteration in appetite--Depression is characterized by feelings of hopelessness, helplessness, and despair, leaving little room for any pleasure; alteration in appetite (either decreased or increased) is common in depressed clients. Although there is a narrowing of perception, rigidity is uncommon with depression. Fatigue is continually present and does not alternate with a high energy level. There is a loss of interest in socialization and little participation in activities of daily living.
During a home visit to a client, the nurse identifies tremors of the client's hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Of the additional assessment findings, which one should the nurse report to the practitioner? 1-Increased appetite 2-Recent weight loss 3-Feelings of warmth 4-Fluttering in the chest
Fluttering in the chest--Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure. Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening. Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening. Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening.
Which statement is true about the sleep pattern of preschoolers? 1-Daytime naps are very common among preschoolers. 2-On average, a preschooler sleeps about 12 hours a night. 3-Partial awakening leading to sleeplessness is common among preschoolers. 4-About 30% of sleep time in preschoolers is spent in the rapid eye movement sleep (REM) cycle.
On average, a preschooler sleeps about 12 hours a night--The average preschooler sleeps about 12 hours a night. By the age of five, children rarely take daytime naps except in cultures in which a siesta is the custom. Partial awakening followed by a normal return to sleep is frequent. About 30% of an infant's sleep time is in the rapid eye movement sleep (REM) cycle.
What would the nurse instruct the parent to refrain from doing if a 4-year-old child has nightmares on a routine basis? 1-Keeping the lights on 2-Sleeping with the child 3-Tucking in a favorite soft toy with the child 4-Leaving the room after comforting the child
Sleeping with the child--If a child has nightmares, the parent should avoid sleeping with the child. Sleeping with the child may create a habit of delaying bedtime. In case of nightmares, keeping the lights on may help the child to overcome fear. Tucking in a soft toy gives the feeling of security to the child. The parent should comfort the child and leave the child in his or her own bed so that the child does not use the fear as an excuse to delay bedtime.
How are toddlers different from children of other age groups? 1-Toddlers grow more rapidly than infants do. 2-Toddlers need more calories than infants do. 3-Toddlers have fewer febrile seizures than preschoolers do. 4-Toddlers sleep more during the daytime than preschoolers do.
Toddlers sleep more during the daytime than preschoolers do--A toddler sleeps an average of 12 hours during the day, whereas a preschooler sleeps for 12 hours during the night and less in the daytime. The growth rate of toddlers is much slower than that of infants. A toddler needs fewer kilocalories than an infant does but needs more protein relative to body weight. Dehydration and febrile seizures occur during periods of high body temperature in children between 6 months and 3 years of age.
