Deck 7: Sleep Alterations and Management

Question 1

Which stage of NREM sleep is associated with anabolic processes?

A) N1
B) N2
C) N3
D) N4

Answer 1

N3

Question 2

_____ is a diagnostic test used to determine sleep disturbances.

A) Electrooculography
B) Electromyography
C) Electroencephalography
D) Polysomnography

Answer 2

Polysomnography

Question 3

_____ is the external element that has the most significant effect on circadian rhythms.

A) Lower body temperature
B) Light
C) Melatonin cycle
D) Background noise

Answer 3

Light

Question 4

Which of the following older patients demonstrates changes in sleep patterns attributable to central sleep apnea?

A) A patient who wakes up two to three times per night and is tired during the day
B) A patient who reports sleeping less soundly and not feeling rested
C) A patient who consistently awakens at 4 AM and goes to bed at 7 PM
D) A patient who has irregular respiration during sleep and whose inspiratory muscles intermittently fail

Question 5

Which of the following patients would the nurse most strongly suspect of having obstructive sleep apnea?

A) A severely obese woman with diabetes
B) A moderately obese man who snores
C) A nonobese woman with hypertension
D) A severely obese man with renal dysfunction

Question 6

Where are EMG leads placed to detect muscle atonia?

A) Scalp
B) Intercostal
C) Anterior tibialis
D) Chin

Question 7

Sleep deprivation can result from which of the following?

A) CPAP machine use
B) Mechanical ventilation
C) Use of nonbenzodiazepine short-acting hypnotics
D) Use of analgesic medications to control pain

Question 8

Caffeine is an example of which classification of wake-promoting medications?

A) Direct-acting sympathomimetics
B) Indirect-acting sympathomimetics
C) Stimulants that are not sympathomimetics
D) Hypnotic benzodiazepines

Question 9

The primary determinant in the efficacy of CPAP in patients with OSA is

A) compliance.
B) weight.
C) tonsil size.
D) respiratory effort.

Question 10

Interventions to help with circadian synchronization include

A) opening the window blinds.
B) encouraging the patient to take frequent naps during the day.
C) administering sedatives at bedtime.
D) keeping the patient awake during the early morning hours.

Question 11

The patient has been in the critical care unit for 3 weeks and has been on an intra-aortic balloon pump for the past 3 days.The patient's condition has been serious,and hourly assessments and vital signs have been necessary.The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time.The patient has been given diazepam (Valium)prn.The anticipated effect of diazepam on the patient's sleep is

A) a decrease in NREM stage 1.
B) an increase in NREM stage 3.
C) total NREM suppression.
D) REM suppression in larger doses.

Question 12

Sleep disturbance in critically ill patients is defined as insufficient duration or stages of sleep that results in

A) less sleep that promotes recovery.
B) discomfort and interferes with quality of life.
C) adaptation of the environment to promote sleep.
D) more sleep that promotes recovery.

Question 13

_____ is used during polysomnography to determine when the patient enters REM sleep.

A) Electrooculography
B) Electromyography
C) Electroencephalography
D) Polysomnography

Question 14

What occurs physiologically during REM sleep?

A) Growth hormone is secreted.
B) Metabolic needs are decreased.
C) Sympathetic nervous system predominates.
D) Heart rate and blood pressure decrease.

Question 15

A patient was given the diagnosis of congestive heart failure (CHF)2 years ago.The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring.Central sleep apnea is suspected.Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea.Which of the following indicates a diagnosis of nonhypercapnic central sleep apnea (CSA)?

A) Polysomnography with absence of airflow for at least 5 seconds
B) Apnea-hypopnea index of 10
C) Peripheral edema, polycythemia, and obesity
D) Insomnia, awakenings accompanied by choking, and normal body mass index

Question 16

During a sleep study,which of the following groups of information are gathered?

A) Airflow, snoring, and tonsil size
B) Electroencephalogram, electrocardiogram, and end-tidal carbon dioxide
C) Oxygen saturation, number of arousals, and airflow
D) Frequency of awakenings, REM speed, and apnea-hypopnea index

Question 17

Hypnotic benzodiazepines

A) promote deeper sleep stages.
B) can produce prolonged effects in older adults.
C) are metabolized more rapidly in the presence of steroids.
D) enhance short-term recall.

Question 18

A patient with mild obstructive sleep apnea (OSA)can expect treatment to consist of

A) medical management with protriptyline.
B) weight loss, elimination of alcohol before bedtime, and side sleeping.
C) immediate use of continuous positive airway pressure (CPAP).
D) surgical intervention with uvulopalatopharyngoplasty (UPPP).

Question 19

A patient was given the diagnosis of congestive heart failure (CHF)2 years ago.The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring.Central sleep apnea is suspected.Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea.The patient's primary treatment plan should include

A) CPAP.
B) bilevel positive airway pressure (BiPAP).
C) acetazolamide and medroxyprogesterone.
D) modafinil and zolpidem.

Question 20

The patient has been in the critical care unit for 3 weeks and has been on the intraaortic balloon pump for the past 3 days.The patient's condition has been serious,and hourly assessments and vital signs have been necessary.The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time.The patient has been given diazepam (Valium)prn.Which techniques may assist in assessing the patient's sleep pattern?

A) Correlating sleep time with vital signs
B) Documenting sleep periods of more than 90 minutes
C) Assessing degree of arousal on hourly checks
D) Observing the length of NREM sleep periods

Question 21

Which of the following are characteristic of sleep in elderly adults?

A) Insomnia
B) Less sleep required
C) Altered circadian rhythms
D) Higher incidence of sleep apnea
E) Longer periods of non-REM sleep

Question 22

Which of the following occur during REM sleep stages?

A) Vital signs remain at basal levels.
B) Dreams occur.
C) Myocardial infarction often occurs.
D) Sweating or shivering is common.
E) Growth hormone is released.

Question 23

A sufficient amount of sleep has been achieved when a person awakens

A) after 8 to 10 hours of uninterrupted sleep.
B) with external stimuli and gets through the day without feeling sleepy.
C) without external stimuli and gets through the day without feeling sleepy.
D) feeling rested in the morning and takes a nap in the afternoon.

Question 24

Identify the usual cycle of sleep onset.

A) NR1, NR2, NR3, NR2, REM
B) NR1, NR2, NR3, REM
C) NR1, NR2, NR3, NR1, REM
D) NR1, NR2, NR3, REM, NR3

Question 25

REM sleep comprises what percent of the sleep cycle?

A) 70% to 75%
B) 45% to 65%
C) 15% to 20%
D) 20% to 25%