Question 1

The nurse is discussing with a new mother the sleep requirements of a neonate.Which of these comments would indicate that the patient has an understanding of the neonate's sleeping pattern?

Accepted Answer

The neonate averages about 16 hours of sleep.During the first week of life,the child sleeps almost constantly.

Question 2

The patient has just been diagnosed with narcolepsy.The nurse provides an educational session and teaches the patient to avoid

Accepted Answer

Patients with narcolepsy need to avoid factors that increase drowsiness such as alcohol,heavy meals,exhausting activities,long-distance driving,and long periods of sitting in hot,stuffy rooms.Patients are treated with antidepressants,and management techniques involve scheduling naps no longer than 20 minutes and chewing gum.Additional management techniques include exercise,light high-protein meals,deep breathing,and taking vitamins.

Question 3

The nurse is discussing lack of sleep with a middle-aged adult.The nurse recognizes that insomnia in this age group is commonly due to

Accepted Answer

During middle adulthood,the total time spent sleeping at night begins to decline.Anxiety,depression,and illness can affect sleep,and women can experience menopausal symptoms.Insomnia is common because of the changes and stresses associated with middle age.Teenagers,caring for pets,and late night television can influence the amount of sleep; however,these are not the most common causes of insomnia in this age group.

Question 4

The nurse assigns a nursing diagnosis of ineffective breathing pattern.Which of the following sleep conditions would support this diagnosis?

Accepted Answer

Obstructive sleep apnea (OSA)occurs when the muscles or structures of the oral cavity or throat relax during sleep.The upper airway becomes partially or completely blocked,diminishing airflow or stopping it for as long as 30 seconds.The person still attempts to breathe because chest and abdominal movements continue,resulting in snoring or snorting sounds.With narcolepsy,the person feels an overwhelming wave of sleepiness and falls asleep.Insomnia is characterized by chronic difficulty falling asleep.Sleep deprivation is a condition caused by dyssomnia.OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe.

Question 5

The nurse is providing an educational session on sleep regulation for new nurses in the Sleep Disorder Treatment Center.Which of these statements by the nurses would best indicate that learning has occurred?

Accepted Answer

Sleep involves a sequence of physiological states maintained by the central nervous system.Current theory indicates that it is an active multiphase process that involves many parts of the brain and hormone and chemical secretion.A disease process associated with the cranial nerves,motor pathway,or spinal reflexes may influence a person's ability to sleep,but the best answer is the central nervous system.

Question 6

The nurse is completing an assessment on an older patient who is having difficulty falling asleep.Which factor has the potential to contribute to this difficulty?

Accepted Answer

Older adults and other individuals who experience depressive mood problems experience delays in falling asleep,earlier appearance of REM sleep,frequent awakening,increased total bed time,feelings of sleeping poorly,and early awakening.Smoking (nicotine)decreases the total sleep time and REM and causes awakening or difficulty staying asleep.Alcohol speeds the onset of sleep.A person who is moderately fatigued usually achieves restful sleep.

Question 7

The nurse is caring for a patient who is having trouble sleeping.To encourage decreased stimulus to the reticular activating system and activation of the bulbar synchronizing region,which actions would the nurse implement?

Accepted Answer

Researchers believe that the ascending reticular activating system (RAS)located in the upper brainstem contains special cells that maintain alertness and wakefulness.Researchers also hypothesize that the release of serotonin from specialized cells in the bulbar synchronizing region (BSR)produces sleep.As the patient closes his eyes and assumes relaxed positions,stimuli to the RAS decrease,and at some point the BSR takes over.Television,walking,and drinking a favorite beverage would not necessarily encourage sleep.

Question 8

The nurse is having a conversation with an adolescent regarding the need for sleep.The adolescent states that it is common to stay up with friends several nights a week.Which nursing action should the nurse take?

Accepted Answer

On average,a teenager needs about 71/2 hours of sleep per night.Many activities at school,social activities,and jobs can reduce the number of sleep hours,resulting in excessive daytime sleepiness.This can lead to decreased performance at school,vulnerability to accidents,behavior and mood problems,and increased use of alcohol.Discussion regarding adolescent sleep needs should first occur with the adolescent.Although it may be common for this adolescent to want to visit with friends and experience activities that go late into the night,these activities can and do impact the hours of sleep and the physical needs of the adolescent,no matter the reason for the late nights,and they do need to be addressed.

Question 9

A single dad is discussing with the nurse the sleep needs of a preschooler.Which of the following directions would be most helpful to the parent?

Accepted Answer

The preschooler usually has difficulty relaxing or settling down after long,active days.By the age of 5,naps are rare for children,except those for whom a siesta is a custom.Preschoolers frequently partially awaken during the night.On average,a preschooler needs 12 hours of sleep.

Question 10

The patient shares with the nurse the vivid,full color dreams experienced by the patient last night.These data would indicate that the patient has reached what stage of sleep?

Accepted Answer

Vivid,full color dreaming occurs during REM sleep.This stage usually begins about 90 minutes after sleep has begun.The eyes move rapidly,and heart rate,respiratory rate,and blood pressure fluctuate; loss of skeletal muscle tone occurs.The patient has an increase in gastric secretions and is difficult to arouse.

Question 11

The nurse is completing a sleep assessment on a patient.The nurse utilizes which of the following tools to complete the assessment?

Accepted Answer

The Visual Analogue Scale is utilized for assessing sleep quality.The OUCHER and FACES scales are used to measure pain,and the Glasgow Coma Scale is used to measure level of consciousness.

Question 12

Which of the following would be most important for the nurse to monitor in a patient who has obstructive sleep apnea?

Accepted Answer

In obstructive sleep apnea,the upper airway becomes partially or completely blocked,diminishing airflow and stopping it.The person still attempts to breathe because the chest and abdominal movement continue,which results in loud snoring and snorting sounds.According to the ABCs of prioritizing care,airway and respiratory status take priority.

Question 13

The nurse is caring for a young adult patient on the medical-surgical unit.When doing midnight checks,she sees that the patient is awake and is doing a puzzle.What is the best explanation for the patient being awake?

Accepted Answer

All persons have biological clocks that synchronize their sleep-wake cycle.This explains why some individuals fall asleep in the early evening and some late evening or early morning.This patient is awake and alert enough to do a puzzle.The individual's sleep-wake preference is probably late evening.Waiting to talk with the nurse,being lonely,and noise on the unit may contribute to lack of sleep,but the best explanation for the patient being awake is the biological clock.

Question 14

The patient presents to the clinic with reports of irritability,being sleepy during the day,not being able to fall asleep,and being tired.Select the most appropriate nursing diagnosis.

Accepted Answer

Insomnia is experienced when the patient has difficulty falling asleep,frequent awakenings from sleep,and/or short sleep or nonrestorative sleep.It is the most common sleep-related complaint and includes symptoms such as irritability,excessive daytime sleepiness,not being able to fall asleep,and fatigue.Anxiety is a vague,uneasy feeling of discomfort or dread accompanied by an autonomic response.Fatigue is an overwhelming sustained sense of exhaustion with decreased capacity for physical and mental work at a usual level.Sleep deprivation is a condition caused by dyssomnia and includes symptoms caused by illness,emotional distress,or medications.

Question 15

The nurse is caring for an adolescent who is complaining of difficulty falling asleep.Which intervention would be most appropriate?

Accepted Answer

Cola and chocolate contain caffeine,which interferes with the ability to fall asleep.Personal preference influences the temperature of the room,as well as the lighting of the room.Noise can be a factor in the unit and can awaken the patient,but caffeine can make it difficult to fall asleep.

Question 16

Which nursing observation of the patient in intensive care indicates that the patient is sleeping comfortably?

Accepted Answer

During NREM sleep,biological functions slow.During sleep,the heart rate decreases to 60 beats per minute or less.The patient experiences decreased respirations,blood pressure,and muscle tone.

Question 17

The nurse is beginning a sleep assessment on a patient.Which of the following would be the most appropriate question to ask?

Accepted Answer

Asking patients how they are sleeping is an introductory question.After this beginning question is asked,problems with sleep such as the nature of the problem,signs and symptoms,onset and duration of the issue,severity,predisposing factors,and the effect on the patient can be assessed.What is going on is too broad and open ended for information about sleep to be obtained specifically.Medications and food intake can be part of the detailed assessment of sleep issues.

Question 18

The nurse is caring for a patient who has been in holding in the emergency department for 24 hours.The nurse is concerned about the patient experiencing sleep deprivation.What would be the best action for the nurse to take?

Accepted Answer

The most effective treatment for sleep deprivation is elimination or correction of factors that disrupt the sleep pattern.Nurses play an important role in identifying treatable sleep deprivation problems.Obtaining a private room in the designated unit for the patient will help with decreasing stimuli and promoting more rest than an individual can obtain in an emergency department even with the interventions mentioned.

Question 19

The nurse is caring for a postpartum patient.The patient's labor has lasted over 28 hours within the hospital; the patient has not slept and is disoriented to date and time.What is the most appropriate nursing diagnosis?

Accepted Answer

This patient has been deprived of sleep by staying awake during a 28-hour labor.Disorientation is one potential sign of sleep deprivation.In this scenario,we have a clear cause for the patient's lack of sleep,and it is a one-time episode.Insomnia,on the other hand,is a chronic disorder whereby patients have difficulty falling asleep,awaken frequently,or sleep only for a short time.This scenario does not indicate that this has been a chronic problem for this patient.Although ineffective coping can manifest as a sleep disturbance,we have clear evidence that it was labor that deprived this patient of sleep,not an inability to cope.It could be difficult to care for an infant when sleep deprived; however,this scenario gives no evidence that this mother displays impaired parenting and is not caring adequately for her child or lacks the skills to do so.

Question 20

The nurse is caring for a patient in the sleep lab.The nurse recognizes that the patient is in stage 4 NREM from which of the following assessments?

Accepted Answer

Stage 4 NREM is the deepest stage of sleep.The patient is difficult to arouse,vital signs are significantly lower,and this stage lasts about 15 to 30 minutes.Sleep walking and enuresis sometimes occur.Lighter sleep is seen in stages 1 and 2,where the patient awakens easily.In stage 2,body functions slow and REM sleep is characterized by rapid eye movement.

Quiz 90: Sleep