Question 1

A 57-year-old patient is concerned about the inability to fall/stay asleep at night.This started about 3 months ago.The nurse asks about recent changes in lifestyle and activities of daily living.Which of the following changes is probably most responsible for the change in sleeping pattern?

Accepted Answer

Alterations in routine that disrupt sleep patterns include performing unaccustomed heavy work or exercise,engaging in late-night social activities,and changing evening mealtime.Eating a large,heavy,and/or spicy meal within 3 to 4 hours of bedtime sometimes results in indigestion that interferes with sleep.The physical environment in which a person sleeps has a significant influence on the ability to fall and remain asleep.Exercising 2 or more hours (patient exercised 3 hours)before bedtime allows time for the body to cool and maintain a state of fatigue that promotes relaxation.A new support mattress will promote relaxation and sleep.Proper ventilation,a comfortable temperature,and a darkened (blackout blinds)or softly lit room are essential for restful sleep.

Question 2

When visiting the clinic,a nurse takes the patient's sleep history and notes the appearance of a deviated septum.The nurse knows that this structural abnormality predisposes the patient to which condition?

Accepted Answer

Structural abnormalities such as a deviated septum,nasal polyps,narrow lower jaw,or enlarged tonsils sometimes predispose a patient to obstructive sleep apnea.Insomnia is a symptom rather than the name of a disease and is common among patients suffering from depression.It is experienced by patients who have chronic difficulty falling asleep,frequent awakenings from sleep,and/or a sleep or a nonrestorative sleep.Narcolepsy is a rare central nervous system dysfunction of mechanisms that regulate sleep and wake states; during the day a person suddenly feels an overwhelming wave of sleepiness and falls asleep.Cataplexy is a sudden muscle weakness during intense emotions such as anger or laughter that occurs at any time during the day.

Question 3

During a sleep study test,the patient states,"I never dreams anymore." The health care provider tells the patient that everyone dreams,but most people forget about them upon awakening.The health care provider tells the patient that the best way to remember dreams is to do which of the following?

Accepted Answer

To remember a dream,a person must consciously think about it on awakening.People who recall dreams vividly usually awaken just after a period of rapid eye movement (REM)sleep.Personality influences the quality of dreams; for example,a creative person may have very vivid,unusual dreams,whereas a depressed person may have dreams of helplessness.Eating a large,heavy,and/or spicy meal within 3 to 4 hours of bedtime sometimes results in indigestion that interferes with sleep.Alcohol consumed in the evening has insomnia-producing and diuretic effects.Coffee,tea,cola,and chocolate contain caffeine and xanthines that cause sleeplessness as a result of central nervous system stimulation.Avoiding caffeine and becoming more creative do not increase a person's memory for dreams.

Question 4

A 45-year-old obese patient has been scheduled for cardiac bypass surgery.The nurse who is preparing the patient for surgery asks,"Do you have a history of sleep apnea?" This is important to know before surgery because patients with sleep apnea:

Accepted Answer

If a patient is scheduled for surgery,be sure to ask about a history of sleep apnea.Patients with sleep apnea who receive general anesthesia and pain medications after surgery have increased risk for developing airway obstruction during recovery.A private room is not necessary.Sleep apnea does not require a patient to need additional pain medication or sleep aids after surgery.

Question 5

The health care provider is seeing a 16-year-old boy at the local clinic.The guardian is concerned about the patient's lack of sleep.The guardian states that the patient "goes to school,works at a part-time job until 10 PM,and then stays up doing homework until after midnight.I am worried that he is not getting enough sleep." What is the best response for the health care provider to give the patient and his guardian?

Accepted Answer

Adolescents need between 8 11ea1a5c_b889_98a2_ab1a_e911dd2ee243_TB1105_11 and 9 11ea1a5c_b889_bfb3_ab1a_99c309c59e22_TB1105_11 hours of sleep each night; however,the typical teenager gets about 7 11ea1a5c_b889_bfb4_ab1a_599baa26e558_TB1105_11 hours of sleep per night.At a time when sleep needs actually increase,the typical adolescent is subject to a number of changes that often reduce the time spent sleeping,such as the time when school starts,after-school social events,part-time jobs,and extracurricular activities.The shortened sleep time in adolescents often results in excessive daytime sleepiness (EDS),which can reduce performance in school,increase risk of accidents,increase the use of alcohol,and lead to behavior and mood problems.Sleep deprivation affects immune functioning,metabolism,nitrogen balance,protein catabolism,and quality of life.Saying,"I don't get enough sleep either" or "You need to discuss this with the primary health care provider" is not focusing on the guardian's question.Saying the boy "will be fine" is false reassurance.

Question 6

A 73-year-old patient reports to the nurse about waking up early and not being able to return to sleep.The patient states,"I do not go to bed until after the evening news." What is the best advice for the nurse to give this patient to encourage a good night's sleep?

Accepted Answer

Older patients become sleepier in the early evening (going to bed when the body is naturally sleepy is beneficial)and wake earlier in the morning,but still require the necessary 7 to 8 hours of sleep a day.Going to bed later would not be beneficial.Research indicates that exercise is beneficial,particularly for older adults,to improve nighttime sleep.General recommendations include increasing daytime activity or exercise,not taking a nap.The use of benzodiazepines in the older adult population is potentially dangerous.Long-term use and high doses in this population have been associated with suicidal ideation.

Question 7

A patient has been hospitalized with pneumonia.The patient has had some difficulty sleeping while in the hospital.The patient would like to avoid taking medication for sleep because there have been problems with sleeping pills in the past.Which action by the nursing assistant personnel will cause the nurse to intervene?

Accepted Answer

Coffee,tea,cola,and chocolate cause a person to stay awake or awaken throughout the night.Promote comfort by encouraging the patient to wear loose-fitting nightwear,void before bedtime,give a relaxing back rub,and offer an extra blanket to prevent chilling when trying to fall asleep.

Question 8

A new mother has brought in her week-old infant to the health care provider for a 1-week well-baby checkup.She is breastfeeding and has only been sleeping a couple of hours at a time during the night between feedings.She asks the nurse,"When can I expect the baby to sleep through the night?" What is the nurse's best response?

Accepted Answer

Infants usually develop a nighttime pattern of sleep by 3 months of age.The neonate and infant up to the age of 3 months average about 16 hours of sleep a day.A symptom of anemia or depression is fatigue,but this does not focus on the question the new mother asked about the baby sleeping.

Question 9

Which of the following data are most important to assess if a patient is receiving sufficient sleep?

Accepted Answer

Because sleep is a subjective experience,only the patient is able to report whether it is sufficient and restful.Patients are your best resource for describing a sleep problem and any change from their usual sleep and waking patterns.Number of hours of sleep,sleep-wake pattern,and number times awakes while sleeping are not the most important to assess to determine effectiveness of the patient's sleep,the subjective experience of the patient is the most important.

Question 10

A college student who is working in northern Alaska during the summer reports that he or she has an increase in difficulty sleeping since moving north.During a pre-employment physical,the patient asks the health care provider what could be causing this.The health care provider suspects the sleep disturbance is most likely because of which factor?

Accepted Answer

Northern Alaska has extended daylight hours.Light and temperature affect all circadian rhythms,including the sleep-wake cycle.The most familiar rhythm is the 24-hour,day-night cycle known as the diurnal or circadian rhythm.When the sleep-wake cycle becomes disrupted (e.g.,by working rotating shifts),other physiological functions change as well.Stress of the new job,physical demands of the new job,and a change in diet are not the issues.The patient stated that the difficulty started when he or she moved north.

Question 11

The nurse manager for a busy medical unit in an acute care hospital noticed a trend of complaints regarding the restful environment of the unit in the patient satisfaction reports.At the staff meeting,this issue was discussed with the staff,and they decide that the best thing to do is which of the following?

Accepted Answer

A challenge in the hospital is controlling noise.Because many patients spend only a short time in hospitals,it is easy to forget the importance of establishing good sleep conditions.
In the hospital setting,plan nursing care activities to avoid awakening patients.Try to schedule assessments,treatments,procedures,and routines for times when patients are awake.Perform nursing activities before the patient receives sleeping medication or begins to fall asleep.For example,you have a patient who has had surgery.Before the patient gets ready for bed,change the surgical dressing,reposition the patient,administer pain medication,and check vital signs (clustering nursing activities).Turning alarms off is a violation of safety protocols in most hospitals because of patient safety concerns.Lights on in the hallway can cause distraction to sleep patterns.Regular use of any sleep medication leads to tolerance,and withdrawal causes rebound insomnia.

Question 12

The long-term care facility nurse is assessing the patient's sleep environment for safety.Which finding will cause the nurse to intervene as it is an unsafe situation for the patient?

Accepted Answer

A bed in high position with side rails up is a safety hazard.Safety precautions are important for patients who awaken during the night to use the bathroom and for those with excessive daytime sleepiness.Set beds lower to the floor to lessen the chance of the patient falling when first standing.Remove clutter,and move equipment from the path a patient uses to walk from the bed to the bathroom.If patient needs assistance in ambulating from the bed to the bathroom,make sure the call light is within the patient's reach.The call light helps alert the nursing staff,not the family.A small night light is beneficial to help with vision

Question 13

A 67-year-old farmer is at the clinic because he has been sleepy during the day.Which sleep change occurs with age?

Accepted Answer

Older adults awaken more often during the night,and it takes more time for them to fall asleep.To compensate they increase the number of naps taken during the day.Older adults spend more time in stage 1 and have less stages 3 and 4 NREM sleep; some older adults have almost no NREM stage 4 or deep sleep.Episodes of REM sleep tend to shorten,and there is less deep sleep and more lighter sleep.

Question 14

A primary health care provider prescribes eszopiclone (Lunesta)for a patient.Which classification of drug will the nurse be administering to the patient?

Accepted Answer

The nonbenzodiazepine,benzodiazepine receptor agonists are newer medications that appear to have better safety profiles and fewer adverse effects than the benzodiazepines.They are also associated with a lower risk of abuse and dependence than the benzodiazepines,although abuse and dependence do occur.Examples of medications in this class include zolpidem (Ambien),zaleplon (Sonata),and eszopiclone (Lunesta).Benzodiazepines are a common classification of drug used to treat sleep problems when a change in sleep hygiene is not effective.Examples of benzodiazepines include temazepam (Restoril),flurazepam (Dalmane),estazolam (ProSom),and triazolam (Halcion).A new class of drugs called melatonin agonists promotes the onset of sleep by increasing levels of the natural hormone melatonin,which helps normalize circadian rhythm and sleep-wake cycles.Ramelteon (Rozerem)belongs to this drug class.There is no such classification as L-tryptophan antagonist.L-tryptophan is thought to promote sleep.

Question 15

A 6-year-old girl is being seen at the clinic for a well-child checkup.The guardian tells the nurse that the child is having difficulty getting to sleep at night and asks for suggestions.What is the nurse's best response?

Accepted Answer

A 6-year-old child averages 11 to 12 hours of sleep nightly.Encouraging quiet activities usually persuades the 6- or 7-year-old child to go to bed.Playing an active game,doing homework right before bed,and delaying dinner are not quiet activities.

Question 16

A primary health care provider has diagnosed the patient with having a parasomnia.The patient asks the nurse to explain what that means.What is the best explanation?

Accepted Answer

The parasomnias are sleep disorders that can occur during arousal from REM or partial arousal from NREM sleep.They include sleep walking,night terrors,nightmares,teeth grinding,and bed-wetting.Narcolepsy is a rare central nervous system dysfunction of mechanisms that regulate sleep and wake states.Excessive daytime sleepiness is the most common complaint associated with narcolepsy.Cataplexy is a sudden muscle weakness during intense emotions such as anger or laughter that occurs at any time during the day.If the cataplectic attack is severe,the patient loses voluntary muscle control and falls to the floor.Sleep apnea is a disorder in which the individual is unable to breathe and sleep at the same time.

Question 17

A nurse is caring for an elderly patient with a sleeping disorder.When formulating a care plan for this patient it was determined that the goal will be that "the patient establishes a healthy sleep pattern." Which of the following is the best example of a measurable outcome to meet this goal?

Accepted Answer

Outcomes serve as measurable guidelines to determine goal achievement."Less than two awakenings" is a measurable goal.The other responses are subjective (more easily,sleep longer,more refreshed)and do not have a measurable outcome.

Question 18

A nurse is admitting a patient to the hospital.The patient admits to a history of sleep problem.Which of the following questions will help the nurse understand the severity of the patient's sleep problem?

Accepted Answer

Severity questions include: How long does it take you to fall asleep? How often during the week do you have trouble falling asleep or staying asleep? Nature of the problem question includes: Tell me what type of problem you have with your sleep.Signs and symptoms question includes: Have you been told that you snore loudly? Onset and duration question includes: When did you notice the problem?

Question 19

A patient recently came to the clinic with complaints of having difficulty sleeping.After the primary health care provider assesses the patient the nurse instructs the patient and partner on how to keep a sleep-wake diary.Entries in the diary often include _____ of sleep-wake activities.

Accepted Answer

Entries in the diary often include 24-hour information on waking and sleeping activities such as exercise,work activities,mealtimes,and alcohol and caffeine intake.They should also include time and length of daytime naps,evening and bed routines,the time the patient tries to fall asleep,time and number of awakenings,and the time of morning awakening.72 and 1 to 2 weeks are too long,whereas 7 to 9 hours is not long enough.

Question 20

While making night shift rounds,the nursing assistive personnel become concerned when a patient stops breathing from 1 to 2 minutes several times during the shift.The nurse informs the nursing assistive personnel that this condition is known as which of the following?

Accepted Answer

Sleep apnea is a disorder in which the individual is unable to breathe and sleep at the same time and has periods of apnea throughout the night.Cataplexy is a sudden muscle weakness during intense emotions such as anger or laughter that occurs at any time during the day.Insomnias are primary disorders related to difficulty falling asleep.Narcolepsy is a central nervous system dysfunction of mechanisms that regulate sleep and wake states.

Quiz 31: Sleep