Question 1

Which information obtained by the nurse about an older adult who complains of occasional insomnia indicates a need for patient teaching ?&#10;A)Drinks a cup of coffee every morning with breakfast&#10;B)Eats a snack every evening 1 hour before going to bed&#10;C)Reads or watches television in bed on most evenings&#10;D)Takes a warm bath just before bedtime every night&#10;E)Uses diphenhydramine as an occasional sleep aid

Accepted Answer

Reading and watching television in bed may contribute to insomnia. Older adults should avoid the use of medications that have anticholinergic effects,such as diphenhydramine. Having a snack 1 hour before bedtime or coffee early in the day should not affect sleep quality. Rituals such as a warm bath before bedtime can enhance sleep quality.

Question 2

Which action should the nurse manager promote as an evidence-based practice to support alertness for night shift nurses?&#10;A)Arrange for older staff members to work most night shifts.&#10;B)Provide a sleeping area for staff to use for napping at night.&#10;C)Post reminders about the relationship of sleep and alertness.&#10;D)Schedule nursing staff to rotate day and night shifts monthly.

Accepted Answer

Short onsite naps will improve alertness. Rotating shifts causes the most disruption in sleep habits. Reminding staff members about the impact of lack of sleep on alertness will not improve sleep or alertness. It is not feasible to schedule nurses based on their ages.

Question 3

The nurse cares for an unstable patient in the intensive care unit (ICU). Which intervention should the nurse include in the plan of care to improve this patient's sleep quality?&#10;A)Ask all visitors to leave the ICU for the night.&#10;B)Lower the level of lighting from 8:00 PM until 7:00 AM.&#10;C)Avoid the use of opioids for pain relief during the evening.&#10;D)Schedule assessments to allow 4 hours of uninterrupted sleep.

Accepted Answer

Lowering the level of light will help mimic normal day/night patterns and maximize the opportunity for sleep. Although frequent assessments and opioid use can disturb sleep patterns,these actions are necessary for the care of unstable patients. For some patients,having a family member or friend at the bedside may decrease anxiety and improve sleep.

Question 4

When caring for patients with sleep disorders,which activity can the nurse appropriately delegate to unlicensed assistive personnel (UAP)?&#10;A)Assist a patient to place the CPAP device on correctly at bedtime.&#10;B)Interview a patient about risk factors for obstructive sleep disorders.&#10;C)Discuss the benefits of oral appliances in decreasing obstructive sleep apnea.&#10;D)Help a patient choose a new continuous positive airway pressure (CPAP) mask.

Accepted Answer

Because a CPAP mask is consistently worn in the same way and will have been previously fitted by a licensed health professional,a UAP can assist the patient with putting the mask on. The other actions require critical thinking and nursing judgment by the RN.

Question 5

Which patient statement indicates a need for further teaching about extended-release zolpidem (Ambien CR)?&#10;A)&#34;I should take the medication on an empty stomach.&#34;&#10;B)&#34;I will take the medication 1 to 2 hours before bedtime.&#34;&#10;C)&#34;I should not take this medication unless I can sleep for at least 6 hours.&#34;&#10;D)&#34;I will schedule activities that require mental alertness for later in the day.&#34;

Accepted Answer

Benzodiazepine receptor agonists such as zolpidem work quickly and should be taken immediately before bedtime. The other patient statements are correct.

Question 6

What is the first action the nurse should take in addressing a patient's concerns about insomnia and daytime fatigue?&#10;A)Question the patient about the use of over-the-counter sleep aids.&#10;B)Suggest that the patient decrease intake of caffeinated beverages.&#10;C)Advise the patient to get out of bed if unable to fall asleep in 10 to 20 minutes.&#10;D)Recommend that the patient use any prescribed sleep aids for only 2 to 3 weeks.

Accepted Answer

The nurse's first action should be assessment of the patient for factors that may contribute to poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions may be appropriate,but assessment is needed first to choose appropriate interventions to improve the patient's sleep.

Question 7

A patient with sleep apnea who uses a continuous positive airway pressure (CPAP)device is preparing to have inpatient surgery. Which instructions should the nurse provide to the patient?&#10;A)Schedule a preoperative sleep study.&#10;B)Take your home device to the hospital.&#10;C)Expect intubation with mechanical ventilation after surgery.&#10;D)Avoid requesting pain medication while you are hospitalized.

Accepted Answer

The patient should be told to take the CPAP device to the hospital if an overnight stay is expected. Many patients will be able to use their own CPAP equipment. Patients should be treated for pain and monitored for respiratory depression. Another sleep study is not required before surgery. A person with sleep apnea would not routinely be expected to require postoperative intubation and mechanical ventilation.

Question 8

Which information regarding a patient's sleep is most important for the nurse to communicate to the health care provider?&#10;A)A 21-yr-old student who takes melatonin to assist in sleeping when traveling from the United States to Europe&#10;B)A 64-yr-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning&#10;C)A 41-yr-old librarian who has a body mass index (BMI) of 42 kg/m2 says that the spouse complains about snoring&#10;D)A 32-yr-old accountant who is experiencing a stressful week uses diphenhydramine (Benadryl) for several nights

Accepted Answer

The patient's BMI and snoring suggest possible sleep apnea,which can cause complications such as cardiac dysrhythmias,hypertension,and right-sided heart failure. Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to affect this patient's sleep quality.

Question 9

A patient complains of difficulty falling asleep and daytime fatigue for the past 6 weeks. What is the best initial action for the nurse to take in determining whether this patient has chronic insomnia?

A)Schedule a polysomnograph (PSG).
B)Teach the patient how to use an actigraph.
C)Ask the patient to keep a 2-week sleep diary.
D)Arrange for the patient to have a sleep study.

Accepted Answer

The diagnosis of insomnia is made on the basis of subjective complaints and an evaluation of a 1- to 2-week sleep diary completed by the patient. Actigraphy and PSG studies or sleep studies may be used for determining specific sleep disorders but are not necessary to make an initial insomnia diagnosis.

Question 10

A patient with chronic insomnia asks the nurse about ways to improve sleep quality. Which response by the nurse is accurate?&#10;A)Avoid exercise during the day.&#10;B)Keep the bedroom temperature warm.&#10;C)Read in bed for a few minutes each night.&#10;D)Go to bed at the same time every evening.

Accepted Answer

A regular evening schedule is recommended to improve sleep time and quality. Aerobic exercise may improve sleep quality but should occur at least 6 hours before bedtime. Reading in bed is discouraged for patients with insomnia. The bedroom temperature should be slightly cool.

Question 11

What teaching should be included in the plan of care for a patient with narcolepsy?&#10;A)Driving an automobile may be possible with appropriate treatment of narcolepsy.&#10;B)Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.&#10;C)Antidepressant drugs are prescribed to treat the depression caused by the disorder.&#10;D)Stimulant drugs should be used for less than a month because of the risk for abuse.

Accepted Answer

The answer of What teaching should be included in the...

Deck 7: Sleep and Sleep Disorders