Question 1

Which action is best for the nurse to include in the plan of care in order to improve sleep quality for a critically ill client in the intensive care unit (ICU)?&#10;A)Ask all visitors to leave the ICU for the night.&#10;B)Lower the level of light from 8:00 P.M. until 7:00 A.M.&#10;C)Avoid the use of opioids for pain relief during the evening hours.&#10;D)Schedule assessments to allow at least 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 critically ill clients. For some clients, having a family member or friend at the bedside may decrease anxiety and improve sleep.

Question 2

Which action by the nurse manager of an acute care unit will improve the alertness of nurses who work the night shift?&#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 on-site 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.

Question 3

The nurse is caring for a client in the ambulatory care setting who has chronic insomnia. Which of the following interventions should the nurse do initially?&#10;A)Schedule a polysomnography (PSG) study.&#10;B)Arrange for the client to have a sleep study.&#10;C)Ask the client to keep a 2-week sleep diary.&#10;D)Teach the client about the use of an actigraph.

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 client. Actigraphy and PSG studies/sleep studies may be used for determining specific sleep disorders, but are not necessary to make an initial insomnia diagnosis.

Question 4

Which of these actions should the nurse take first for a client in the clinic who is complaining of insomnia and daytime fatigue?&#10;A)Question the client about the use of over-the-counter (OTC) sleep aids.&#10;B)Suggest that the client decrease intake of caffeine-containing beverages.&#10;C)Advise the client to get out of bed if unable to fall asleep in 10-20 minutes.&#10;D)Recommend that the client use any prescribed sleep aids for only 2-3 weeks.

Accepted Answer

The nurse's first action should be assessment of the client 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 client's sleep.

Question 5

The nurse takes the health history for four clients in the clinic. Which information regarding the clients' sleep is most important to communicate to the health care provider?&#10;A)A 21-year-old student takes melatonin to assist in sleeping when travelling from Canada to Europe.&#10;B)A 32-year-old who is experiencing a stressful week uses diphenhydramine for several nights.&#10;C)A 41-year-old with a body mass index (BMI) of 42 kg/m2 says that the spouse complains about the client's snoring.&#10;D)A 64-year-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning.

Accepted Answer

The client'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 be affecting this client's sleep quality.

Question 6

After the nurse has taught a client about the use of extended-release zopiclone for insomnia, which client statement indicates a need for further teaching?&#10;A)&#34;I will take the medication an hour before bedtime.&#34;&#10;B)&#34;I should take the medication on an empty stomach.&#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 zopiclone work quickly and should be taken immediately before bedtime, not one hour before. The other client statements are correct.

Question 7

Which instruction will the nurse include when teaching a client with chronic insomnia about ways to improve sleep quality?&#10;A)Avoid aerobic exercise during the day.&#10;B)Read in bed for a few minutes each night.&#10;C)Keep the bedroom temperature slightly warm.&#10;D)Try to 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 several hours before bedtime.
Reading in bed is discouraged for clients with insomnia. The bedroom temperature should be slightly cool.

Question 8

Aclient with sleep apnea who received a new prescription for a continuous positive airway pressure (CPAP) device a week ago returns to the clinic and says that severe daytime fatigue is still a problem. Which action should the nurse take first?

A)Teach about radiofrequency ablation.
B)Plan to schedule a nighttime PSG study.
C)Ask the client whether the CPAP is being used every night.
D)Discuss the possible surgical approaches used for sleep apnea.

Accepted Answer

CPAP is very effective in reducing sleep apnea, but patient adherence is frequently a problem. Surgery, radiofrequency ablation, or a follow-up PSG study may be indicated, but the nurse's first action should be to assess whether the CPAP is being used as prescribed.

Question 9

The nurse is caring for a client who has sleep deprivation and teaching about the effects that lack of sleep can have on the body. Which of the following information would be included in the teaching plan for this client? (Select all that apply.)

A)Decreased insulin resistance
B)Increased growth hormone
C)Increased risk of type 2 diabetes
D)Irritability, moodiness
E)Increased risk of gastro-esophageal reflux disease (GERD)

Accepted Answer

Clients with sleep deprivation are at an increased risk of GERD, type 2 diabetes, heart disease, hypertension, and impaired immune function and can also experience cognitive impairment, and behavioural changes such as irritability and moodiness. Sleep deprivation causes an increase in insulin resistance and a decrease in growth hormone.

Question 10

The nurse is providing a health-promotion session to young adults who have difficulty sleeping at night and has instructed them to limit their caffeine intake. Which of the following beverages have 50 mg or more of caffeine? (Select all that apply.)

A)Green tea (237 mL)
B)Dr. Pepper soda (237 mL)
C)Chocolate cake (5 cm square)
D)Brewed coffee (237 mL)
E)Black tea (237 mL)

Accepted Answer

Brewed coffee has 135 mg caffeine and black tea, either leaf or bag, has 50 mg of caffeine. Green tea has 30 mg, chocolate cake has 36 mg, and Dr. Pepper soda has 41 mg.

Question 11

Which information will the nurse plan to include when teaching a client with narcolepsy about management of the disorder?&#10;A)Stimulant drugs should be used for only a short time because of the risk for abuse.&#10;B)Driving an automobile may be possible with appropriate treatment of narcolepsy.&#10;C)Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.&#10;D)Antidepressant drugs are prescribed to treat the depression caused by the disorder.

Accepted Answer

The answer of Which information will the nurse plan to...

Deck 9: Sleep and Sleep Disorders