Question 1

A nurse is giving a presentation to a community group about sleep and its relationship to health. In explaining the relationship between rapid eye movement (REM) sleep and body temperature, which statement by the nurse would be most appropriate?

Accepted Answer

The greatest amount of REM sleep is seen when the body temperature cycle is at its lowest. Temperature regulation is impaired; that is, people do not sweat or shiver during REM sleep.

Question 2

The nurse is assessing the sleep patterns of a 70-year-old client whose life partner died 6 months ago. Based on the knowledge of circadian rhythms and the influence of age, which statement would the nurse anticipate that the client would report about a personal sleep pattern?

Accepted Answer

Insomnia has a greater prevalence among older people and among divorced, separated, and widowed adults. Increasing age and comorbid disorders (e.g., medical, mental disorders, and substance use) are all risks for developing insomnia disorder.

Question 3

A student nurse is preparing a nursing care plan for a client who has been diagnosed with insomnia and is experiencing sleep deprivation. Which nursing diagnosis would the nurse most likely identify as reflecting a priority care issue?

Accepted Answer

Safety is a priority for people with insomnia. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Sedating medication could potentially increase falls.

Question 4

A client who is receiving counseling at a community health center has reported being unable to sleep during the last three weekly sessions. A nurse interviews the family members to determine the effect of the client's problem on them. Which response would the nurse most likely expect to hear?

Accepted Answer

Living with a family member with insomnia is challenging. Irritability, complaints of sleeplessness, and chronic fatigue interfere with quality interpersonal relationships. It would be highly unlikely that things are not problematic or that the effects of the insomnia would be positive.

Question 5

A nurse is discussing strategies to enhance sleep with a client who is experiencing insomnia. Which recommendation would be most appropriate for the nurse to suggest?

Accepted Answer

Routines are important, especially when preparing the body to sleep. Therefore, establishing and maintaining a regular time for bedtime and awakening is appropriate. Clients with insomnia should be counseled not to eat anything heavy for several hours before retiring. Spicy foods, alcohol, and caffeine should be avoided. Additionally, exercise promotes sleep, but regular exercise should be planned for 3 hours before bedtime.

Question 6

A nurse is working with a psychiatric client who is being discharged from an inpatient facility. The client asks the nurse, "What should I do at home to promote getting adequate sleep?" Which response by the nurse would be most appropriate?

Accepted Answer

The nurse can help the client develop bedtime rituals and good sleep hygiene. Bedtime should be at a regular hour, and the bedroom should be conducive to sleep. Preferably, the bedroom should not be a place where the individual watches television or does work-related activities. The bedroom should be viewed as a room for sleeping and sex, and the environment should be cool, with minimal lighting.

Question 7

A client diagnosed with a mental disorder is being discharged from an inpatient unit. During the hospital stay, the client eventually was able to get an adequate night's sleep even though there was a history of chronic insomnia over the years. The client's spouse asks the nurse what the family can do in the home environment to promote healthy sleep. Which response by the nurse would be most appropriate?

Accepted Answer

Family and friends should be encouraged to support the new habits that the client is trying to establish. Avoiding stimulating activities and engaging in relaxing activities before bedtime are crucial, and family and friends can help create an environment conducive to sleep. Alcohol, spicy foods, and caffeine should be avoided.

Question 8

A client has been admitted to the psychiatric unit with a diagnosis of narcolepsy. Which client statement would the nurse interpret as reflecting this condition?

Accepted Answer

The overwhelming urge to sleep is the primary symptom of narcolepsy. This irresistible urge to sleep occurs at any time of the day, regardless of the amount of sleep the client has had. Falling asleep often occurs in inappropriate situations, such as while driving a car or reading a newspaper. These sleep episodes are usually short, lasting 5 to 20 minutes, but may last up to an hour if sleep is not interrupted. Individuals with narcolepsy may experience sleep attacks and report frequent dreaming. They usually feel alert after a sleep attack, only to fall asleep unintentionally again several hours later. Excitement with leg restlessness, worrying, an inability to relax, and the use of sleeping pills are not associated with narcolepsy.

Question 9

A nurse is preparing a presentation on sleep disorders for a community group. Which statement would the nurse include when explaining the differences between narcolepsy and obstructive sleep apnea syndrome?

Accepted Answer

Unlike narcolepsy, naps tend to be unrefreshing to those with obstructive sleep apnea syndrome. The disorders are different. Individuals with narcolepsy may experience cataplexy, a bilateral loss of muscle tone.

Question 10

A nurse is working with a client diagnosed with insomnia. When developing an education plan for the client, which sleep promotion intervention would the nurse implement first?

Accepted Answer

Nonpharmacologic, health-promoting interventions are the first choice before administering pharmacologic agents. Sleep hygiene strategies, such as keeping regular times for going to bed and rising, are effective and should be encouraged. The goal is to normalize sleep patterns to improve well-being.

Question 11

A nurse obtaining information about sleep patterns asks the client about the total amount of sleep time, as compared to the amount of time spent in bed. The nurse is assessing which aspect?

Accepted Answer

Sleep efficiency refers to the ratio of total sleep time to time in bed. Sleep latency is the time period measured from "lights out" or bedtime to the initiation of sleep. Sleep architecture is the pattern of NREM and REM, which is in about a 90- to 110-minute cycle. The sleep-wake cycle is an endogenously generated rhythm close to 24 to 25 hours, synchronized with the day-night cycle.

Question 12

A group of nursing students is reviewing information about factors affecting the pattern and quality of sleep. The students demonstrate a need for additional review when they identify which factor?

Accepted Answer

Sleep patterns change dramatically over the course of the lifespan. Sleep problems and poorer quality sleep are reported more often by women than men. Lifestyle factors such as working the night shift and sleeping during the day can affect normal sleep. The external and internal environment can affect sleep.

Question 13

The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. Which effect of caffeine on sleep would the nurse incorporate into a discussion with the client?

Accepted Answer

Caffeine causes increased sleep latency, decreased total sleep time, and decreased REM sleep. It does not affect slow-wave sleep.

Question 14

A client diagnosed with insomnia is taught to avoid watching television, eating, and doing work in the bedroom. Which technique is being used?

Accepted Answer

Stimulus control is a technique used when the bedroom environment no longer provides cues for sleep but has become the cue for wakefulness. Clients are instructed to avoid behaviors in the bedroom that are incompatible with sleep, including watching television, doing homework, and eating. This allows the bedroom to be reestablished as a stimulus for sleep. Clients often increase their time in bed to provide more opportunity for sleep, resulting in fragmented sleep and irregular sleep schedules. With sleep restriction, clients are instructed to spend less time in bed and to avoid napping. Relaxation training involves the use of progressive relaxation, autogenic training, and biofeedback to relieve physical or emotional distress affecting sleep. Cognitive-behavioral therapy identifies the maladaptive behavior, bringing the distortions to the client's attention and extinguishing the association between effort to sleep and increased arousals.

Question 15

A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the medication's effect on which of the following?

Accepted Answer

Zolpidem is a benzodiazepine receptor agonist that exerts its effects by facilitating GABA effects. Serotonin, dopamine, and norepinephrine are not involved.

Question 16

A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent as a melatonin receptor agonist?

Accepted Answer

Ramelteon is a melatonin receptor agonist. Trazodone and mirtazapine are sedating antidepressants. Estazolam is a benzodiazepine classified as a benzodiazepine receptor agonist.

Question 17

After educating a group of nursing students about the physiology of sleep, the instructor determines that the education was successful when the group identifies which of the following as responsible for maintaining wakefulness?

Accepted Answer

From a physiologic perspective, dopamine, gamma-aminobutyric acid (GABA), adenosine, histamine, hypocretin, melatonin, and cortisol appear to play roles in changing sleep states (Monti, 2013). Wakefulness is maintained by the reticular activating system in the brain. As the cycle of the reticular activating system dwindles, neurotransmitters that promote sleep take over.

Question 18

A nurse interviewing a client about sleep patterns is told that the client goes to bed about 11 p.m. and usually falls asleep by 11:15 p.m. The nurse identifies this as which time period?

Accepted Answer

Sleep latency is the time period measured from "lights out," or bedtime, to initiation of sleep. Sleep architecture is the pattern of non-rapid eye movement (NREM) and rapid eye movement that are in approximately a 90- to 110-minute cycle. Sleep occurs in stages, and the timing of sleep is regulated by circadian rhythms. Sleep efficiency is the ratio of total sleep time to time in bed. Slow-wave sleep is the deepest state of sleep occurring during stages 3 and 4 of NREM sleep.

Question 19

A nursing instructor is describing the prevalence of sleep-wake disorders as being greater among individuals with mental health disorders. Which disorders would the instructor include as being associated with sleep-wake disorders? Select all that apply.

Accepted Answer

Sleep-wake disorders occur independent of a diagnosis of other mental disorders, but they also occur in people with mental disorders. For example, a core feature of posttraumatic stress disorder (PTSD) is sleep disturbance. Insomnia often increases the risk for relapse of the mental disorder. Documented comorbid conditions include cardiovascular disorders, diabetes, musculoskeletal disorders, respiratory disorders, digestive disorders, pain conditions, and mental disorders including depression, PTSD, and other sleep disorders such as sleep apnea and restless legs syndrome. Obstructive sleep apnea is not associated with borderline personality disorder or schizophrenia.

Question 20

After teaching a class about circadian rhythm disorders, a nursing instructor determines that the education was successful when the class identifies which subtype of this disorder according to the DSM-5? Select all that apply.

Accepted Answer

According to the DSM-5, subtypes of circadian rhythm disorders include a delayed sleep phase and shift work type. Although jet lag type is a circadian rhythm sleep-wake disorder, it is not included in the DSM-5. Nightmare and sleep terror are separate disorders.

Quiz 34: Sleepwake Disorders: Nursing Care of Persons With Insomnia and Sleep Problems