Deck 31: Sleep

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?

A) Changing to a later evening mealtime
B) Using blackout blinds
C) Exercising 3 hours before bed time
D) Buying a new support mattress

Answer 1

Changing to a later evening mealtime

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?

A) Narcolepsy
B) Cataplexy
C) Obstructive sleep apnea
D) Insomnia

Answer 2

Obstructive sleep apnea

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?

A) Eat spicy food before going to sleep.
B) Avoid caffeine in the afternoon.
C) Consciously think about the dreams upon awakening.
D) Become more creative.

Answer 3

Consciously think about the dreams upon awakening.

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:

A) are prone to snore after surgery and require a private room.
B) who receive general anesthesia have a greater risk for airway obstruction.
C) generally need additional pain medication.
D) usually require sleep aids to provide more restful sleep.

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?

A) "I don't get enough sleep either; I spend most of my time studying."
B) "You need to discuss this with the primary health care provider."
C) "Sleep deprivation can cause a person to get sick or have excessive daytime sleepiness."
D) "High school is a tough time in life, but I'm sure he will be fine."

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?

A) Take a nap in the afternoon.
B) Go to bed earlier.
C) Go to bed later.
D) Take a benzodiazepine.

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?

A) Encouraging the patient to void before bedtime
B) Offering to give the patient a backrub
C) Giving the patient an extra blanket when cold
D) Providing a warm cup of hot cocoa before bedtime

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?

A) "Are you feeling tired, maybe you are experiencing depression."
B) "Most children begin to sleep through the night around 3 months."
C) "Most children begin to sleep through the night around 6 months."
D) "Are you feeling tired? Maybe you are anemic?"

Question 9

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

A) Hours of sleep each night
B) Sleep-wake pattern
C) Whether the patient feels rested
D) Number of times the patient awakens during sleep

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?

A) Stress of the new job
B) Increased daylight hours in Northern Alaska
C) Physical demands of the new job
D) Change in diet

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?

A) Administer sleeping medications at 2200 hours.
B) Cluster nursing activities at night.
C) Turn off all alarms after 2200.
D) Keep lights on in the main hallway for safety reasons.

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?

A) A small night light left on in the bedroom
B) All clutter removed between the bed and the bathroom
C) Bed in high position with side rails up
D) Call bell at the bedside for the patient to alert family members

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?

A) Older adults spend more time in stage 3.
B) Older adults spend more time in REM sleep.
C) Older adults spend more time in falling asleep.
D) Older adults spend more time in deep 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?

A) Benzodiazepine
B) Melatonin agonist
C) L-tryptophan antagonist
D) Nonbenzodiazepine, benzodiazepine receptor agonist

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?

A) "You should play an active game with her like basketball to wear her out."
B) "It would be a good idea to save homework until right before bedtime."
C) "Quiet activities like reading sometimes help to settle down children her age."
D) "Try to delay dinner time until later to help make her sleepy."

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?

A) A person is unable to breathe and sleep at the same time.
B) It is a sleep disorder that produces abnormal sleep movements.
C) It is a rare dysfunction of the mechanism that regulates sleep and wake states.
D) It is a sudden muscle weakness occuring during intense emotions.

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?

A) The patient will fall asleep more easily.
B) The patient will sleep longer throughout the night.
C) The patient will have less than two awakenings throughout the night.
D) The patient will wake up more refreshed in the morning.

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?

A) "How long does it take you to fall asleep?"
B) "Tell me why you think you have a sleep problem."
C) "Have you been told that you snore loudly?"
D) "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.

A) 24 hours
B) 72 hours
C) 1 to 2 weeks
D) 7 to 9 hours

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?

A) Cataplexy
B) Insomnia
C) Narcolepsy
D) Sleep apnea

Question 21

The nurse encourages a postoperative patient to get adequate amounts of sleep after discharge from the health care facility.When the patient asks why,how should the nurse respond?

A) Sleep restores biological processes.
B) Sleep stimulates appetite on waking.
C) Sleep causes a mental and physiological calm.
D) Sleep produces dreams that decrease epinephrine.

Question 22

A 2-year-old child in the pediatric unit resists going to sleep.To promote sleep,which is the best action for the nurse to take?

A) Eliminate a daytime nap.
B) Offer the child warm chocolate milk.
C) Maintain the child's home bedtime routine.
D) Allow the child to sleep longer in the morning.

Question 23

A patient asks the nurse to explain how sleep occurs.The nurse explains to the patient that the physiology of sleep is a complex process.However,in simple terms,what is the nurse's best response?

A) Circadian sleep rhythm controls sleep.
B) Sleep occurs when a person's basal metabolic rate falls.
C) Sleep is a dreaming process.
D) Interrelated mechanisms of the brain control wake and sleep cycles.

Question 24

A nurse is caring for a patient who suffers from a sleep pattern disturbance.To promote adequate sleep,what are the most appropriate nursing interventions? (Select all that apply.)

A) Straighten and change any soiled bed linens.
B) Synchronize the medication, treatment, and vital signs schedule.
C) Provide personal hygiene before bedtime.
D) Discuss with the patient the benefits of beginning a long-term nighttime medication regimen.
E) Assist the patient to use the toilet before bed.

Question 25

Which of the following bedtime snack(s)helps to promote sleep in a patient?

A) Cereal and milk
B) A full meal
C) Chips and cola
D) Coffee and toast

Question 26

A patient has returned from back surgery.The family has brought in the patient's continuous positive airway pressure (CPAP)machine.What is the best rationale for allowing the patient to use the CPAP machine at night?

A) It will keep the patient in deep levels of REM, which will decrease the need for pain medication.
B) It will help decrease hospital noise that will keep the patient awake.
C) The patient needs ventilator support owing to the increased chance of postoperative respiratory complications.
D) The patient needs to follow the same bedtime routine to promote a safe environment for sleep.

Question 27

A nurse has been temporarily assigned to the night shift.A change in this circadian rhythm may cause which of the following? (Select all that apply.)

A) Anxiety
B) Weight gain
C) Decreased appetite
D) Increased periods of sleep
E) Impaired judgment

Question 28

A patient's vital signs are significantly lower than normal while sleeping.The nurse understands this to be a normal finding when the patient is in what stage of the sleep cycle?

A) 1
B) 2
C) 3
D) 4

Question 29

A patient arrives at the ambulatory clinic for a routine physical.The nurse inquires about the patient's sleep pattern.The patient has a history of sleep pattern disturbances.The nurse evaluates that the patient is sleeping better when he or she states which of the following?

A) "I don't take melatonin as frequently."
B) "I increased my alcohol consumption before bedtime."
C) "I decreased my activity level."
D) "I take more daytime power naps."

Question 30

An older adult widow reports having problems sleeping at night and states,"I miss my spouse." The nurse also recognizes that older patients:

A) are difficult to assess.
B) take less time to fall asleep.
C) may suffer from emotional stress or depressive mood problems.
D) require less sleep than middle-age adults.

Question 31

The nurse is triaging a patient for an annual check-up with the health care provider.When questioned about changes in sleep habits the patient replies,"Since my spouse passed away last month,I have not been sleeping well at all." What are the most appropriate interventions for the nurse to make? (Select all that apply.)

A) Speaking to the health care provider for a benzodiazepine sleeping aid
B) Contacting a pastoral care professional
C) Consulting with a psychiatric clinical nurse specialist
D) Consulting with a clinical psychologist
E) Referring the patient for evaluation to the sleep clinic