Deck 47: Sleep

Question 1

The client calls the neurology clinic nurse and questions a newly prescribed medication. The client states, "The pharmacist told me this drug is used for Parkinson's disease". Upon checking the medical record the nurse discovers the client was diagnosed with periodic limb movements disorder (PLMD) this morning. What action should the nurse take?

A) Call the pharmacy and reprimand the pharmacist for dispensing the wrong medication.
B) Have the client bring the medication to the clinic for review.
C) Assure the client that medications used to treat Parkinson's disease are also used to treat PLMD.
D) Tell the client not to take the medication because there is most likely an error.

Answer 1

Assure the client that medications used to treat Parkinson's disease are also used to treat PLMD.

Question 2

The nurse is completing the admission assessment on a client who has obstructive sleep apnoea. Which findings would be probable in this client?

A) Reddened uvula
B) Large soft palate
C) Obesity
D) Short neck
E) Deviated septum

Answer 2

Reddened uvula
Large soft palate
Obesity

Question 3

The nurse is developing a plan of care for a 25-year-old client of the outpatient clinic who has just been diagnosed with narcolepsy. Which intervention should the nurse include in this plan of care?

A) Encourage the client to take an over-the-counter medication to improve night time sleep.
B) Be certain the client obtains antihistamines to control nasal stuffiness.
C) Be certain the client has his prescription for modafinil (Modavigil) filled.
D) Have the client purchase sodium oxybate (Xyrem) over the counter to prevent daytime drowsiness.

Answer 3

Be certain the client has his prescription for modafinil (Modavigil) filled.

Question 4

The client reports having difficulty sleeping. Which environmental intervention would the nurse recommend?

A) Provide white noise with a fan.
B) Keep a television on in the bedroom.
C) Play a talk radio station.
D) Play soft music through the night.

Question 5

The client who has sleep apnoea reports falling asleep while driving, almost being involved in an accident, and frequent episodes of sleepwalking. What nursing diagnosis should be a priority for this client?

A) Anxiety related to the diagnosis of a sleep disorder.
B) Insomnia related to difficulty staying asleep.
C) Risk for Impaired Gas Exchange related to sleep apnoea.
D) Risk for Injury related to somnambulism.

Question 6

The client is being treated with a nasal continuous positive airway pressure device (CPAP) for sleep apnoea. What finding would the nurse evaluate as indicating that this treatment has been helpful to the client?

A) The client sleeps so soundly that he snores.
B) The client's diabetes is now under control.
C) The client has lost three kilograms since treatment began.
D) The client reports a decrease in morning headache.

Question 7

The 70-year-old woman tells the nurse, "I can go to sleep without a problem, but then I wake up in a couple of hours and can't go back to sleep". What nursing action would help promote rest and sleep in this client?

A) Encourage the client to avoid taking pain medication prior to sleep.
B) Have the client perform moderate exercises before bedtime.
C) Evaluate if the client perceives sleeplessness to be a serious problem.
D) Have the client develop a bedtime ritual of quiet music and a glass of wine.

Question 8

The nurse is planning interventions for a client who has difficulty falling asleep. Which intervention regarding sleep times would be most helpful?

A) If daytime drowsiness occurs, go to bed earlier that night.
B) If bedtime is delayed on one night, go to bed that much earlier the next night.
C) Maintain a regular bedtime and wake-up time for all days of the week.
D) Sleep at least one hour later on mornings you don't have to go to work.

Question 9

The mother of a newborn calls the paediatric clinic and states, "I am concerned about my baby. When she first goes to sleep, her eyes dart around under her eyelids, she doesn't breathe regularly, and she sometimes twitches." What advice should the nurse give this mother?

A) These are common behaviours in newborns and are normal.
B) Please bring your baby in immediately for a check-up.
C) You should ask your medical practitioner about these symptoms at your next check-up.
D) If your baby does this again, take her to the emergency department.

Question 10

The client who has obstructive sleep apnoea is being treated with a nasal continuous positive airway pressure (CPAP) device, but has just been prescribed modafinil (Modavigil). What client statement should the nurse evaluate as indicating understanding of the discharge instructions regarding these two therapies?

A) "Once I get regulated on the Modavigil, I will wean myself off the CPAP."
B) "I am so glad that I won't have to sleep in this machine anymore."
C) "I can turn down the pressure on my CPAP machine in about one week."
D) "I will continue using my CPAP machine at night."

Question 11

A client who is deprived of non-rapid-eye-movement (NREM) sleep would show symptoms of:

A) lowered pain tolerance.
B) slower healing rates.
C) immunosuppression.
D) disorientation.

Question 12

The mother of a teenager is concerned because she says he stays up late, has eight hours sleep a night, but is hard to wake up for school, yawns all day and is irritable. The nurse would reply:

A) "This is normal. He is just going through a hormonal period."
B) "Adolescents need 12 to 14 hours sleep."
C) "We need to assess his sleep patterns."
D) "You need to make him go to bed earlier."

Question 13

Some drugs can affect the quality of sleep for a client. Which of the following does not disrupt sleep?

A) Beta-blockers.
B) Steroids.
C) Diuretics.
D) Decongestants.

Question 14

During a corporate health retreat, an attendee states that he "just can't stay awake" during the daytime, although he "sleeps just fine at night". What advice should the occupational health nurse offer this man?

A) "Go to a mental health professional for evaluation of possible depression."
B) "Drink more caffeinated beverages in the daytime to stay awake."
C) "Go to your general practitioner for a physical examination."
D) "Purchase an over-the-counter sleep aid to deepen night time sleep."

Question 15

The nurse is admitting a critically ill client to the intensive care unit. What questions should the nurse ask regarding this client's sleep history?

A) When do you usually go to sleep?
B) What are your bedtime rituals?
C) No questions should be asked.
D) Do you have any problems with sleeping?

Question 16

The nurse is working with a client to develop an expected outcome for the nursing diagnosis Insomnia, difficulty staying asleep, related to anxiety secondary to multiple life stressors. Which expected outcome would be most applicable to this client's situation? The client will:

A) report getting sufficient sleep to provide energy for daily activities.
B) manifest less anxiety after taking prescribed medications.
C) sleep at least eight hours each night.
D) list three positive coping mechanisms for anxiety relief.

Question 17

In preparing her clients for sleep, the nurse dims the lights, as exposure to darkness:

A) causes an increase in the reticular activating system (RAS).
B) causes a decrease in stimulation of the reticular activating system (RAS).
C) reduces the amount of melatonin secreted by the pineal gland.
D) increases the amount of noradrenaline by the pineal gland.

Question 18

The client has been prescribed zolpidem (Stilnox) for the short-term management of insomnia. What information should the nurse include in discharge planning for this client?

A) For best results, take the medication just prior to bedtime.
B) Do not take the medication with any liquid that contains calcium.
C) Drink an entire glass of water with the dose to avoid kidney stones.
D) Take the medication at dinnertime to avoid gastric upset.

Question 19

The 5-year-old has recurrent night terrors. What nursing intervention would the nurse plan to help alleviate this problem?

A) Have the child walk around in the room when night terrors occur.
B) Use an additional pillow behind the child's head at night.
C) The next morning, ask the child to describe the event.
D) Have the child empty the bladder prior to going to bed.

Question 20

The parents of a 6-month-old tell the nurse that they are exhausted because their baby wakes up several times every night. What advice should the nurse give these parents?

A) Continue to respond to the baby anytime he is restless during the night.
B) Bring the baby in for a possible sleep study to check for sleeping disorders.
C) Be certain that the baby is truly awake before picking him up for feeding.
D) Let the baby "cry it out" for a few nights until he can sleep through the night.

Question 21

The client reports having difficulty sleeping and awakening several times during the night. What intervention should the nurse recommend for the client when unable to sleep?

A) Get out of bed, go into another room, and exercise until tired before trying to go back to sleep.
B) Stay in bed with eyes closed and do some mental arithmetic until sleepy.
C) Get out of bed, go into another room, and pursue some relaxing activity until drowsy.
D) Sit in bed and watch the bedroom television until drowsy.

Question 22

The nurse is working on a hospital committee tasked with reducing environmental distractions to sleep within the hospital. Which recommendations by the committee would be helpful?

A) Turn off all overhead lights on the unit and use night-lights and torches.
B) Establish a time at which radios and televisions should be turned off or down.
C) Discontinue use of the paging system after 2100.
D) Conduct nursing reports in the hallway.
E) Open curtains between beds in semi-private rooms.

Question 23

The hospitalised client requests a bedtime snack. Which food should the nurse offer this client?

A) Cereal with milk.
B) Tea and crackers.
C) Chips and salsa.
D) Hot chocolate.