Deck 8: Sleep and the Older Adult

Question 1

An older client with sleep apnea is prescribed continuous positive airway pressure (CPAP). What will the nurse explain to the client about this treatment? Select all that apply.
1) Continuous pressure keeps the airway open to enhance breathing.
2) This is considered an oral airway to keep the tongue in place.
3) The machine is noisy and will keep the client awake.
4) Noninvasive treatment is administered through a nasal mask.
5) The face mask is uncomfortable but important to well-being.

Answer 1

1, 4, 5

Question 2

The nurse assesses a client before bedtime. The spouse at bedside jokes about the client's snoring. Which assessment finding most concerns the nurse?
1) The client reports unrefreshing sleep.
2) Blood pressure 168/98 mmHg.
3) Choking sounds during sleep.
4) Oxygen saturation 88 percent during sleep.

Answer 2

2

Question 3

An older client who is hospitalized has been having difficulty sleeping since admission and is prescribed a low dose of zolpidem (Ambien). Why is the nurse most concerned about administering this medication?
1) It is not a natural option like melatonin.
2) It is associated with daytime hangover and sleepiness.
3) The client is documented as being on fall precautions.
4) The client takes diphenhydramine (Benadryl) for allergies.

Answer 3

3

Question 4

The nurse is caring for an older client who is experiencing sleep deprivation due to a prolonged stay in intensive care. Which manifestation is the nurse most likely to observe in this client?
1) Constant fatigue
2) Gustatory hallucinations
3) Increased activity
4) Need for repeated instructions

Question 5

An older client is diagnosed with sleep apnea. Which interventions can the nurse add to the client's care plan to address this health problem? Select all that apply.
1) Discussing smoking cessation techniques
2) Encouraging the client to sleep on the side
3) Instructing to avoid alcohol before going to sleep
4) Suggesting sleeping in an upright position in a chair
5) Consulting with a dietitian to discuss meal planning for weight reduction

Question 6

The nurse is most concerned about which assessment finding in an older client with sleep apnea?
1) The client's body mass index is 48.7.
2) The client takes a sleeping medication at night.
3) The client has a family history of sudden death.
4) The client has added pillows for sleep at night.

Question 7

An older client reports insomnia. What is the best suggestion the nurse can offer this client?
1) "Taking a nap during the day might help you catch up."
2) "During the week, wake up at the same time every day."
3) "Drink a little liquor or wine just prior to bedtime."
4) "Stay busy during the daytime with social and physical activities."

Question 8

Which actions should the nurse take to ensure effective sleep for older clients in a long-term care facility? Select all that apply.
1) Use nightlights during the night.
2) Establish consistent nighttime routines.
3) Schedule routine care in the early evening hours.
4) Put clients to bed immediately after the evening meal.
5) Reduce noise and light disruption throughout the night.

Question 9

An older client lives in an assisted living facility and is seen reading in the lounge area most nights. Which issue causes the greatest concern for the nurse caring for this client?
1) The client may have significant underlying problems.
2) The client is averaging five hours of sleep every 24 hours.
3) The client occasionally expresses the desire for more sleep.
4) The client is forgetful, irritable, and frequently lethargic.

Question 10

An older client is being prescribed medication to help with sleep. What is most important for the nurse to teach a group of orienting nurses caring for geriatric clients?
1) Lorazepam is the best benzodiazepine to use for sleep.
2) Medications for sleep disorders should be used for less than one month.
3) Some medications are not safe for an older client, regardless of dose.
4) A dose of an antidepressant medication is helpful for sleep.

Question 11

An older client is having difficulty sleeping. What can the nurse instruct the client to help improve the client's sleep? Select all that apply.
1) Do not nap during the day.
2) Take a walk an hour before going to sleep.
3) Have a glass of wine before going to sleep.
4) Avoid reading or watching television in bed.
5) If unable to sleep, get up and go to another room.

Question 12

The nurse is implementing sleep restriction therapy with an older client. What intervention will be performed to support this plan of treatment?
1) Structuring client naps to occur midmorning and midafternoon
2) Putting on the television in the room after getting the client ready for sleep
3) Teaching the client to watch the second hand move on the clock while waiting to fall asleep
4) Planning to wake the client up at the same time each morning regardless of the sleep obtained

Question 13

An older client has been reading about the use of melatonin for sleep. Which statement best indicates to the nurse that the client understands instruction about taking this supplement?
1) "Melatonin is a hormone my body makes on its own without intervention."
2) "Nausea is the worst side effect associated with melatonin."
3) "Older adults have reduced levels of melatonin and need a supplement."
4) "A melatonin dose should be taken a few hours before bedtime."

Question 14

An older client with difficulty sleeping wants to use an herbal remedy to help getting to sleep since problems with hay fever and nasal congestion are interfering with "drifting off" at night. Which herbal remedy should the nurse caution the client to avoid?
1) Lemon balm
2) A glass of warm milk
3) A cup of chamomile tea
4) A small turkey sandwich

Question 15

The nurse is teaching an older client about an overnight sleep study to diagnose sleep apnea. What will the nurse include when teaching this client? Select all that apply.
1) Oxygen saturation level will be measured.
2) An electrocardiogram will be used to measure heart activity.
3) Pins will be inserted into leg muscles to measure tone and tension.
4) An electromyogram will be done to measure face and leg movements.
5) An electroencephalogram will be done to measure brain wave activity.

Question 16

Which findings most concern the nurse that a client is experiencing sleep apnea? Select all that apply.
1) Frequent daily headaches
2) Sleeping with three pillows
3) Daytime sleepiness
4) Restless legs during long drives
5) Reports of choking when waking from sleep

Question 17

An older client in a long-term care facility does not sleep much at night and prefers to stay up late reading. The client takes "power naps" during the day. How should the nurse respond to this client's plan to acquire adequate sleep?
1) "Daytime napping is a positive method to restore the missed sleep time at night."
2) "You do not need the same quantity of sleep as younger adults."
3) "If you feel like you are getting enough rest at night, a daytime nap is acceptable."
4) "There is no problem as long as the total number of hours slept per 24-hour period is at least 8."

Question 18

How should the nurse explain rapid eye movement (REM) sleep to an older client?
1) Is when dreaming occurs
2) Is necessary for physical restoration
3) Involves sudden sustained muscle contractions in the extremities
4) Is accompanied by slowing of the heart rate and a fall in blood pressure

Question 19

The nurse is concerned that an older client with dementia is receiving psychotropic medications for sleep. Which assessment findings best indicate the client is experiencing side effects? Select all that apply.
1) Feeling lightheaded upon standing
2) Unable to have bowel movement for four days
3) Hearing a conversation though no one is present
4) Inability to stay awake while completing a puzzle
5) Attempting to swallow one bite multiple times

Question 20

The nurse is assessing an older client who wakes up during the night. Which finding does the nurse identify as the greatest risk factor for disturbed sleep?
1) Client has osteoarthritis of both hips.
2) Client drinks two cups of coffee per day.
3) Client takes antidepressant medication in the morning.
4) Client leaves the television on all day and night.

Question 21

An older client does not understand why an alcoholic drink cannot be provided before going to sleep in the evening. What should the nurse explain to the client?
1) Alcohol has an initially depressant effect.
2) Alcohol can increase the time needed to fall asleep.
3) Alcohol is disruptive of the second half of the sleep cycle.
4) Alcohol can enable an individual to sleep through the entire night.

Question 22

The nurse is planning care for an older client who reports interrupted sleep. Which assessment findings most concern the nurse? Select all that apply.
1) Frequent nighttime urination
2) History of kidney stones
3) Morning headaches
4) Early morning awakening
5) Feeling unable to empty bladder

Question 23

An older client has taken paroxetine hydrochloride (Paxil) for depression for one month. When discussing the medication, which client statements are most concerning? Select all that apply.
1) "I feel tired after taking this medication."
2) "I have not had trouble with driving my vehicle."
3) "I take all my medications with breakfast except Paxil."
4) "I take the Paxil before eating my evening meal."
5) "I cannot take this medication with my other medications."

Question 24

After completing an assessment, the nurse reviews the older client's medications. Which finding is most concerning?
1) Client takes diphenhydramine (Benadryl) and zolpidem (Ambien) at night.
2) Client has not filled the new prescription for suvorexant (Belsomra).
3) Client reports taking zolpidem (Ambien) nightly for the past three months.
4) Client takes diazepam (Valium) during the day for anxiety as needed.

Question 25

During a routine physical examination, an older client reports having problems falling asleep at night despite engaging in vigorous activities to become tired in the evening. How should the nurse respond to the client?
1) "You should vary your routine each day."
2) "You should time activities to end within an hour of bedtime."
3) "Exercise should be done before the evening meal."
4) "Concentrate exercise toward the morning hours."