Deck 42: Sleep

Question 1

A new mother is concerned that her 2-week-old daughter is not sleeping through the night.The nurse should respond that infants usually develop a nighttime pattern of sleep by:
1) 1 month
2) 2 months
3) 3 months
4) 6 months

Answer 1

3
Infants usually develop a nighttime pattern of sleep by 3 months of age.

Question 2

An 11-year-old boy in middle school is currently experiencing sleep-related fatigue during classes.Which of the following is the most appropriate response by the school nurse when counseling the child's parents regarding this assessment?
1) "What are the child's usual sleep patterns?"
2) "Establish bedtimes for the child,and withhold his allowance whenever those times are not adhered to."
3) "We need to explore other health-related problems,because sleep problems are not likely the cause of his fatigue."
4) "The bulbar synchronizing region of the child's central nervous system is causing these insomniac problems."

Answer 2

1
A school-age child will be tired the following day if allowed to stay up later than usual.The nurse should ask a question to assess the child's usual sleep patterns.The nurse should first assess the child's usual sleep pattern to determine if the child is adhering to a bedtime.A sleep problem is often the cause of fatigue.

Question 3

Teaching for a client who is currently taking a diuretic should include information that he or she may experience:
1) Nocturia
2) Nightmares
3) Increased daytime sleepiness
4) Reduced REM sleep

Answer 3

1
For the client who is currently taking a diuretic,the nurse should inform the client that he or she might experience nighttime awakening caused by nocturia.Diuretic use does not cause nightmares or daytime sleepiness or reduce REM sleep.

Question 4

Which of the following may improve the sleep of an older adult client?
1) Drinking an alcoholic beverage before bedtime
2) Using an over-the-counter sleeping agent
3) Eliminating naps during the day
4) Going to bed at a consistent time even if not feeling sleepy

Question 5

The nurse recognizes that the sleep patterns of older adults differ and older adults generally:
1) Are more difficult to arouse
2) Require more sleep than middle-age adults
3) Take less time to fall asleep
4) Have a decline in stage 4 sleep

Question 6

The nurse and a client are discussing possible behaviors that might be interfering with the client's ability to fall asleep.Which of the following assessment questions is most likely to identify possible problems with the client's sleep routine that possibly are contributing to the difficulty?
1) "When do you usually retire for the night?"
2) "What do you do to help yourself fall asleep?"
3) "How much time does it usually take for you to fall asleep?"
4) "Have you changed anything about your presleep ritual lately?"

Question 7

The physiology of sleep is complex.Which of the following is the most appropriate statement in regard to this process?
1) Ultradian rhythms occur in a cycle longer than 24 hours.
2) Nonrapid eye movement (NREM)refers to the cycle that most clients experience when in a high-stimulus environment.
3) The reticular activating system is partly responsible for the level of consciousness of a person.
4) The bulbar synchronizing region (BSR)causes the rapid eye movement (REM)sleep in most normal adults.

Question 8

A 74-year-old client has been having sleeping difficulties.To have a better idea of the client's problem,the nurse should respond:
1) "What do you do just before going to bed?"
2) "Let's make sure that your bedroom is completely darkened at night."
3) "Why don't you try napping more during the daytime?"
4) "Do you eat a small snack before going to bed?"

Question 9

A client is discussing his recent restlessness and increased irritability.Which of the following assessment questions is likely to be most helping in determining the cause of these complaints?
1) "When did you start noticing these changes?"
2) "Has anything caused you to change your usual routine lately?"
3) "Do you have any idea what might be causing these problems?"
4) "What makes you think that you are more irritable than is normal for you?"

Question 10

New research indicates that to increase safety the nurse should instruct parents to do which of the following?
1) Provide a stuffed toy for comfort.
2) Cover the infant loosely with a blanket.
3) Place the infant on his or her back.
4) Use small pillows in the crib.

Question 11

It is determined that the client will need pharmacological treatment to assist with the client's sleep patterns.The nurse anticipates that treatment with an anxiety-reducing,relaxation-promoting medication will include the use of:
1) Barbiturates
2) Amphetamines
3) Benzodiazepines
4) Tricyclic antidepressants

Question 12

The mother of a 2-year-old child is frustrated because the child does not want to go to bed at the scheduled bedtime.The nurse should suggest that the parent:
1) Offer the child a bedtime snack
2) Eliminate one of the naps during the day
3) Allow the child to sleep longer in the mornings
4) Maintain consistency in the same bedtime ritual

Question 13

A 9-year-old client asks the nurse,"Why do I need to sleep?" The nurse's most age-appropriate,informative response is:
1) "Everyone needs to sleep to feel rested."
2) "It gives your body a chance to really rest."
3) "You'll be able to do so much better in school if you're rested."
4) "Your body needs to rest in order to grow and be really healthy."

Question 14

A client has reported to the nurse that his sprained ankle resulted from "a careless accident.I seem so clumsy and unfocused lately." Which of the following assessment questions is most likely to reveal information regarding the cause of these symptoms?
1) "How many accidents have you had lately?"
2) "Have the accidents resulted in serious injuries?"
3) "Have there been any changes in your daily routine lately?"
4) "Do you have any idea what is responsible for this lack of focus?"

Question 15

Which of the following information provided by the client's bed partner is most associated with sleep apnea?
1) Restlessness
2) Talking during sleep
3) Somnambulism
4) Excessive snoring

Question 16

The nurse is completing an assessment of the client's sleep patterns.A specific question that the nurse should ask to determine the potential presence of sleep apnea is:
1) "How easily do you fall asleep?"
2) "Do you have vivid,lifelike dreams?"
3) "Do you ever experience loss of muscle control or falling?"
4) "Do you snore loudly or experience headaches?"

Question 17

Which of the following symptoms should the nurse assess with a client who is deprived of sleep?
1) Elevated blood pressure and confusion
2) Confusion and irritability
3) Inappropriateness and rapid respirations
4) Decreased temperature and talkativeness

Question 18

The nurse knows that which of the following habits may interfere with a client's sleep?
1) Listening to classical music
2) Finishing office work
3) Reading novels
4) Drinking warm milk

Question 19

An older adult client diagnosed as being in the early stage of Alzheimer's disease shares with the nurse that her sleep is interrupted by "the noises I hear all through the night." The nurse explains that the most likely reason for this problem is:
1) The client's age
2) A lack of presleep relaxation
3) The amount of noise entering into the client's environment
4) A manifestation of the disease process causing the brain disorder

Question 20

A client is concerned that her habit of sleeping during the day and being awake at night is not "healthy or normal." The nurse's most therapeutic response to the client's concern is:
1) "What makes you think that sleeping during the day and being up at night is unhealthy or abnormal?"
2) "Many people share your sleep habits.As long as you feel all right,I don't think there is anything to worry about."
3) "Are you interested in changing your sleep habits for any particular reason? Is sleeping during the day a problem for you?"
4) "Everyone has a different biological clock that controls his or her sleep cycle.As long as you are sleeping and functioning well,your habit isn't abnormal or unhealthy."

Question 21

On a 2-week follow-up visit to the health care provider,a 64-year-old female postoperative client shares with the nurse that she is having difficulty sleeping and has never had a history of sleeping problems.The nurse shares with the client that:
1) Because of her age,the client should expect to begin having some problems sleeping
2) It may take a while to get used to sleeping in her bed at home after getting used to sleeping on a hospital bed
3) The medications used for anesthesia can disturb sleep cycles for several weeks following surgery
4) She may not be sleeping as well with her partner after being in a bed by herself while being hospitalized

Question 22

A client hospitalized for a myocardial infarction in a cardiac critical care unit (CCU)is most likely to experience sleep deprivation as a result of:
1) A drug-disrupted circadian sleep pattern
2) Generally diminished cardiac output
3) Unfamiliar environmental stimuli
4) Increased emotional stressors

Question 23

The night nurse goes quietly into the sleeping client's room to assess him.The client wakes up as soon as the nurse is in the room.The nurse knows that the client was most likely in which stage of sleep?
1) Stage 1: NREM
2) Stage 2: NREM
3) Stage 3: NREM
4) Stage 4: NREM

Question 24

Which of the following clients experiencing disrupted sleep patterns is most at risk for obstructive sleep apnea (OSA)?
1) A 15-year-old boy with type 1 diabetes
2) A 22-year-old diagnosed with Crohn's disease
3) A 49-year-old man who is an avid cross-county runner
4) A 58-year-old woman diagnosed with chronic depression

Question 25

A 73-year-old male client who normally sleeps on his right side recently underwent a right-side hip replacement surgery and now has trouble sleeping.One of the interventions that the nurse might try with this client is to:
1) Request medication to help the client sleep while in the hospital
2) Carefully prop the client on his operative side using pillows to support the hip
3) Schedule therapy for the evening to help the client become tired so he can sleep
4) Question the client to learn more about his normal sleep pattern

Question 26

A 25-year-old client's wife complains to the nurse that he sleepwalks during the night.The nurse knows that this behavior normally occurs in which stage of sleep?
1) Stage 2: NREM
2) Stage 3: NREM
3) Stage 4: NREM
4) REM

Question 27

A nurse caring for a patient prior to surgery should recognize which of the following factors place a client at risk for obstructive sleep apnea? (Select all that apply. )
1) Heart disease
2) Respiratory tract infections
3) Nasal polyps
4) Obesity

Question 28

The nurse and the parents of a 3-year-old are discussing their child's sleep habits.They share a concern over the child's tendency to wake up several times during the night crying out loudly but not really being awake.The nurse addresses the parents' concern most therapeutically by responding:
1) "Have you ever tried reading a bedtime story before putting her to bed?"
2) "If she does that only a few times a week,I wouldn't be too overly concerned."
3) "Children her age often become poor sleepers.Have you discussed this with her pediatrician?"
4) "It is common for children to have trouble relaxing,and this behavior is the result.It's usually temporary."

Question 29

A 22-year-old male client shares with the nurse that he is always tired.In assessing the client's sleep pattern to determine the quantity of sleep the client is getting,the nurse should ask:
1) "On a scale from 0 to 10,how much sleep to you think you get each night?"
2) "What time do you usually go to bed?"
3) "What time do you usually get up?"
4) "Do you have a bedtime ritual?"

Question 30

Which of the following clients is most likely to experience difficulty returning to sleep?
1) A 60-year-old with benign hypertropic prostatic disease
2) A 15-year-old with type 1 diabetes
3) A 35-year-old diagnosed with hypothyroidism
4) A 55-year-old diagnosed with hypertension

Question 31

A 70-year-old client is reporting to the nurse a concern over "taking longer to fall asleep and waking up three to four times during the night." The most therapeutic nursing response to the client's concern is:
1) "I think you need to mention your concerns to your health care provider."
2) "Older adults seem to need less sleep.Do you still feel rested in the morning?"
3) "I suggest that you plan for a nap in the afternoon to make up for that missed sleep."
4) "As we age,those kinds of problems seem more common.Does this disruption in your sleep cause you to be tired or irritable?"

Question 32

The client asks the nurse,"How will I know if I'm really rested?" The nurse's most therapeutic response is:
1) "Everyone's definition of rested is different.How would you define rested?"
2) "When you aren't tired when you get up in the morning or after an afternoon nap."
3) "When you are mentally,physically,and emotionally ready to go about your daily activities."
4) "You are rested if you fall asleep easily and sleep uninterruptedly for at least 6 to 8 hours."

Question 33

A 63-year-old client is discussing the recent problem the client is experiencing with falling asleep.The nurse is discussing strategies to minimize this problem.Which of the following bedtime snacks would be the most likely to induce sleep?
1) One slice of cheese on four wheat crackers and a glass of skim milk
2) Two cups of air-popped popcorn and a glass of fruit juice
3) Two fig cookies and a cup of decaffeinated tea
4) One small pear and a glass of soymilk

Question 34

A 44-year-old female client shares with the nurse that she is having difficulty falling asleep at night,even though she is exhausted.The nurse knows that which of the following could be causing the sleeplessness?
1) Two cups of hot cocoa every evening
2) Vegetarian diet
3) Afternoon exercise program
4) Hot bath in the evening

Question 35

The nurse is discussing child care strategies with a mother of a newborn.The mother asks the nurse,"What causes sudden infant death syndrome (SIDS)?" Which of the following responses is most likely to answer the mother's question therapeutically?
1) "SIDS is a common fear for new mothers.The best advice is to put your baby to sleep on her back."
2) "We aren't sure exactly,but it may have something to do with undetected cardiac or oxygen problems."
3) "Research is inconclusive,but it's thought to be a result of a nervous system problem that occurs when the baby is asleep."
4) "Your pediatrician wants you to put your baby to sleep on her back because research has shown that more stomach sleepers are victims."

Question 36

The nurse is caring for a 35-year-old father of three young children who has experienced a compound fractured femur as a result of a work-related incident.He has expressed great concern over both his physical recovery and his long-term ability to work again.This has affected both his emotional status and his sleeping patterns.The nurse's most immediate concern is that:
1) The client needs medication to prevent depression
2) The lack of appropriate rest will affect his healing process
3) An occupational therapy consult should be ordered to help him regain his ability to return to his job
4) A psychiatric consult should be ordered to help the client deal with his various emotional concerns

Question 37

A client shares with the nurse that "My wife complains about my snoring,and I never really feel rested." Which of the following responses best attempts to explain the cause of the problem to the client?
1) "Sleep disturbances can really affect all aspects of your life.How long have you been experiencing this problem?"
2) "You need to get help to breathe more effortlessly at night so both you and your wife can get sufficient deep stage sleep."
3) "Something is interfering with your ability to breathe while you are asleep.Have you talked with your health care provider about the problem?"
4) "Your upper airway is blocked,and that is making it difficult for you to breathe effectively,so you are spending most of the night in the light sleep stage."

Question 38

A female client describes the most elaborate dreams to the nurse.She states that she could see colors,hear music,and even had the sensation of flying.The nurse replies to the client that her dreams indicate that she must be:
1) Depressed
2) Pragmatic
3) Creative
4) Mentally ill

Question 39

The assistive nursing personnel reports that the heart rate of the sleeping 23-year-old athlete,who is hospitalized following complications of a tonsillectomy,is 56.The assistive nursing personnel states that this is 10 beats per minute slower than when she took it earlier in the evening.The nurse knows that this is considered:
1) Normal,and they will continue to monitor the vital signs as ordered
2) Abnormally slow,and the health care provider should be notified immediately
3) Abnormally slow,and the nurse will recheck the heart rate before taking any action
4) Abnormally slow,signaling that the client may be hemorrhaging