Question:
A nurse on the night shift notices that a client is grinding his teeth while sleeping. How should the nurse document the diagnosis for the client?
A. Narcolepsy
B. Cataplexy
C. Bruxism
D. Insomnia
Correct answer: C
Insomnia is not appropriate because the client does not have trouble sleeping, Narcolepsy is an inappropriate diagnosis because the client does not have a sudden onset of daytime sleep, Cataplexy is not an accurate diagnosis because cata
Question:
When a client tells the clinic nurse that he has irresistible sleep attacks through out the day lasting from 10-15 mins, the nurse suspects that the client may be experienced what?
A. Narcolepsy
B. Insomnia
C. Cataplexy
D. Prolonged latency
Correct answer: A
Narcolepsy is a disorder of excessive daytime sleepiness characterized by short, almost irresistible daytime sleep attacks, usually lasting 10-15 mins and with abnormal manifestations of REM sleep
Question:
Which factor necessitates the need for more sleep in the adolescent population?
A. Increased life stress
B. Rapid growth
C. Part-time employment
D. Increased nutritional needs
Correct answer: B
The growth spurt that occurs during adolescence may necessitate the need for more sleep. However, the stresses of school, activities, and part-time employment may cause adolescents to have restless sleep, and many adolescents do not get
Question:
The nurse has entered the room of a newly admitted client and observed a continuous positive airway pressure (CPAP) on the client's bedside table. The nurse would recognize that this client likely has a history of what condition?
A. Narcolepsy
B
Correct answer: B
CPAP is a common treatment for sleep apnea that helps to maintain the patency of the client's airway. It does not address the signs and symptoms of insomnia, narcolepsy, or somnambulism (sleepwalking).
Question:
A nurse caring for a client with restless leg syndrome who complains of sleeplessness. Which of the following nursing diagnoses is most appropriate for this client?
A. Sleep deprivation
B. Impaired bed mobility
C. Risk of injury
D. Relocation st
Correct answer: A
Sleep deprivation is the most appropriate nursing diagnosis for this client because the symptoms of restless leg syndrome keep the person awake and prevent continuous sleep. Eventually, sleep deprivation affects the person's life, damagi
Question:
A nurse is instructing her students on the role of hormones in sleep patterns. Which statement would indicate to the nursing instructor that the student needs additional teaching?
A. "A hyperactive thyroid can make the client sleepy all the time
Correct answer: A
Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow wave sleep.
Question:
The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborn's sleep patterns. Which of the following is a accurate about a newborn's sleep patterns?
A. Newborns will nap two times per day
B. Ne
Correct answer: C
Newborns sleep an average of 16-17 hours per 24 hours a day, divided into about seven sleep periods distributed fairly evenly throughout the day and night.
Question:
Which factor has the most influence on an individual's sleep-wake patterns?
A. Bedtime rituals
B. Body's need for 8 hours of sleep
C. Daylight and darkness
D. The inner biological clock
Correct answer: D
The inner biological clock is the regulating mechanism for the body's sleep-wake patterns. No formula exists for the duration of sleep. Although light and dark appear to be powerful regulators of the sleep-wake pattern, they do not exert
Question:
A new mother calls the pediatric nurse to talk to her about her baby, who sleeps "all day long." The nurse informs the new mother that an infant requires how many hours of sleep?
A. 8-9 hours of sleep each day
B. 12-14 hours of sleep each day
C.
Correct answer: D
The pediatric nurse informs the new parent that on average, infants require 14-20 hours of sleep each day.
Question:
A nurse at the health care facility is caring for an older adult client who complains of sleeplessness. Which of the following conditions is a manifestation of depression in an older client?
A. Insomnia
B. Nightmares
C. Somnambulism
D. Nocturnal
Correct answer: A
Insomnia and hypersomnia are often manifestations of depression in older clients. Nightmares, somnambulism (sleepwalking), and nocturnal enuresis are examples of parasomnias. These are conditions associated with activities that cause aro
Question:
The nurse learns during the assessment of a client that the client has difficulty falling asleep, wakes up early, and does not feel refreshed in the morning. Which of the following is this client most likely experiencing?
A. Disturbed sleep patt
Correct answer: A
This client is experiencing a disturbed sleep patten because the client has difficulty with sleeping patterns and does not feel refreshed after sleep. The client is not experiencing an increase in sleep. Ineffective coping may be more ap
Question:
A client tells the nurse that she often has a difficult time falling asleep at night. What suggestion offered by the nurse may assist the client in achieving sleep?
A. It is best to avoid a snack prior to bedtime
B. A snack containing carbohydra
Correct answer: B
A small snack containing protein and carbohydrates may be effective in promoting calmness and relaxation prior to bed time
Question:
A nurse working in the health care clinic assesses sleep patterns during each health assessment. Based upon the nurse's knowledge regarding sleep needs, the nurse recognizes which age group as generally needing the least amount of sleep?
A. Adol
Correct answer: C
As people age, the number of hours needed sleep decreases. An average of five to seven hours of sleep is usually adequate for the older adult age group.
Question:
For the last three weeks, a nurse in a long-term care facility has administered a sedative-hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now laying awake at night. Which of the follo
Correct answer: A
Although most sedative-hypnotic drugs provide several nights of excellent sleep, the medication often loses its effects after one or two weeks. Alcohol and diphenhydramine should not be administered with a sedative-hypnotic drug. Increas
Question:
A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning the client complains of overwhelming fatigue and has told the nurse, "I just can't manage to get any sle
Correct answer: B
Assessment is the first step in the nursing process. Consequently, the nurse should determine the factors contributing to the client's problem before preforming interventions.
Question:
When the nurse attempts to wake a client who has just closed his eyes and appears to be asleep, the client states he is not asleep. What stage of sleep is this client in?
A. Stage 4
B. Stage 1
C. Stage 2
D. Stage 3
Correct answer: B
Stage 1 is transitional stage between drowsiness and sleep, indicated by a shift from alpha waves to low-voltage, fast theta on the EEG. This stage usually lasts only a few minutes, and, if awakened, the person may say he or she was not
Question:
A nurse teaches the parents of a toddler about normal sleep patterns for this age group. How many hours of sleep per night is normal near the end of this stage?
A. 12-15 hours
B. 8-10 hours
C. 7-8 hours
D. 10-12 hours
Correct answer: B
Need for sleep declines as this stage progresses. The toddler may initially sleep 12 hours at night with two naps during the day, but end this stage sleeping 8-10 hours a night and napping once during the day.
Question:
Which of the following client conditions indicates the presence of a parasomnia?
A. A child who awakens with nightmares 3-4 times a week
B. A man who takes several hours to fall asleep each night
C. A child who wets his bed each night
D. A woman
Correct answer: C
Enuresis is considered a parasomnia. Insomnia and RLS are classified as dyssomnias.
Question:
A maternity nurse is instructing new parents on the proper sleeping position for their newborn child. In what position does the nurse instruct the parents to place the infant?
A. Side-lying position
B. Supine position
C. Prone position
D. High-F
Correct answer: B
The nurse will teach the parents to position the infant on the back (supine). Sleeping in the prone position increases the risk for sudden infant death syndrome (SIDS).
Question:
A client visits a health care facility with complaints for early wakening after sleep, which leaves him tired and weak. For which of the following lifestyle practices should the nurse assess the client in this case?
A. Recreational activities
B.
Correct answer: C
The nurse should ask the client if he consumes alcohol before bedtime, because alcohol reduces normal REM and deep sleep stages or NREM sleep. As alcohol is metabolized, stimulating chemicals that were blocked by the sedative effects of
Question:
A nurse is explaining to an insomniac client the effect of a prescribed medication and the different phases of sleep. Which of the following statements is true for non-rapid eye movement (NREM) sleep?
A. It is called paradoxical sleep
B. It is t
Correct answer: D
Non-rapid eye movement sleep, which progresses through 4 stages, is also called slow wave sleep, because during this phase, electroencepalograpic (ECG) waves appear as progressively slower oscillations. The REM phase of sleep is referred
Question:
A nurse is caring for a client diagnosed with sleep apnea. What should the nurse do in order to promote sleep in the client?
A. Encourage the client to loose weight
B. Encourage deep breathing exercises
C. Avoid sedatives for sleeping
D. Provide
Correct answer: C
The nurse should avoid sedatives in the client because the sedatives may depress respiration. The client with sleep apnea already has decreased ventilation and low blood oxygenation; the condition may become worse if the respiration is f
Question:
Which of the following statements about the sleep patterns of toddlers should the nurse incorporate into an education plan for parents?
A. Nightmares are rare in toddlers
B. Slow-wave sleep is less in toddlers than adults
C. Getting the child to
Correct answer: C
Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.
Question:
A client who previously was a smoker has recently stopped smoking but reports having much trouble sleeping at night. How would the nurse respond?
A. "Sleep problems from stopping smoking are temporary."
B. "You have to decide what is more import
Correct answer: A
Total withdrawal from smoking may be associated with temporary sleep disturbances. Clients who stop smoking often have more daytime sleepiness and report significantly more restlessness at night.
Rest
a state of mental and physical relaxation while being awake, alert, and responsive to external stimuli
Sleep
a regular occurring, reversible behavioral state in which consciousness, skeletal mm activity, metabolism and external stimuli are decreased
Circadian Rythm
a cycle that tells our bodies when to sleep, rise, eat--regulating many physiological processes. This internal body clock is affected by environmental cues, like sunlight and temperature
Bulbar Synchronizing System (BSS)
causes sleep, bulbar is associated with the medulla oblongata in the brain, melatonin is a strong sleep inducer and serotonin is also associated with sleep (precursor= tryptophan, found in milk, turkey, and bananas)
Reticular Activating System (RAS)
wakes us up, a network of nn fibers in the thalamus, hypothalamus, brain stem and cerebral cortex, essential to wakefulness, attention, concentration, and introspection, may release catecholamines (NE/E)
REM Sleep
metabolic needs of the brain are increased but the body is quiet, vivid dreaming, 25% of sleep
NREM Sleep
there are 4 stages, begins with light sleep through to mm relaxation, vital signs declining but regular and a deeper sleep, 75% of sleep
Dyssomnias
altered amount, quality, timing of sleep, characterized by insomnia or excessive sleepiness
Parasomnias
abnormal behaviors or movements during sleep, patterns of waking behavior that appears during sleep
Dyssomnias- Insomnia
difficulty initiating/maintaining sleep, most common dyssomnias
Dyssomnias- Hypersomnia (Narcolepsy)
excessive sleep, many types: narcolepsy, abnormal sleep tendencies as well as pathological REM sleep, risk for injury
Dyssomnias- Sleep Apnea
breathing repeatedly starts and stops during sleep
**treatment: oral appliance, CPAP
Dyssomnias- Restless Leg Syndrome
irritation in legs
Dyssomnias- Sleep Deprivation
lack of sleep
Dyssomnias- 3 types- Intrinsic
primary disorders; insomnia, sleep deprivation, narcolepsy, sleep apnea, restless leg syndrom
Dyssomnias- 3 types- Extrinsic
secondary disorders; due to environmental factors, drugs/alcohol
Dyssomnias- 3 types- Circadian Rhythm
shift work, jet lag
Treatment for Dyssomnias
pharmacologic therapy: sedatives and hypnotics
non pharmocology therapy: stimulus control, sleep restriction, relaxation therapy
Sundown Syndrome
the onset of confusion and agitation that generally affects people with dementia or cognitive impairment and usually strikes around sunset
Parasomnias- Somnambulism
sleep walking
Parasomnias- Sleep Talking
talking during sleep
Parasomnias- Bruxism
teeth grinding
Parasomnias- Enuresis
involuntary urination at night
Parasomnias- Sleep Related Eating Disorder
eating disorder brought on by sleep schedule
Parasomnias- Sleep Terrors
intense anxiety, isolated episodes-occurs during NREM sleep
Parasomnias- Nightmares
vivid frightening dreams- occurs during REM sleep
Physiology and Regulation of Sleep & Alertness
metabolic rate slows, cerebral blood flow decreases, decrease BP, decrease temp, decrease pulse, decrease respirations
Developmental Factors- Infant
may put the awake infants in the crib to sleep, rather than waiting until the child falls asleep before putting them in the crib. Sometimes wrapping or swaddling an infant will help them fall asleep. Sleeps about 15 hours in a 24 hour period
Developmental Factors- Toddler/Preschoolers
for toddlers and preschoolers who are starting to cope with autonomy, separation, sleep problems can increase, may have trouble falling asleep, resisting going to sleep, provide an activity before bedtime, drink of water at bedside and sleep with a transi
NREM Sleep Stages
1. light sleep, can be aroused
2. not as easy to arouse as stage 1, relaxation progresses, brain waves synchronized
3. begins bursts of slow DELTA wave sleep- vital signs decline
4. stage of deepest sleep, difficult to arouse, may sleep walk, much of slee
Sleep Cycle
the person passes thru 4 stages of NREM sleep, then the pattern is reversed--return from stage 4 to 3 to 2, enter REM sleep instead of stage 1; sleep provides energy conservation and resortation
Sudden Infant Death Syndrome (SIDS)
sudden death of infant remains unexplained after complete investigation, most occur while infant sleeps, leading cause of death, occur 1-4 months, cannot be predicted, risk factors= sleeping on stomach, smoking while pregnant, exposure to second hand smok
Assessment of Sleep Disorders
sleep hx, physical exam, sleep studies, factors affecting sleep (genetics, illness etc), key findings in physical exam (energy level, facial characteristics, behavioral changes, data)
Polysomnography
also called a sleep study, is a test used to diagnose sleep disorders, records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study
Common Etiologies for Nursing Diagnoses
-physical/emotional discomfort or pain
-changes in bedtime rituals/sleep environment
-disruption of circadian rhythm
-exercise/diet before sleep
-drug dependences
-symptoms of physical illness
Common Etiologies for Nursing Diagnoses-- Related To....
noisy environment, symptoms of chronic disease, concern about work/loss f job, drug use (alcohol, barbiturate dependency)
Nursing Interventions to Promote Sleep
prepare restful environment, promote bedtime rituals, offer appropriate bedtime snacks and beverages, promote relaxation and comfort, respect normal sleep-wake patterns, schedule nursing care to avoid disturbances, use medications to produce sleep, teach
Nursing Interventions to Promote Restful Sleep
promoting sleep onset, facilitating uninterrupted sleep, preventing early or late awakenings, promoting rest
Nursing Interventions--Self Care Activity
develop a plan or care for yourself to maximize restful sleep while in nursing school, address- nursing diagnosis, goal and interventions
Question:
A client is admitted to the intensive care unit with a myocardial infarction. When taking a sleep history, you learn that the client's loud snoring often awakens the partner and that the client frequently experiences unrefreshing sleep. These fi
Correct answer:
2
Question:
The nurse would encourage which of the following bedtime snacks for a client with a sleep pattern disturbance?
1) a large serving of nachos with cheese.
2) a cup of tea and a chocolate bar.
3) a 12-ounce glass of beer.
4) an 8-ounce glass of mil
Correct answer:
4
Question:
You awaken a client during the night to measure blood pressure and heart rate. You observe that these vital signs are elevated. Based on your knowledge of normal sleep cycles, you can expect that the client was experiencing which of the followin
Correct answer:
3
Question:
Which of the following should you do to optimize sleep and address elimination needs for a client diagnosed with nocturnal enuresis?
1) restrict fluids in the evening hours.
2) put a diaper on the client.
3) prepare a "floor bed" as close to the
Correct answer:
1
Question:
The nurse would select which of the following nursing diagnoses as having the highest priority for a client with narcolepsy?
1) Self-care deficit.
2) Risk for injury.
3) Disturbed thought processes.
4) Insomnia.
Correct answer:
2
Question:
You have taught a client about the use of a continuous positive airway pressure (CPAP) mask for obstructive sleep apnea. Which client statement shows that the client understands your teaching?
1) "I will need to use CPAP every night for the rest
Correct answer:
1
Question:
Which of the following sleep-related changes is seen in the older adult?
1) decreased sleep efficiency.
2) increased slow-wave sleep.
3) increased stage 4 sleep.
4) decreased nocturnal awakenings.
Correct answer:
1
Question:
Mr. A. is 66 and has chronic joint pain from arthritis and has a disturbed sleep pattern. Which of the following interventions will help Mr. A. the most to increase his sleep time?
1) Give pain meds for the joint pain in the evening.
2) Give a s
Correct answer:
1
Question:
Which of the following medications are appropriate for the patient having difficulty sleeping?
1) Restoril or Ambien.
2) Dalmane or Ativan.
3) Sonata or Klonopin.
4) All of the above.
Correct answer:
4
Question:
Which of the following sleep disorders is characterized by violent and repetitive grinding of the teeth?
1) Narcolepsy.
2) Sleep Terror.
3) Restless leg syndrome.
4) Bruxism.
Correct answer:
4
Foods high in carbs...
tend to cause drowsiness, therefore a small protein and carb containing snack, such as PB on toast or cheese and crackers, may be more effective in promoting sleep
Apnea can kill you...
at any age, CPAP machiene
Insomnia is the difficulty falling asleep, intermitted sleep...
the most common of all sleep disorders