Chapter 22: Clients with Sleep and Rest Disorders and Fatigue Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 22: Clients with Sleep and Rest Disorders and Fatigue

MULTIPLE CHOICE

1. The substance produced in the body that acts a strong sleep inducer is

a.

acetylcholine.

b.

melanin.

c.

melatonin.

d.

serotonin.

ANS: C

The suprachiasmatic nucleus controls the production of melatonin, which is believed to be a potent sleep inducer.

DIF: Knowledge/Remembering REF: p. 416 OBJ: N/A

MSC: Physiologic Integrity Physiological Adaptation

2. During rapid eye movement (REM) sleep, there is an increase in the neurotransmitter

a.

acetylcholine.

b.

dopamine.

c.

norepinephrine.

d.

serotonin.

ANS: A

The later transition to rapid eye movement (REM) sleep is marked by a dramatic increase in acetylcholine level and further decreases in serotonin and norepinephrine levels.

DIF: Knowledge/Remembering REF: p. 348 OBJ: N/A

MSC: Physiologic Integrity Physiological Adaptation

3. Most sleeping time is spent in

a.

REM sleep.

b.

stages 1 and 2 sleep.

c.

stage 4 sleep.

d.

very light sleep.

ANS: B

More than 50% of sleep is in stages 1 and 2.

DIF: Knowledge/Remembering REF: p. 349 OBJ: N/A

MSC: Physiologic Integrity Physiological Adaptation

4. A client with emphysema reports fatigue and non-refreshing sleep. The nurse explains that emphysema will affect sleep in that the client will have

a.

a longer sleep latency period.

b.

limited time spent in slow-wave sleep.

c.

difficulty in maintaining slow-wave sleep.

d.

difficulty in maintaining REM sleep.

ANS: D

During rapid eye movement (REM) sleep, ventilation primarily depends on the movement of the diaphragm because intercostal and accessory muscle tone is greatly diminished, and all postural and nonrespiratory muscles are essentially paralyzed. Clients with chronic airway limitations have flattened, inefficient diaphragms.

DIF: Comprehension/Understanding REF: p. 412 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

5. The nurse arranges the client care to prevent waking the older adult because the sleep patterns of older clients are characterized by

a.

increased REM sleep.

b.

increased time spent in stage 1 sleep.

c.

increased time spent in stage 4 sleep.

d.

decrease in time to fall asleep.

ANS: B

With aging, the percentage of stage 4 sleep decreases considerably, REM sleep decreases somewhat, and more time is spent in stage 1 sleep. REM sleep is more evenly distributed through the night. Sleep latency (time required to go to sleep) increases, as does the average length of time it takes to go back to sleep after arousal.

DIF: Application/Applying REF: p. 410 OBJ: Intervention

MSC: Health Promotion Aging Process

6. A client with severe emphysema had a myocardial infarction and is hospitalized on the telemetry unit. The night nurse notices that the client has frequent dysrhythmias. The priority action for the nurse would be to check the clients

a.

cardiac enzymes.

b.

electrocardiogram.

c.

electrolyte values.

d.

oxygen saturation.

ANS: D

Dysrhythmias are common during sleep in clients with advanced airflow-limiting diseases, especially when the oxygen saturation drops below 60%.

DIF: Analysis/Analyzing REF: p. 412 OBJ: Intervention

MSC: Safe, Effective Care Environment-Establishing Priorities

7. The nurse explains that clients with narcolepsy often also experience cataplexy, which is a/an

a.

inability to move for several minutes on awakening.

b.

seizure-like episode with tonic and clonic movements.

c.

sudden loss of muscle tone that lasts for several minutes.

d.

trance-like period of 5 minutes or more.

ANS: C

Many narcoleptic clients also experience cataplexy, a sudden loss of muscle tone at times of unexpected emotion (e.g., fright).

DIF: Comprehension/Understanding REF: p. 407 OBJ: Intervention

MSC: Physiological Integrity Pathophysiological Adaptation-Pathophysiology

8. A client has mild obstructive sleep apnea syndrome (OSAS). The nursing teaching plan should include information regarding

a.

alternate sleeping positions.

b.

breathing exercises.

c.

foods high in vitamin B2.

d.

scheduling regular naps.

ANS: A

In milder cases of OSAS, when excessive daytime sleepiness is not yet a concern, clients may respond to weight reduction, measures to promote sleeping in positions other than supine, and avoidance of alcohol. Clients can position themselves in a side-lying position using pillows to avoid sleep apnea.

DIF: Comprehension/Understanding REF: p. 408 OBJ: Intervention

MSC: Physiological Integrity Pathophysiological Adaptation-Pathophysiology

9. The nurse explains to a client with periodic limb movement disorder that the drug that might be helpful in alleviating the clinical manifestations of this sleeping disorder is

a.

amitriptyline (Elavil).

b.

carbidopa/levodopa (Sinemet).

c.

fluoxetine (Prozac).

d.

haloperidol (Haldol).

ANS: B

The anti-Parkinson drug carbidopa/levodopa (Sinemet) and the tricyclic antidepressant imipramine seem to act more directly and almost eliminate the movements.

DIF: Comprehension/Understanding REF: p. 409 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects

10. During assessment of a client who complains of frequent sleep starts, the nurse should question the client regarding

a.

alcohol intake.

b.

caffeine intake.

c.

food intake before bedtime.

d.

medication intake.

ANS: B

The frequency and intensity of sleep starts may be greater with high caffeine intake, stress, or intense physical activity before going to bed.

DIF: Application/Applying REF: p. 410 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation

11. The nurse explains to a client with severe depression and who takes tricyclic antidepressants that the effectiveness of this type of medication may be a result of

a.

increased stage 4 sleep.

b.

prevention of night awakenings.

c.

prevention of sleep terrors.

d.

suppression of REM sleep.

ANS: D

Depressed people deprived of REM sleep often show improved mood. The action of tricyclic antidepressants in suppressing REM sleep has been proposed as the primary mechanism underlying their effectiveness in treating depression.

DIF: Comprehension/Understanding REF: p. 411 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies

12. After a clients discharge from the critical care unit to the step-down unit after a myocardial infarction, the nurse assesses the client carefully during sleep because

a.

anxiety relative to the recent myocardial infarct may cause sleep disorders.

b.

apnea is more common immediately after myocardial infarction.

c.

breathing abnormalities may result in hypoxia.

d.

REM rebound may occur, placing greater demands on the heart.

ANS: D

The greater cardiac demands during REM sleep may put some additional strain on the recovering heart, making continued nursing surveillance during this period particularly important.

DIF: Application/Applying REF: p. 412 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

13. When a client who has severe gastroesophageal reflux during sleep asks how to improve sleep, the nurse would suggest that the client

a.

avoid antacid use.

b.

decrease caffeine intake.

c.

eat six small meals a day.

d.

raise the head of the bed on blocks.

ANS: D

The nurse would suggest that this client avoid eating within 3 hours of bedtime, consider use of antacids or histamine antagonists, and raise the head of the bed on blocks (reverse Trendelenburg position) to decrease the likelihood of reflux and subsequent aspiration.

DIF: Comprehension/Understanding REF: p. 412 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

14. The nurse would explain to a client with a sleep disorder that alcohol intoxication

a.

decreases REM sleep.

b.

increases sleep latency.

c.

increases stage 4 sleep.

d.

promotes periodic limb movements.

ANS: A

Alcohol hastens sleep onset but leads to wakening later in the night. In acute intoxication, REM sleep is suppressed.

DIF: Application/Applying REF: p. 413 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation

15. A client with chronic fatigue syndrome is crying and says I cant do anything anymore. I cant even walk up a flight of stairs because I am so tired all the time. My spouse thinks I am just lazy, but I simply cant do anything that requires physical activity. Nursing interventions for this client should focus on

a.

discovering the cause of the fatigue and correcting it.

b.

helping the client manage and cope effectively.

c.

showing the client how to plan and group activities.

d.

working with the client to improve communicating needs to the spouse.

ANS: B

Nurses have an important role in helping the client with chronic fatigue manage and cope effectively. Some included interventions include having the client keep a fatigue diary, learning to perform activities when energy levels are highest, and learning to balance gentle exercise with rest. This is a chronic condition, not one that is correctable. Planning and grouping activities and assertive communication skills are helpful components of managing and coping.

DIF: Application/Applying REF: pp. 417-418 OBJ: Intervention

MSC: Psychological Integrity Coping Mechanisms

16. When a client tells the nurse that she has been experiencing early-morning awakening, the nurse should assess the client for manifestations of

a.

depression.

b.

psychophysiologic insomnia.

c.

respiratory problems.

d.

sleep deprivation.

ANS: A

Clients who are disturbed by early-morning awakening should be screened for indications of depression.

DIF: Application/Applying REF: p. 411 OBJ: Assessment

MSC: Physiological Integrity Pathophysiology

17. To best promote improved sleep patterns for the hospitalized client, the nurse should

a.

administer mild sleeping medications.

b.

limit television and radio music during the night.

c.

provide a light, complex-carbohydrate snack.

d.

wake the client only during REM sleep.

ANS: C

If the clients condition allows, a light complex-carbohydrate snack (e.g., whole-wheat crackers) may improve the hospitalized clients sleep.

DIF: Application/Applying REF: p. 415 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Rest and Sleep

18. The nurse teaching a client with narcolepsy should include the

a.

importance of avoiding caffeine.

b.

need to increase exercise.

c.

proper way to use continuous positive-airway pressure (CPAP).

d.

recommendation to take regular naps.

ANS: D

In counseling the client who experiences narcolepsy, the nurse should emphasize good sleep hygiene, stress the importance of maintaining a regular schedule with adequate nocturnal sleep, and recommend regular naps at the times that the client is prone to increased sleepiness.

DIF: Application/Applying REF: p. 407 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Rest and Sleep

MULTIPLE RESPONSE

1. A hospitalized client complains that the loud noise and activity outside the room hinders sleep. The physician leaves an order for a hypnotic agent. The night nurse administering this medication needs to monitor client safety afterwards because these medications may cause (Select all that apply)

a.

antegrade amnesia.

b.

hangover effects.

c.

increased falls and hip fractures.

d.

less time in REM sleep.

e.

restless leg syndrome.

ANS: A, B, C

Most hypnotics cause some degree of antegrade amnesia, which means that normally cognitively intact individuals may become disoriented and forget where they are. Longer-acting hypnotics often have a hangover effect, and there is an increased risk of falls and hip fractures in people taking long-acting benzodiazepines.

DIF: Comprehension/Understanding REF: p. 413 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

2. A nurse is teaching a community group good sleep hygiene practices. Steps that individuals can take to improve their sleep include (Select all that apply)

a.

allowing for one or two restful daytime naps per day.

b.

avoiding vigorous exercise within 3 hours of bedtime.

c.

establishing a regular bedtime routine associated with preparing for sleep.

d.

if you wake at night, work quietly in bed and avoid getting up.

e.

maintaining a regular sleep-wake pattern throughout the week.

ANS: B, C, E

In addition to the correct answers, the National Sleep Foundation recommends no daytime napping; avoiding stimulants too close to bedtime; avoiding large meals within 3 hours of bedtime; getting adequate sunlight during the day; associating your bed only with sleep, not work or TV; and ensuring a quality sleep environment with comfortable clothes, bedding, temperature, and light levels.

DIF: Comprehension/Understanding REF: p. 406 OBJ: Intervention

MSC: Health Promotion Health Promotion Programs

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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