Chapter 33- Sleep and Rest Nursing School Test Banks

 

1.

The nurse is preparing a care plan for a patient with insomnia. Which of the following would be an appropriate outcome criteria for the goal that the patient will report fewer problems falling asleep.

A)

The patient will fall asleep faster.

B)

The patient will report a decrease in sleep latency to 10 to 15 minutes within 30 days.

C)

The nurse will administer the patients hypnotic at bedtime each night.

D)

The nurse will give the patient a backrub at bedtime each night.

Ans:

B

Feedback:

Outcome criteria for the goal should be patient focused, measurable and with a specific time frame.

2.

A student nurse is preparing a presentation regarding hypnotic medications. What information should the student nurse include? Select all that apply.

A)

Hypnotics induce a normal sleep pattern.

B)

Hypnotics may impair waking in a patient.

C)

Hypnotics are safe for long-term use.

D)

Hypnotics may be addictive.

E)

Tapering of doses may be required after long-term use.

Ans:

B, D, E

Feedback:

Hypnotics do not induce a normal sleep pattern and are not indicated for long-term use. Hypnotics may impair waking functions, which can cause daytime sleepiness. Due to the potentially addictive qualities of hypnotics, tapering of doses may be required after long-term use.

3.

The nurse is preparing a care plan for a patient recently diagnosed with obstructive sleep apnea. The patient complains of daytime sleepiness, fatigue and excessive snoring that wakes me up. What nursing diagnosis would be appropriate for this patient?

A)

Disturbed Sleep Pattern as evidenced by complaints of daytime sleepiness

B)

Disturbed Sleep Pattern related to obstructive sleep apnea as evidenced by excessive snoring

C)

Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring

D)

Disturbed Sleep Pattern related to obstructive sleep apnea

Ans:

C

Feedback:

Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring is the correct nursing diagnosis. The medical diagnosis of obstructive sleep apnea should not be used in the nursing diagnosis.

4.

A school nurse is speaking to a group of parents regarding the sleep needs of adolescents. Which statement by a parent indicates a need for further education?

A)

Adolescents naturally develop an owl like sleep pattern in which they go to bed later and sleep later in the morning.

B)

Academic performance in adolescents is good when they sleep about 7 hours per night.

C)

Adolescents catch up on sleep on the weekends, when they typically sleep later.

D)

Adolescent girls are more likely to develop insomnia than boys.

Ans:

B

Feedback:

Adolescents need about 9 hours of sleep per night. Academic performance is negatively impacted when adolescents get less sleep. Due to irregular sleep patterns, adolescents typically sleep later on weekends in an attempt to catch up on sleep. Adolescent sleep patterns change to a more owl-like pattern in which they rise later and go to sleep later. Adolescent girls have a higher risk of developing insomnia than adolescent boys.

5.

A student nurse is preparing a presentation on sleep hygiene practices. What information should the nurse include? Select all that apply.

A)

Eliminate caffeine intake 6 hours prior to bedtime.

B)

Do not watch television in bed.

C)

Use blackout or other types of curtains/blinds to keep the room as dark as possible.

D)

Take a warm bath prior to bedtime.

E)

Do 15 to 30 minutes of exercise prior to bedtime.

Ans:

A, B, C

Feedback:

Caffeine is a stimulant and can interfere with sleeping. Establishing a routine of only sleeping, not reading or watching television, in bed and keeping the room as dark as possible may help decrease insomnia. Taking a warm bath or doing exercise prior to bedtime may increase the time it takes to fall asleep. These activities should be done at least 1 to 2 hours prior to bedtime.

6.

A patient has voiced concerns about her inability to fall asleep. When reviewing her history, what information would the nurse expect to find? Select all that apply.

A)

Smokes 1 pack of cigarettes daily

B)

Drinks coffee with all meals

C)

History of hyperthyroidism

D)

Exercises 30 to 60 minutes daily

E)

Works 30 hours per week

Ans:

A, B, C

Feedback:

Insomnia is associated with the consumption of stimulants (e.g., caffeine, nicotine, methamphetamine, and other drugs of abuse). Insomnia is also a side effect of hyperthyroidism . Exercising 30 to 60 minutes daily can help a patient fall asleep faster.

7.

A nursing instructor is speaking to a group of students regarding the effects of shift work on sleep patterns. Which pattern of work shifts has been shown to enhance work production?

A)

Working multiple night shifts in a row

B)

Working one week of day shifts then one week of night shifts

C)

Clockwise rotation of shifts

D)

Rotating between day and night shifts each week.

Ans:

C

Feedback:

Research has shown that clockwise rotation of shifts is preferable and that short naps during breaks enhance work performance. Recent studies have shown a negative relation between the number of consecutive night shifts worked and urinary levels of melatonin metabolites.

8.

When a nurse notes that the patient appears to be sleeping, is demonstrating irregular respirations, and is showing eye movement, the nurse identifies the stage of sleep the patient is experiencing as

A)

Transitional

B)

Rapid eye movement (REM)

C)

Light sleep

D)

Slow wave

Ans:

B

Feedback:

In REM sleep, respirations are irregular and oxygen consumption increases.

9.

Which of the following problems is associated with obesity, heavy snoring, and shallow breathing?

A)

Sleep apnea

B)

Narcolepsy

C)

Hypersomnia

D)

Hyperpnea

Ans:

A

Feedback:

Sleep apnea refers to recurrent periods of absence of breathing for 10 seconds or longer, occurring at least five times per hour.

10.

When a patient tells the clinic nurse that he has irresistible sleep attacks throughout the day lasting from 10 to 15 minutes, the nurse suspects that the patient may be experiencing

A)

Cataplexy

B)

Narcolepsy

C)

Insomnia

D)

Prolonged latency

Ans:

B

Feedback:

Narcolepsy is a disorder of excessive daytime sleepiness characterized by short, almost irresistible daytime sleep attacks, usually lasting 10 to 15 minutes, and abnormal manifestations of REM sleep.

11.

A nurse instructor 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 patient sleepy all the time.

B)

Women often experience fatigue due to loss of estrogen.

C)

Estrogen has been shown to decrease sleep latency.

D)

Hypothyroidism may contribute to a lack of slow-wave sleep.

Ans:

A

Feedback:

Hyperthyroidism causes fragmented, short-wave stages, whereas hypothyroidism seems to cause excessive sleepiness and a lack of slow-wave sleep.

12.

When the newly admitted patient with chronic obstructive pulmonary disease informs the nurse that she frequently awakens during the night, the nurse may notify the physician for which of the following interventions?

A)

A hypnotic medication

B)

A narcotic medication

C)

Low-flow oxygen

D)

Warm milk

Ans:

C

Feedback:

The pattern of frequent arousals seen in people with chronic obstructive lung disease may result from the bodys adaptation to maintain adequate oxygenation. Usually, these patients require low doses of oxygen at night.

13.

While instructing young adults about the need for adequate sleep, the nurse instructs the group that to improve sleep quality, individuals should

A)

Take an afternoon nap whenever possible

B)

Catch up on sleep on days off from work

C)

Stay awake until midnight consistently

D)

Have a consistent time for arising

Ans:

D

Feedback:

A regular time of rising is one of the most effective means of improving sleep quality and synchronizing circadian rhythms with clock time.

14.

The student nurse is providing an education program for preschool parents. The nursing student should include which of the following interventions to improve the childs sleep?

A)

Have the child limit fluids after supper

B)

The child should drink milk at bedtime

C)

The parents should keep the child up until 10 PM

D)

The child should sleep with the parents

Ans:

A

Feedback:

Parents and other caregivers can assist children in establishing the habit of voiding as part of preparing for bedtime. Drinking milk at bedtime, keeping the child up until 10 PM and sleeping with the parents will not improve the childs sleep.

15.

Which of the following activities would be appropriate to suggest to the patient who states that she has difficulty falling asleep every evening?

A)

Take a warm shower before bedtime

B)

Drink a glass of milk with a turkey sandwich

C)

Exercise vigorously for 30 minutes before sleep

D)

Clean the bedroom prior to falling asleep

Ans:

B

Feedback:

Hunger disturbs sleep of some people, whereas others have difficulty sleeping after large meals. Ingestion of L-tryptophan, a precursor of serotonin found in foods such as milk, beef, eggs, wheat flour, turkey, and corn, has been found to decrease sleep latency and increase stage 4 sleep. The bodys temperature drops during sleep; therefore taking a warm shower prior to bedtime may increase the time it takes to fall asleep.

16.

A nurse working the night shift understands the importance of enhancing the sleep patterns of his patients. In order to do so, he should

A)

Only wake them for the 12:00 AM and 4:00 AM vital signs

B)

Allow the patient time to sit at the desk to enhance better rest

C)

Evaluate the sleep response of the patient with a polysomnogram

D)

Cluster activities to allow 90 to 120 minutes of sleep

Ans:

D

Feedback:

When possible, the nurse should cluster activities at night to provide periods of 90 to 120 minutes of uninterrupted sleep.

17.

Nurses who experience no difficulty working a variety of shifts are generally viewed as which type of person?

A)

Evening

B)

Afternoon

C)

Morning

D)

Nighttime

Ans:

A

Feedback:

Evening people find they function best late in the day and are usually wide awake and ready for activity in the evening.

18.

What factor has been hypothesized by researchers regarding current thoughts on sleep?

A)

The current population requires less sleep

B)

More sleep is obtained through napping

C)

Population is healthier due to sleep

D)

Chronic sleep deprivation is present

Ans:

D

Feedback:

Most recently, researchers have hypothesized that much of the population in industrialized nations may be chronically sleep deprived.

19.

Which of the following guidelines does the nurse apply to the discussion of sleep patterns with elderly patients?

A)

Circadian rhythms become more prominent as patients age

B)

The amount of stage 4 sleep increases as patients age

C)

Total sleep time decreases as the patients age

D)

Older patients fall asleep more quickly than younger

Ans:

C

Feedback:

As people age, the amount of stage 4 sleep decreases significantly. Sleeping patterns may become polyphasic, with a shorter nocturnal period plus daytime naps.

20.

Which of the following statements about the sleep patterns of toddlers should the nurse incorporate into a teaching plan for parents?

A)

Getting the child to sleep can be difficult

B)

Most toddlers fall asleep easily

C)

Nightmares are rare in toddlers

D)

Slow-wave sleep is less than in adults

Ans:

A

Feedback:

Getting the child to fall asleep is the most commonly reported problem, but frequent awakenings and occasional night terrors may also occur.

21.

REM sleep in a toddler is about

A)

10%

B)

20%

C)

30%

D)

40%

Ans:

C

Feedback:

REM sleep in the toddler and preschooler drops to about 30%, which is still higher than adults.

22.

The parents of a newborn ask when they can expect the baby to sleep through the night. The nurse responds that the baby will most likely sleep through the night by

A)

6 weeks of age

B)

3 months of age

C)

6 months of age

D)

1 year of age

Ans:

B

Feedback:

Most infants sleep through the night by 3 months of age, but nocturnal awakenings continue to be frequent during the latter half of the first year.

23.

The nurse is caring for new parents. During her education session, the nurse instructs the parents on a newborns sleep patterns. Newborns

A)

Have shorter periods of REM sleep

B)

Are inactive when awake

C)

Will nap two times per day

D)

Sleep 16 to 17 hours per day

Ans:

D

Feedback:

Newborns sleep an average of 16 to 17 hours per 24 hours a day, divided into about seven sleep periods distributed fairly evenly throughout the day and night.

24.

A patient states to the nurse during a sleep assessment that it takes her more than 30 minutes to fall asleep. The patient states it increases her anxiety. This is considered

A)

Sleeplessness

B)

Sleep anxiety

C)

Sleep disturbance

D)

Sleep latency

Ans:

D

Feedback:

The range of normality with respect to sleep patterns is also broad. Most people require 10 to 30 minutes to fall asleep; this period is called sleep latency.

25.

When a newly admitted patient informs the nurse that he averages 6 hours of sleep per night, the nurse determines that this patient is most likely

A)

In need of sleeping pills

B)

Sleep deprived

C)

Getting efficient sleep

D)

In need of a sleep clinic visit

Ans:

B

Feedback:

Optimum daytime performance with minimal sleepiness and no accumulation of sleep debt in adults is related to obtaining 8 hours of sleep each night. Sleeping less than 6 hours and more than 9 hours per night has been linked to an increase in morbidity and early mortality.

26.

During the first cycle of sleep, the patient will be in REM sleep for

A)

1 hour

B)

3 minutes

C)

15 minutes

D)

6 minutes

Ans:

B

Feedback:

The time spent in REM sleep in the first cycle may only be 3 to 4 minutes.

27.

In Stage 4 sleep, the

A)

Blood pressure is elevated

B)

Pulse rate is slow

C)

Respirations are irregular

D)

Temperature increases

Ans:

B

Feedback:

During slow-wave sleep, the muscles are relaxed, but muscle tone is maintained; respirations are even; and blood pressure, pulse, temperature, urine formation, and oxygen consumption by muscle decreases.

28.

During stage 3 sleep, the patient may experience

A)

Enuresis

B)

Anxiety

C)

Diaphoresis

D)

Shortness of breath

Ans:

A

Feedback:

Stages 3 and 4 are the stages during which snoring, sleepwalking (somnambulism), and bed-wetting (enuresis) are most likely to occur.

29.

A patient begins snoring and is sleeping lightly. The stage of sleep is

A)

Stage 1

B)

Stage 2

C)

Stage 3

D)

Stage 4

Ans:

B

Feedback:

Stage 2 is relatively light sleep from which the patient is easily awakened. Rolling eye movements continue, and snoring may occur.

30.

When the nurse attempts to wake a patient who has just closed his eyes and appears asleep, the patient states he is not asleep. The stage of sleep the patient is in is

A)

Stage 1

B)

Stage 2

C)

Stage 3

D)

Stage 4

Ans:

A

Feedback:

Stage 1 is the 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 asleep.

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