Chapter 41: Sleep Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. The physiology of sleep is complex. Which of the following is the most appropriate statement in regard to this process?

a.

Ultradian rhythms occur in a cycle longer than 24 hours.

b.

Nonrapid eye movement (NREM) refers to the cycle that most clients experience when in a high-stimulus environment.

c.

The reticular activating system is partly responsible for the level of consciousness of a person.

d.

The bulbar synchronizing region causes the rapid eye movement (REM) sleep in most normal adults.

ANS: c

c. The ascending reticular activating system (RAS) located in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness.

a. Infradian rhythms, not ultradian rhythms, occur in a cycle longer than 24 hours.

b. Nonrapid eye movement refers to the sleep cycle that most clients experience in a low-stimulus environment.

d. The bulbar synchronizing region is the area of the brain where serotonin is released to produce sleep. It is not responsible for REM sleep.

REF: Text Reference: p. 1200

2. The nurse is alert to clients who may be predisposed to obstructive sleep apnea, including those individuals with:

a.

Heart disease

b.

Respiratory infections

c.

Nasal polyps

d.

Obesity

ANS: c

c. Structural abnormalities such as a deviated septum, nasal polyps, certain jaw configurations, or enlarged tonsils predispose a client to obstructive apnea.

a. Individuals with mixed apnea often have signs and symptoms of right-sided heart failure.

b. Respiratory infections do not predispose a client to obstructive sleep apnea.

d. Clients with obstructive apnea are often middle-aged, obese men. Obesity itself does not predispose a client to obstructive sleep apnea.

REF: Text Reference: p. 1204

3. When a client is deprived of sleep, the nurse might assess such symptoms as:

a.

Elevated blood pressure and confusion

b.

Confusion and irritability

c.

Inappropriateness and rapid respirations

d.

Decreased temperature and talkativeness

ANS: b

b. Psychological symptoms of sleep deprivation include confusion and irritability.

a. Elevated blood pressure is not a symptom of sleep deprivation.

c. Rapid respirations are not a symptom of sleep deprivation. A decreased ability of reasoning and judgment could lead to inappropriateness.

d. Decreased temperature is not a symptom of sleep deprivation. The client with sleep deprivation is often withdrawn, not talkative.

REF: Text Reference: p. 1205

4. The parents of a newborn wonder when she should start to sleep through the night. The nurses response should be that in infants, a nighttime pattern of sleep usually develops by:

a.

1 month

b.

2 months

c.

3 months

d.

6 months

ANS: c

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

a. This is not when infants usually develop a nighttime pattern of sleep.

b. This is not when infants usually develop a nighttime pattern of sleep.

d. This is not when infants usually develop a nighttime pattern of sleep.

REF: Text Reference: p. 1206

5. The mother of a 2-year-old tells the nurse that the child has started crying and resisting going to sleep at the scheduled bedtime. The nurse should advise the parent to:

a.

Offer the child a bedtime snack

b.

Eliminate one of the naps during the day

c.

Allow the child to sleep longer in the mornings

d.

Maintain consistency in the same bedtime ritual

ANS: d

d. The nurse should advise the parent to maintain a regular bedtime and wake-up schedule and to reinforce patterns of preparing for bedtime. A bedtime routine (e.g., same hour for bedtime, quiet activity) used consistently helps young children avoid delaying sleep.

a. It is most important that the parent maintain a consistent bedtime routine. If a bedtime snack is already part of that routine, then this is allowable. If it is not, then the child may use having a snack only as a measure of procrastination.

b. After age 3 years, the child may give up daytime naps. A bedtime routine used consistently will be more effective in helping the child resist going to sleep.

c. The same regular bedtime and wake-up schedule should be maintained.

REF: Text Reference: p. 1219

6. An 11-year-old child 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 childs parents regarding this assessment?

a.

What are the childs usual sleep patterns?

b.

Establish bedtimes for the child and withhold his allowance whenever those times are not adhered to.

c.

We need to explore other health-related problems, as sleep problems are not likely the cause of his fatigue.

d.

The bulbar synchronizing region of the childs central nervous system is causing these insomniac problems.

ANS: a

a. 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 childs usual sleep patterns.

b. The nurse should first assess the childs usual sleep pattern. This response is not appropriate because the nurse is assuming the child is not adhering to a bedtime.

c. The nurse should first assess the childs usual sleep pattern. A sleep problem is often the cause of fatigue.

d. The nurse is assuming the child is experiencing insomnia. The nurse should first determine the childs sleep pattern.

REF: Text Reference: p. 1207

7. In describing the sleep patterns of older adults, the nurse recognizes that they:

a.

Are more difficult to arouse

b.

Require more sleep than middle-aged adults

c.

Take less time to fall asleep

d.

Have a decline in stage 4 sleep.

ANS: d

d. As people age, a progressive decrease occurs in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep sleep.

a. As people age, they do not become more difficult to arouse.

b. The older adult does not require more sleep than the middle-aged adult.

c. An older adult awakens more often during the night, and it may take more time for an older adult to fall asleep.

REF: Text Reference: p. 1207

8. For a client who is currently taking a diuretic, the nurse should inform the client that he or she may experience:

a.

Nocturia

b.

Nightmares

c.

Increased daytime sleepiness

d.

Reduced REM sleep

ANS: a

a. For the client who is currently taking a diuretic, the nurse should inform the client that he or she might experience nighttime awakening because of nocturia.

b. Diuretic use does not cause nightmares.

c. Diuretics do not cause increased daytime sleepiness.

d. Diuretics do not reduce REM sleep.

REF: Text Reference: p. 1208

9. As a result of recent studies regarding infant safety during sleep, the nurse instructs the parents to:

a.

Provide a stuffed toy for comfort

b.

Cover the infant loosely with a blanket

c.

Place the infant on its back

d.

Use small pillows in the crib

ANS: c

c. Infants are usually placed on their backs to prevent suffocation or on their sides to prevent aspiration of stomach contents.

a. To reduce the chance of suffocation, pillows, stuffed toys, or the ends of loose blankets should not be placed in cribs.

b. An infants should not be covered loosely with a blanket, because the infant might pull it over the faces and suffocate.

d. To reduce the chance of suffocation, pillows should not be placed in cribs.

REF: Text Reference: p. 1218

10. A 74-year-old client has been having sleeping difficulties. To have a better idea of the clients problem the nurse should respond:

a.

What do you do just prior to going to bed?

b.

Lets make sure that your bedroom is completely darkened at night.

c.

Why dont you try napping more during the daytime?

d.

You should always eat something just before bedtime.

ANS: a

a. To assess the clients sleeping problem, the nurse should inquire about predisposing factors, such as by asking, What do you do just before going to bed? Assessment is aimed at understanding the characteristics of any sleep problem and the clients usual sleep habits so that ways for promoting sleep can be incorporated into nursing care.

b. Older adults sleep best in softly lit rooms.

c. Napping more during the daytime is often not the best solution. The nurse should first assess the clients sleeping problem.

d. The client does not always have to eat something before going to bed. The nurse should first assess the clients sleeping problem. It may not be difficulty falling asleep.

REF: Text Reference: p. 1210

11. Which of the following information provided by the clients bed partner is most associated with sleep apnea?

a.

Restlessness

b.

Talking during sleep

c.

Somnambulism

d.

Excessive snoring

ANS: d

d. Partners of clients with sleep apnea often complain that the clients snoring disturbs their sleep.

a. Restlessness is not most associated with sleep apnea.

b. Sleeptalking is associated with sleep-wake transition disorders, not sleep apnea.

c. Somnambulism is associated with parasomnias (specifically arousal disorders and sleep-wake transition disorders).

REF: Text Reference: p. 1211

12. In teaching methods to promote positive sleep habits at home, the nurse instructs the client to:

a.

Use the bedroom only for sleep or sexual activity

b.

Eat a large meal 1 to 2 hours before bedtime

c.

Exercise vigorously before bedtime

d.

Stay in bed if sleep does not come after 1/2 hour

ANS: a

a. The nurse should explain that if possible, the bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity, besides sex.

b. The nurse should instruct the client to avoid heavy meals for 3 hours before bedtime; a light snack may help.

c. The nurse should instruct the client to try to exercise daily, preferably in morning or afternoon, and to avoid vigorous exercise in the evening within 2 hours of bedtime.

d. The nurse should advise the client to get out of bed and do some quiet activity until feeling sleepy enough to go back to bed if the client does not fall asleep within 30 minutes of going to bed.

REF: Text Reference: p. 1219

13. The nurse is discussing sleep habits with the client in the sleep-assessment clinic. Of the following activities performed before sleeping, the nurse is alert to the one that may be interfering with the clients sleep, which is:

a.

Listening to classical music

b.

Finishing office work

c.

Reading novels

d.

Drinking warm milk

ANS: b

b. At home a client should not try to finish office work or resolve family problems before bedtime.

a. Noise should be kept to a minimum. Soft music may be used to mask noise if necessary.

c. Reading a light novel, watching an enjoyable television program, or listening to music helps a person to relax. Relaxation exercises can be useful at bedtime.

d. A dairy-product snack such as warm milk or cocoa that contains L-tryptophan may be helpful in promoting sleep.

REF: Text Reference: p. 1219

14. It is determined that the client will need pharmacologic treatment to assist with his sleep patterns. The nurse anticipates that treatment with an anxiety-reducing, relaxation-promoting medication will include the use of:

a.

Barbiturates

b.

Amphetamines

c.

Benzodiazepines

d.

Tricyclic antidepressants

ANS: c

c. The benzodiazepines cause relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the CNS that suppress responsiveness to stimulation, therefore decreasing levels of arousal.

a. Withdrawal from CNS depressants such as barbiturates can cause insomnia and must be managed carefully. Barbiturates can cause tolerance and dependence.

b. CNS stimulants, such as amphetamines, should be used sparingly and under medical management. Amphetamine sulfate may be used to treat narcolepsy. Prolonged use may cause drug dependence.

d. Tricyclic antidepressants can cause insomnia when discontinued, and should be managed carefully. They are used primarily to treat depression.

REF: Text Reference: p. 1222

15. The nurse is completing an assessment on the clients sleep patterns. A specific question that the nurse should ask to determine the potential presence of sleep apnea is:

a.

How easily do you fall asleep?

b.

Do you have vivid, lifelike dreams?

c.

Do you ever experience loss of muscle control or falling?

d.

Do you snore loudly or experience headaches?

ANS: d

d. To assess for sleep apnea, the nurse may ask, Do you snore loudly? and, Do you experience headaches after awakening? A positive response may indicate that the client experiences sleep apnea.

a. This question is directed at assessing the potential presence of insomnia.

b. This question is directed at determining the potential presence of narcolepsy.

c. This question is directed at determining the potential presence of narcolepsy.

REF: Text Reference: p. 1212

16. Older adults at the community center are having a discussion on health issues, led by a nurse volunteer. One of the participants asks the nurse what to do about not being able to sleep well at night. The nurse informs the participants that sleep in the evening may be enhanced by:

a.

Drinking an alcoholic beverage before bedtime

b.

Using an over-the-counter sleeping agent

c.

Eliminating naps during the day

d.

Going to bed at a consistent time even if not feeling sleepy

ANS: c

c. To promote sleep, daytime naps should be eliminated. If naps are used, they should be limited to 20 minutes or less twice a day.

a. Alcohol should be limited in the late afternoon and evening because it has an insomnia-producing effect.

b. The use of nonprescription sleeping medications is not advisable. Over the long term, these drugs can lead to further sleep disruption, even when they initially seemed to be effective.

d. Following a bedtime routine should be consistent, not necessarily going to bed. The client should engage in quiet activities that promote relaxation, and then may go to bed. If the client hasnt fallen asleep in 30 minutes, the client should get up out of bed and do some quiet activity until they feel sleepy enough to go back to bed.

REF: Text Reference: p. 1219

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