Chapter 42: Sleep Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank

MULTIPLE CHOICE

1. 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.

ANS: 3

The ascending reticular activating system (RAS) located in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness. Infradian rhythms, not ultradian rhythms, occur in a cycle longer than 24 hours. Nonrapid eye movement refers to the sleep cycle that most clients experience in a low-stimulus environment. The bulbar synchronizing region is the area of the brain where serotonin is released to produce sleep. It is not responsible for REM sleep.

DIF: C REF: 1029 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

2. 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

ANS: 2

Psychological symptoms of sleep deprivation include confusion and irritability. Elevated blood pressure is not a symptom of sleep deprivation. Rapid respirations are not a symptom of sleep deprivation. There may be a decreased ability of reasoning and judgment that could lead to inappropriateness. Decreased temperature is not a symptom of sleep deprivation. The client with sleep deprivation is often withdrawn, not talkative.

DIF: A REF: 1034 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

3. 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

ANS: 3

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

DIF: A REF: 1035 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

4. 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

ANS: 4

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. It is most important that the parent maintains 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 only use having a snack as a measure of procrastination. After 3 years of age the child may give up daytime naps. A bedtime routine used consistently will be more effective in helping the child who resists going to sleep. The same regular bedtime and wake-up schedule should be maintained.

DIF: A REF: 1035 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

5. 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 childs parents regarding this assessment?

1.

What are the childs 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 childs central nervous system is causing these insomniac problems.

ANS: 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 childs usual sleep patterns. The nurse should first assess the childs usual sleep pattern to determine if the child is adhering to a bedtime. A sleep problem is often the cause of fatigue.

DIF: C REF: 1035 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

6. 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

ANS: 4

As people age, there is a progressive decrease in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep, sleep. Older people do not become more difficult to arouse, not do they require more sleep than the middle-age adult. An older adult awakens more often during the night, and it may take more time for an older adult to fall asleep.

DIF: A REF: 1035 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

7. 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

ANS: 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.

DIF: A REF: 1036 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

8. 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.

ANS: 3

Infants are usually placed on their backs to prevent suffocation or on their sides to prevent aspiration of stomach contents. To reduce the chance of suffocation, pillows, stuffed toys, or the ends of loose blankets should not be placed in cribs. Infants should not be covered loosely with a blanket because infants might pull them over their faces and suffocate. To reduce the chance of suffocation, pillows should not be placed in cribs.

DIF: A REF: 1045 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

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

1.

What do you do just before going to bed?

2.

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

3.

Why dont you try napping more during the daytime?

4.

Do you eat a small snack before going to bed?

ANS: 1

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. Older adults sleep best in softly lit rooms. Napping more during the daytime is often not the best solution. The nurse should first assess the clients sleeping problem. The client does not always have to eat something before going to bed.

DIF: C REF: 1039 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

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

1.

Restlessness

2.

Talking during sleep

3.

Somnambulism

4.

Excessive snoring

ANS: 4

Partners of clients with sleep apnea often complain that the clients snoring disturbs their sleep. Restlessness is not most associated with sleep apnea. Sleep talking is associated with sleep-wake transition disorders; somnambulism is associated with parasomnias (specifically, arousal disorders and sleep-wake transition disorders).

DIF: A REF: 1036 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

11. The nurse should instruct the client to do which of the following to promote good sleep hygiene at home?

1.

Use the bedroom only for sleep or sexual activity.

2.

Eat a large meal 1 to 2 hours before bedtime.

3.

Exercise vigorously before bedtime.

4.

Stay in bed if sleep does not come after hour.

ANS: 1

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. The nurse should instruct the client to avoid heavy meals for 3 hours before bedtime; a light snack may help. The nurse should also 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. Getting out of bed and doing 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 may also help.

DIF: A REF: 1045 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

12. The nurse knows that which of the following habits may interfere with a clients sleep?

1.

Listening to classical music

2.

Finishing office work

3.

Reading novels

4.

Drinking warm milk

ANS: 2

At home a client should not try to finish office work or resolve family problems before bedtime. Noise should be kept to a minimum. Soft music may be used to mask noise if necessary. 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. A dairy product snack such as warm milk or cocoa that contains L-tryptophan may be helpful in promoting sleep.

DIF: A REF: 1045 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

13. It is determined that the client will need pharmacological treatment to assist with the clients 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

ANS: 3

The benzodiazepines cause relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal. Withdrawal from CNS depressants, such as barbiturates, can cause insomnia and must be managed carefully. Barbiturates can cause tolerance and dependence. Central nervous system 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. Tricyclic antidepressants can cause insomnia when withdrawn and should be managed carefully. They are used primarily to treat depression.

DIF: A REF: 1036 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

14. The nurse is completing an assessment of the clients 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?

ANS: 4

To assess for sleep apnea (unlike assessing for narcolepsy or insomnia), the nurse may ask, Do you snore loudly? and Do you experience headaches after awakening? A positive response may indicate the client experiences sleep apnea.

DIF: C REF: 1033 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

15. 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

ANS: 3

To promote sleep, daytime naps should be eliminated. If naps are used, they should be limited to 20 minutes or less twice a day. Alcohol should be limited in the late afternoon and evening because it has an insomnia-producing effect. 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. 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 has not fallen asleep in 30 minutes, the client should get up out of bed and do some quiet activity until feeling sleepy enough to go back to bed.

DIF: A REF: 1034 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

16. A client is concerned that her habit of sleeping during the day and being awake at night is not healthy or normal. The nurses most therapeutic response to the clients 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 dont 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 isnt abnormal or unhealthy.

ANS: 4

All persons have biological clocks that synchronize their sleep cycles. If the sleep pattern does not adversely affect the clients health or ability to function, it is not problematic.

DIF: C REF: 1029 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

17. 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?

ANS: 2

When the sleep-wake cycle becomes disrupted (e.g., by working rotating shifts), other physiological functions usually change as well. For example, the person experiences a decreased appetite and loses weight. Anxiety, restlessness, irritability, and impaired judgment are other common symptoms of sleep cycle disturbances. Failure to maintain the individuals usual sleep-wake cycle negatively influences the clients overall health. Although the other options are not inappropriate, they are not as directly aimed at determining the cause of the changes.

DIF: C REF: 1030 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

18. The nurse and a client are discussing possible behaviors that might be interfering with the clients ability to fall asleep. Which of the following assessment questions is most likely to identify possible problems with the clients 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?

ANS: 2

As people try to fall asleep, they close their eyes and assume relaxed positions. Stimuli to the RAS decline. If the room is dark and quiet, activation of the RAS further declines. At some point the BSR takes over, causing sleep. If the client engages in activities such as reading or watching television as a means of falling asleep, this could be causing the problem. Although the other questions are not inappropriate, they are not as directed toward the cause of the problem.

DIF: C REF: 1029 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

19. An older adult client diagnosed as being in the early stage of Alzheimers 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 clients age

2.

A lack of presleep relaxation

3.

The amount of noise entering into the clients environment

4.

A manifestation of the disease process causing the brain disorder

ANS: 1

With aging, sleep becomes more fragmented, and a person spends more time in lighter stages that are easily disturbed by noise. The remaining options may be a factor but not to the degree of normal aging.

DIF: C REF: 1035 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

20. A 9-year-old client asks the nurse, Why do I need to sleep? The nurses 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.

Youll be able to do so much better in school if youre rested.

4.

Your body needs to rest in order to grow and be really healthy.

ANS: 4

Sleep contributes to physiological and psychological restoration, maintenance, and growth of the body at any age. The remaining options are not as effective at providing a thorough answer to the childs question. The body needs sleep to routinely restore biological processes.

DIF: C REF: 1030 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

21. 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?

ANS: 4

A loss of REM sleep leads to feelings of confusion and suspicion. Various body functions (e.g., mood, motor performance, memory, and equilibrium) are altered when prolonged sleep loss occurs. Research estimates that traffic, home, and work-related accidents caused by falling asleep are often a result of sleep loss. This answer is the best question because it directly opens up the opportunity for the client to discuss possible sleep problems if they exist. The other questions are not inappropriate but are less likely to reveal the possible cause of the accidents.

DIF: C REF: 1031 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

22. 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

ANS: 1

Nocturia, or urination during the night, disrupts sleep and the sleep cycle. This condition is most common in older people with reduced bladder tone or persons with cardiac disease, diabetes, urethritis, or prostatic disease. After a person awakens repeatedly to urinate, returning to sleep is difficult. Although all the clients may have difficulty falling back to sleep when awakened, the answer represents the client with the greatest tendency to be awakened during the night.

DIF: C REF: 1032 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

23. 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 Crohns disease

3.

A 49-year-old man who is an avid cross-county runner

4.

A 58-year-old woman diagnosed with chronic depression

ANS: 4

Many think OSA affects middle-age men more frequently, particularly when they are obese. However, obstructive sleep apnea is also common in postmenopausal women, younger women, and children. Although the clients in all of the options may experience OSA, the postmenopausal woman has the greatest risk.

DIF: C REF: 1033 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

24. 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.

ANS: 4

The upper airway becomes partially or completely blocked, and diminished nasal airflow (hypopnea) can result for as long as 30 seconds. The person attempts to breathe, which often results in loud snoring and snorting sounds. The effort to breathe during sleep results in arousals from deep sleep, often to the stage 2 cycle, causing interference with deep sleep and thus the clients not feeling rested. The remaining options are not inappropriate, but they are not as directed at explaining the problem to the client.

DIF: C REF: 1033 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

25. 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

ANS: 3

Hospitalization, especially in intensive care units, makes clients particularly vulnerable to the extrinsic and circadian sleep disorders that cause the ICU syndrome of sleep deprivation. Constant environmental stimuli within the intensive care unit (ICU), such as strange noises from equipment, the frequent monitoring and care given by nurses, and ever-present lights, confuse clients and lead to sleep deprivation. Although the other options may be contributing factors, they are not as directly responsible.

DIF: C REF: 1034 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

26. 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 mothers 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 arent sure exactly, but it may have something to do with undetected cardiac or oxygen problems.

3.

Research is inconclusive, but its 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.

ANS: 3

Some have hypothesized that sudden infant death syndrome (SIDS) is caused by abnormalities in the autonomic nervous system that are manifested during sleep, resulting in apnea, hypoxia, and/or cardiac dysrhythmias. This answer provides the most thorough answer to the mothers question, whereas the remaining options stress preventive measures.

DIF: C REF: 1034 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

27. The client asks the nurse, How will I know if Im really rested? The nurses most therapeutic response is:

1.

Everyones definition of rested is different. How would you define rested?

2.

When you arent 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.

ANS: 3

When people are at rest they are in a state of mental, physical, and spiritual activity that leaves them feeling refreshed, rejuvenated, and ready to resume the activities of the day. The remaining options ask questions or provide a limited view on what rested means.

DIF: C REF: 1034 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

28. 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 nurses 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

ANS: 2

You must always be aware of the clients need for rest. A lack of rest for long periods causes illness or worsening of existing illness. Although the other options are appropriate concerns, they are not as immediate in nature as is the sleep problem.

DIF: C REF: 1034-1035 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

29. 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

ANS: 1

One substance that promotes sleep in many people is L-tryptophan, a natural protein found in foods such as milk, cheese, and meats.

DIF: C REF: 1036 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

30. 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 clients 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?

ANS: 4

An older adult awakens more often during the night, and it takes more time for an older adult to fall asleep. The answer provides an opportunity for a discussion about the effect this problem may be creating.

DIF: C REF: 1035 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

31. The nurse and the parents of a 3-year-old are discussing their childs sleep habits. They share a concern over the childs 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 wouldnt 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. Its usually temporary.

ANS: 4

The preschooler usually has difficulty relaxing or quieting down after long, active days and has problems with bedtime fears, waking during the night, or nightmares. Partial wakening followed by normal return to sleep is frequent. In the waking period, the child exhibits brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting. The other options either ask questions or provide possible tactics for preventing the problems.

DIF: C REF: 1035 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

32. 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

ANS: 1

Caffeine is a stimulant and can cause difficulty in falling asleep. There is about 30 mg of caffeine in two cups of hot cocoa.

DIF: C REF: 1029 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

33. A 22-year-old male client shares with the nurse that he is always tired. In assessing the clients 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?

ANS: 1

This question helps quantify the length of sleep that the client receives. A brief subjective method to assess sleep is a numeric scale with a 0 to 10 sleep rating. Ask individuals to separately rate their quantity and quality of sleep on the scale. Instruct clients to indicate with a number between 0 and 10 their sleep quantity then their quality of sleep with 0 being the worst sleep and 10 being the best sleep

DIF: A REF: 1033 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

34. 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

ANS: 3

If the client has recently had surgery, expect the client to experience some disturbance in sleep. Clients usually awaken frequently during the first night after surgery and receive little deep or REM sleep. Depending on the type of surgery, it takes several days to months for a normal sleep cycle to return.

DIF: A REF: 1034 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

35. The night nurse goes quietly into the sleeping clients 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

ANS: 1

Stage 1 NREM includes the lightest level of sleep. Sensory stimuli such as noise easily arouses the person. The stage lasts a few minutes. Decreased physiological activity begins with gradual fall in vital signs and metabolism. Awakened, person feels as though daydreaming has occurred. Stage 2 NREM is a period of sound sleep. Stage 3 NREM involves initial stages of deep sleep. Stage 4 NREM is the deepest stage of sleep. It is very difficult to arouse the sleeper.

DIF: C REF: 1039 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

36. A 25-year-old clients 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

ANS: 3

Stage 4 NREM sleep is the deepest stage of sleep. It is very difficult to arouse the sleeper. If sleep loss has occurred, the sleeper will spend a considerable portion of the night in this stage. Vital signs are significantly lower than during waking hours. The stage lasts approximately 15 to 30 minutes. Sleepwalking and enuresis (bed-wetting) sometimes occur. Stage 2 NREM is a period of sound sleep. Stage 3 NREM involves initial stages of deep sleep. REM sleep involves vivid, full-color dreaming. Loss of skeletal muscle tone occurs. It is very difficult to arouse the sleeper. Less vivid dreaming occurs in other stages. The stage is typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates, and increased or fluctuating blood pressure.

DIF: C REF: 1037 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

37. 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

ANS: 1

A healthy adults normal heart rate throughout the day averages 70 to 80 beats per minute or less if the individual is in excellent physical condition. However, during sleep the heart rate falls to 60 beats per minute or less. This means that the heart beats 10 to 20 fewer times in each minute during sleep or 60 to 120 fewer times in each hour. If the client were hemorrhaging, the heart rate would initially be tachycardic as the body attempts to compensate for the lost blood volume.

DIF: C REF: 1038 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

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

ANS: 3

Personality influences the quality of dreams; for example, a creative person has elaborate and complex dreams, whereas a depressed person dreams of helplessness. Most people dream about immediate concerns such as an argument with a spouse or worries over work. Sometimes a person is unaware of fears represented in bizarre dreams.

DIF: C REF: 1039 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

39. 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

ANS: 4

Knowing a clients usual, preferred sleep pattern allows a nurse to try to match sleeping conditions in a health care setting with those in the home.

DIF: C REF: 1029 OBJ: Application

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

MULTIPLE RESPONSE

1. 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

ANS: 3, 4

Structural abnormalities, such as a deviated septum, nasal polyps, certain jaw configurations, or enlarged tonsils predispose a client to obstructive apnea. Individuals with mixed apnea often have signs and symptoms of right-sided heart failure. Respiratory tract infections do not predispose a client to obstructive sleep apnea. Clients with obstructive apnea are often middle-age, obese men. Obesity itself does not predispose a client to obstructive sleep apnea.

DIF: C REF: 1034 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

2. The nurse and a client are discussing the importance of an effective 24-hour sleep cycle. Which of the following responses by the client may be a direct result of an inadequate sleep pattern? (Select all that apply.)

1.

Gaining weight

2.

Usually feeling cold

3.

Always feeling tired

4.

A heart that beats really fast

5.

Often feeling blue or depressed

6.

Feeling dizzy when getting up from a chair

ANS: 2, 3, 4, 5, 6

The predictable changing of body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood depend on the maintenance of the 24-hour circadian cycle. Weight gain is not typically a result of poor sleep patterns.

DIF: C REF: 1030 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

3. Although the most common effect of obstructive sleep apnea is a disrupted sleep pattern, the condition can cause a serious decline in arterial oxygen levels that may result in: (Select all that apply.)

1.

Hypertension

2.

Angina attacks

3.

Alzheimers disease

4.

Cardiac dysrhythmias

5.

Cerebral vascular accidents

6.

Type 2 diabetes

ANS: 1, 2, 4, 5

Obstructive apnea causes a serious decline in arterial oxygen saturation level. Clients are at risk for cardiac dysrhythmias, right-sided heart failure, pulmonary hypertension, angina attacks, stroke, and hypertension. The other options are not directly related to a diminished supply of arterial oxygen.

DIF: A REF: 1030 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

4. The nurse is preparing to discuss the management of the sleeping disorder narcolepsy. In addition to the prescription of stimulants and antidepressants, which of the following nonpharmaceutical strategies should be included and shared with the client? (Select all that apply.)

1.

Wine with meals

2.

Regular use of a sauna

3.

Light but high-protein meals

4.

Regular use of chewing gum

5.

Adoption of a regular exercise routine

6.

Brief daytime naps of 20 minutes or less

ANS: 3, 4, 5, 6

Narcoleptics may be helped by brief daytime naps no longer than 20 minutes, a regular exercise program, avoiding shifts in sleep, eating light meals high in protein, practicing deep breathing, chewing gum, and taking vitamins. Clients with narcolepsy need to avoid factors that increase drowsiness (e.g., alcohol, heavy meals, exhausting activities, long-distance driving, and long periods of sitting in hot, stuffy rooms).

DIF: C REF: 1031 OBJ: Analysis

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

5. Which of the following client statements made by young adults suggest a risk factor for sleep disturbance problems? (Select all that apply.)

1.

I have a job that requires my attention 110% of the time.

2.

I really enjoy fishing; I wish we lived closer to a river or pond.

3.

My wife just found out she is pregnant for the third time in 5 years.

4.

My father recently suffered a heart attack, and Mom is so very worried about him.

5.

The kids are so active in after-school things that we never have an evening at home.

6.

Gardening always gave me such a sense of accomplishment, but I dont have much free time now.

ANS: 1, 3, 4, 5

It is common for the stresses of jobs, family relationships, and social activities to lead frequently to insomnia and the use of medication for sleep. The remaining options reflect a sense of loss but not necessarily of stress.

DIF: C REF: 1036 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Physiological Integrity/Basic Care and Comfort/Rest and Sleep

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Leave a Reply