Chapter 42: Sleep Nursing School Test Banks

Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a young adult patient on the medical-surgical unit. When doing midnight checks, she sees that the patient is awake and is doing a puzzle. What is the best explanation for the patient being awake?

a.

The patient was waiting to talk with the nurse.

b.

The patient misses his family and is lonely.

c.

The patients sleep-wake cycle preference is late evening.

d.

The patient has been kept up with the noise on the unit.

ANS: C

All persons have biological clocks that synchronize their sleep-wake cycle. This explains why some individuals fall asleep in the early evening and some late evening or early morning. This patient is awake and alert enough to do a puzzle. The individuals sleep-wake preference is probably late evening. Waiting to talk with the nurse, being lonely, and noise on the unit may contribute to lack of sleep, but the best explanation for the patient being awake is the biological clock.

DIF: Understand REF: 939-940

OBJ: Explain the effect the 24-hour sleep-wake cycle has on biological function.

TOP: Evaluation MSC: Physiological Integrity: Basic Care and Comfort

2. The nurse is providing an educational session on sleep regulation for new nurses in the Sleep Disorder Treatment Center. Which of these statements by the nurses would best indicate that learning has occurred?

a.

If the patient has a disease process in the central nervous system, it can influence the functions of sleep.

b.

If the patient has a disease process in the cranial nerves, it can influence the functions of sleep.

c.

If the patient has an interruption in the motor pathways, it can influence the functions of sleep.

d.

If the patient has an interruption in the spinal reflexes, it can influence the functions of sleep.

ANS: A

Sleep involves a sequence of physiological states maintained by the central nervous system. Current theory indicates that it is an active multiphase process that involves many parts of the brain and hormone and chemical secretion. A disease process associated with the cranial nerves, motor pathway, or spinal reflexes may influence a persons ability to sleep, but the best answer is the central nervous system.

DIF: Understand REF: 939-940 OBJ: Discuss mechanisms that regulate sleep.

TOP: Assessment MSC: Physiological Integrity: Basic Care and Comfort

3. The nurse is caring for a patient who is having trouble sleeping. To encourage decreased stimulus to the reticular activating system and activation of the bulbar synchronizing region, which actions would the nurse implement?

a.

Encourage television for distraction.

b.

Encourage relaxed positions.

c.

Walk with the patient.

d.

Provide a favorite beverage.

ANS: B

Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness. Researchers also hypothesize that the release of serotonin from specialized cells in the bulbar synchronizing region (BSR) produces sleep. As the patient closes his eyes and assumes relaxed positions, stimuli to the RAS decrease, and at some point the BSR takes over. Television, walking, and drinking a favorite beverage would not necessarily encourage sleep.

DIF: Understand REF: 940 OBJ: Discuss mechanisms that regulate sleep.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

4. The nurse is caring for a patient in the sleep lab. The nurse recognizes that the patient is in stage 4 NREM from which of the following assessments?

a.

The patient awakens easily.

b.

Body functions slow.

c.

The patient is difficult to awaken.

d.

Eyes rapidly move.

ANS: C

Stage 4 NREM is the deepest stage of sleep. The patient is difficult to arouse, vital signs are significantly lower, and this stage lasts about 15 to 30 minutes. Sleep walking and enuresis sometimes occur. Lighter sleep is seen in stages 1 and 2, where the patient awakens easily. In stage 2, body functions slow and REM sleep is characterized by rapid eye movement.

DIF: Understand REF: 940-941 OBJ: Describe the stages of a normal sleep cycle.

TOP: Assessment MSC: Physiological Integrity: Basic Care and Comfort

5. The patient shares with the nurse the vivid, full color dreams experienced by the patient last night. These data would indicate that the patient has reached what stage of sleep?

a.

Stage 1 NREM

b.

Stage 2 NREM

c.

Stage 3 NREM

d.

REM

ANS: D

Vivid, full color dreaming occurs during REM sleep. This stage usually begins about 90 minutes after sleep has begun. The eyes move rapidly, and heart rate, respiratory rate, and blood pressure fluctuate; loss of skeletal muscle tone occurs. The patient has an increase in gastric secretions and is difficult to arouse.

DIF: Remember REF: 940-941 OBJ: Describe the stages of a normal sleep cycle.

TOP: Assessment MSC: Physiological Integrity: Basic Care and Comfort

6. Which nursing observation of the patient in intensive care indicates that the patient is sleeping comfortably?

a.

Eyes closed, lying quietly, respirations 12, heart rate 60

b.

Eyes closed, tossing in bed, respirations 18, heart rate 80

c.

Eyes closed, mumbling to self, respirations 16, heart rate 68

d.

Eyes closed, lying straight in bed, respirations 22, heart rate 66

ANS: A

During NREM sleep, biological functions slow. During sleep, the heart rate decreases to 60 beats per minute or less. The patient experiences decreased respirations, blood pressure, and muscle tone.

DIF: Understand REF: 941 OBJ: Explain the functions of sleep.

TOP: Assessment MSC: Physiological Integrity: Basic Care and Comfort

7. The nurse is discussing with a new mother the sleep requirements of a neonate. Which of these comments would indicate that the patient has an understanding of the neonates sleeping pattern?

a.

I cant wait to get the baby home to play with the brothers and sisters.

b.

I will ask my mom to come after the first week, when the baby is more alert.

c.

I will get the baby on a sleeping schedule the first week while my mom is here.

d.

I wont be able to nap during the day because the baby will be awake.

ANS: B

The neonate averages about 16 hours of sleep. During the first week of life, the child sleeps almost constantly.

DIF: Analyze REF: 945

OBJ: Compare and contrast the sleep requirements of different age groups.

TOP: Evaluation MSC: Physiological Integrity: Basic Care and Comfort

8. The nurse is discussing lack of sleep with a middle-aged adult. The nurse recognizes that insomnia in this age group is commonly due to

a.

Anxiety.

b.

Teenagers keeping them awake.

c.

Caring for pets.

d.

Late night television.

ANS: A

During middle adulthood, the total time spent sleeping at night begins to decline. Anxiety, depression, and illness can affect sleep, and women can experience menopausal symptoms. Insomnia is common because of the changes and stresses associated with middle age. Teenagers, caring for pets, and late night television can influence the amount of sleep; however, these are not the most common causes of insomnia in this age group.

DIF: Understand REF: 945

OBJ: Compare and contrast the sleep requirements of different age groups.

TOP: Diagnosis MSC: Physiological Integrity: Basic Care and Comfort

9. A single dad is discussing with the nurse the sleep needs of a preschooler. Which of the following directions would be most helpful to the parent?

a.

It is important that the 5-year-old get a nap every day.

b.

Preschoolers sleep soundly all night long.

c.

On average, the preschooler needs to sleep 10 hours a night.

d.

The preschooler may have trouble settling down after a busy day.

ANS: D

The preschooler usually has difficulty relaxing or settling down after long, active days. By the age of 5, naps are rare for children, except those for whom a siesta is a custom. Preschoolers frequently partially awaken during the night. On average, a preschooler needs 12 hours of sleep.

DIF: Apply REF: 945

OBJ: Compare and contrast the sleep requirements of different age groups.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

10. The nurse is having a conversation with an adolescent regarding the need for sleep. The adolescent states that it is common to stay up with friends several nights a week. Which nursing action should the nurse take?

a.

Discuss with the adolescents parent staying up with friends and the need for sleep.

b.

Discuss with the adolescent sleep needs and the effects of excessive daytime sleepiness.

c.

This is a normal occurrence for adolescents and action is not required.

d.

Explore the reason for staying up late with friends several nights a week.

ANS: B

On average, a teenager needs about 71/2 hours of sleep per night. Many activities at school, social activities, and jobs can reduce the number of sleep hours, resulting in excessive daytime sleepiness. This can lead to decreased performance at school, vulnerability to accidents, behavior and mood problems, and increased use of alcohol. Discussion regarding adolescent sleep needs should first occur with the adolescent. Although it may be common for this adolescent to want to visit with friends and experience activities that go late into the night, these activities can and do impact the hours of sleep and the physical needs of the adolescent, no matter the reason for the late nights, and they do need to be addressed.

DIF: Apply REF: 945

OBJ: Compare and contrast the sleep requirements of different age groups.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

11. The nurse is completing an assessment on an older patient who is having difficulty falling asleep. Which factor has the potential to contribute to this difficulty?

a.

Depression

b.

Smoking

c.

Alcohol

d.

Fatigue

ANS: A

Older adults and other individuals who experience depressive mood problems experience delays in falling asleep, earlier appearance of REM sleep, frequent awakening, increased total bed time, feelings of sleeping poorly, and early awakening. Smoking (nicotine) decreases the total sleep time and REM and causes awakening or difficulty staying asleep. Alcohol speeds the onset of sleep. A person who is moderately fatigued usually achieves restful sleep.

DIF: Understand REF: 946

OBJ: Identify factors that normally promote and disrupt sleep. TOP: Assessment

MSC: Physiological Integrity: Basic Care and Comfort

12. The nurse is caring for an adolescent who is complaining of difficulty falling asleep. Which intervention would be most appropriate?

a.

Adjust the temperature in the patients room to 21 C (70 F).

b.

Ensure that the night light in the patients room is working.

c.

Encourage the discontinuation of soda and chocolate nightly snack.

d.

Close the door to decrease noise from unit activities.

ANS: C

Cola and chocolate contain caffeine, which interferes with the ability to fall asleep. Personal preference influences the temperature of the room, as well as the lighting of the room. Noise can be a factor in the unit and can awaken the patient, but caffeine can make it difficult to fall asleep.

DIF: Apply REF: 946

OBJ: Identify factors that normally promote and disrupt sleep. TOP: Implementation

MSC: Physiological Integrity: Basic Care and Comfort

13. Which of the following would be most important for the nurse to monitor in a patient who has obstructive sleep apnea?

a.

Gastrointestinal function

b.

Circulatory status

c.

Respiratory status

d.

Neurological function

ANS: C

In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing airflow and stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status take priority.

DIF: Understand REF: 943

OBJ: Discuss the characteristics of common sleep disorders. TOP: Planning

MSC: Physiological Integrity: Basic Care and Comfort

14. The patient has just been diagnosed with narcolepsy. The nurse provides an educational session and teaches the patient to avoid

a.

Antidepressant medications.

b.

Naps shorter than 20 minutes.

c.

Sitting in hot, stuffy rooms.

d.

Chewing gum.

ANS: C

Patients with narcolepsy need to avoid factors that increase drowsiness such as alcohol, heavy meals, exhausting activities, long-distance driving, and long periods of sitting in hot, stuffy rooms. Patients are treated with antidepressants, and management techniques involve scheduling naps no longer than 20 minutes and chewing gum. Additional management techniques include exercise, light high-protein meals, deep breathing, and taking vitamins.

DIF: Understand REF: 944

OBJ: Discuss the characteristics of common sleep disorders. TOP: Implementation

MSC: Physiological Integrity: Basic Care and Comfort

15. The nurse is caring for a patient who has been in holding in the emergency department for 24 hours. The nurse is concerned about the patient experiencing sleep deprivation. What would be the best action for the nurse to take?

a.

Expedite the process of obtaining a medical-surgical room for the patient.

b.

Pull the curtains shut, dim the lights, and decrease the number of visitors.

c.

Obtain an order for a medication to help the patient sleep.

d.

Ask everyone in the unit to try to be quiet so the patient can sleep.

ANS: A

The most effective treatment for sleep deprivation is elimination or correction of factors that disrupt the sleep pattern. Nurses play an important role in identifying treatable sleep deprivation problems. Obtaining a private room in the designated unit for the patient will help with decreasing stimuli and promoting more rest than an individual can obtain in an emergency department even with the interventions mentioned.

DIF: Apply REF: 944

OBJ: Discuss the characteristics of common sleep disorders. TOP: Implementation

MSC: Physiological Integrity: Basic Care and Comfort

16. The nurse is completing a sleep assessment on a patient. The nurse utilizes which of the following tools to complete the assessment?

a.

Visual Analogue Scale

b.

OUCHER scale

c.

FACES scale

d.

Glasgow Coma Scale

ANS: A

The Visual Analogue Scale is utilized for assessing sleep quality. The OUCHER and FACES scales are used to measure pain, and the Glasgow Coma Scale is used to measure level of consciousness.

DIF: Apply REF: 947-948 OBJ: Conduct a sleep history for a patient.

TOP: Assessment MSC: Physiological Integrity: Basic Care and Comfort

17. The nurse is beginning a sleep assessment on a patient. Which of the following would be the most appropriate question to ask?

a.

What is going on?

b.

How are you sleeping?

c.

Are you taking any medications?

d.

What did you have for dinner last night?

ANS: B

Asking patients how they are sleeping is an introductory question. After this beginning question is asked, problems with sleep such as the nature of the problem, signs and symptoms, onset and duration of the issue, severity, predisposing factors, and the effect on the patient can be assessed. What is going on is too broad and open ended for information about sleep to be obtained specifically. Medications and food intake can be part of the detailed assessment of sleep issues.

DIF: Apply REF: 947-948 OBJ: Conduct a sleep history for a patient.

TOP: Assessment MSC: Physiological Integrity: Basic Care and Comfort

18. The nurse assigns a nursing diagnosis of ineffective breathing pattern. Which of the following sleep conditions would support this diagnosis?

a.

Insomnia

b.

Narcolepsy

c.

Obstructive sleep apnea

d.

Sleep deprivation

ANS: C

Obstructive sleep apnea (OSA) occurs when the muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing airflow or stopping it for as long as 30 seconds. The person still attempts to breathe because chest and abdominal movements continue, resulting in snoring or snorting sounds. With narcolepsy, the person feels an overwhelming wave of sleepiness and falls asleep. Insomnia is characterized by chronic difficulty falling asleep. Sleep deprivation is a condition caused by dyssomnia. OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe.

DIF: Understand REF: 942-944| 950

OBJ: Identify nursing diagnoses appropriate for patients with sleep alterations.

TOP: Diagnosis MSC: Physiological Integrity: Basic Care and Comfort

19. The nurse is caring for a postpartum patient. The patients labor has lasted over 28 hours within the hospital; the patient has not slept and is disoriented to date and time. What is the most appropriate nursing diagnosis?

a.

Impaired parenting

b.

Insomnia

c.

Ineffective coping

d.

Sleep deprivation

ANS: D

This patient has been deprived of sleep by staying awake during a 28-hour labor. Disorientation is one potential sign of sleep deprivation. In this scenario, we have a clear cause for the patients lack of sleep, and it is a one-time episode. Insomnia, on the other hand, is a chronic disorder whereby patients have difficulty falling asleep, awaken frequently, or sleep only for a short time. This scenario does not indicate that this has been a chronic problem for this patient. Although ineffective coping can manifest as a sleep disturbance, we have clear evidence that it was labor that deprived this patient of sleep, not an inability to cope. It could be difficult to care for an infant when sleep deprived; however, this scenario gives no evidence that this mother displays impaired parenting and is not caring adequately for her child or lacks the skills to do so.

DIF: Apply REF: 942| 944| 950

OBJ: Identify nursing diagnoses appropriate for patients with sleep alterations.

TOP: Diagnosis MSC: Physiological Integrity: Basic Care and Comfort

20. The patient presents to the clinic with reports of irritability, being sleepy during the day, not being able to fall asleep, and being tired. Select the most appropriate nursing diagnosis.

a.

Anxiety

b.

Fatigue

c.

Sleep deprivation

d.

Insomnia

ANS: D

Insomnia is experienced when the patient has difficulty falling asleep, frequent awakenings from sleep, and/or short sleep or nonrestorative sleep. It is the most common sleep-related complaint and includes symptoms such as irritability, excessive daytime sleepiness, not being able to fall asleep, and fatigue. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fatigue is an overwhelming sustained sense of exhaustion with decreased capacity for physical and mental work at a usual level. Sleep deprivation is a condition caused by dyssomnia and includes symptoms caused by illness, emotional distress, or medications.

DIF: Apply REF: 942| 944| 950

OBJ: Identify nursing diagnoses appropriate for patients with sleep alterations.

TOP: Diagnosis MSC: Physiological Integrity: Basic Care and Comfort

21. The nurse is preparing an older patients evening medications. Which of the following does the nurse recognize as relatively safe for difficulty sleeping?

a.

Benadryl (diphenhydramine)

b.

Melatonin

c.

Valerian

d.

Lorazepam

ANS: D

One group of medications that are relatively safe are the benzodiazepines such as lorazepam. These medications cause relaxation and antianxiety and hypnotic effects. Caution older adults about using over-the-counter antihistamines because their long duration of action can cause confusion, constipation, and urinary retention. Use of nonprescription sleeping aids is not advisable. Patients need to learn the risks associated with these drugs and should be aware that the U.S. Food and Drug Administration does not regulate herbal products.

DIF: Apply REF: 946| 954| 958

OBJ: Identify nursing interventions designed to promote normal sleep cycles for patients of all ages.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

22. The nurse is caring for a patient on the medical-surgical unit who is experiencing an exacerbation of asthma. Which of the following interventions would be most appropriate to help the patient sleep?

a.

Bed placed in semi-Fowlers position

b.

Increased BNC oxygen to 5 L a minute

c.

A snack provided before bedtime

d.

Encouraging the patient to read

ANS: A

For patients with a physical illness, the nurse helps control symptoms that disrupt sleep. Placing the patient in an upright position eases the work of breathing. Increasing the oxygen provided would require a reason to do so, and a physicians order is required. Providing a snack and encouraging the patient to read may be good interventions for patients, but the most appropriate would be raising the head of the bed.

DIF: Apply REF: 945-946| 952-955

OBJ: Identify nursing interventions designed to promote normal sleep cycles for patients of all ages.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

23. A young mother has been hospitalized for an irregular heartbeat (arrhythmia). The night nurse comes in to see the patient awake. What would be the most appropriate nursing intervention?

a.

Inform the patient that it is late and time to go to sleep.

b.

Ask the patient if she would like medication to help her sleep.

c.

Recommend the great movie that is on television tonight.

d.

Take time to sit and talk with the patient about her inability to sleep.

ANS: D

Assessment is the first step of the nursing process; therefore assessment needs to be done first and involves ascertaining the cause of the patients inability to sleep. Patients who are admitted to the hospital for uncertain diagnoses can be stressed and worried about the testing and outcomes. In addition, a young mother can be worried about the care of the children and those caring for the children. This uncertainty and change in routine can cause difficulty in resting or falling asleep. Take the time to talk with the patient to determine the cause of the inability to sleep. A distraction such as a television may or may not work for the patient. After assessment is completed, a sedative may or may not be in order. Telling the patient that it is late and time to go to sleep is not a therapeutic response for an adult who is under stress.

DIF: Apply REF: 945-947

OBJ: Identify nursing interventions designed to promote normal sleep cycles for patients of all ages.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

24. The nurse is evaluating outcomes for the patient with the nursing diagnosis of Insomnia. During this process, the nurse recognizes that

a.

The patient is the best evaluator of sleep.

b.

Interventions will need to be adjusted.

c.

Medical conditions will not influence outcomes.

d.

Observations of the patient provide needed data.

ANS: A

The patient is the source for evaluating outcomes. The patient is the only one who knows whether sleep problems have improved and what has been successful. Interventions may or may not need to be adjusted. Observations do provide needed data, but in the case of insomnia, the patient is the source for evaluating the restfulness of sleep. Sometimes, the nurse has to work with the patient to redefine sleep expectations associated with medical conditions.

DIF: Understand REF: 958 OBJ: Describe ways to evaluate sleep therapies.

TOP: Evaluation MSC: Physiological Integrity: Basic Care and Comfort

25. A patient has received a nursing diagnosis of sleep deprivation. Which of the following statements by the patient would indicate that outcomes are being met?

a.

I wake up only once a night to go the bathroom.

b.

I feel rested when I wake up in the morning.

c.

I go to sleep within 30 minutes of lying down.

d.

I only take a 20-minute nap during the day.

ANS: B

Being able to sleep and feeling rested would indicate that outcomes are being met for sleep deprivation. Limiting a nap to 20 minutes is an intervention to promote sleep. Going to sleep within 30 minutes indicates that the patient may not be experiencing insomnia. Waking up during the night may indicate insomnia, and decreasing fluids in the evening is an intervention to help prevent this situation.

DIF: Evaluate REF: 958 OBJ: Describe ways to evaluate sleep therapies.

TOP: Evaluation MSC: Physiological Integrity: Basic Care and Comfort

26. The older patient is visiting the clinic after a fall during the night. Which of the following data points obtained most likely would contribute to this fall?

a.

The patient has been taking glucosamine.

b.

The patient has been taking a fish oil.

c.

The patient has been taking Benadryl (diphenhydramine).

d.

The patient has been taking vitamin C.

ANS: C

When older adults are using Benadryl (diphenhydramine), an over-the-counter medication for sleep, caution them that they may experience dizziness, drowsiness, confusion, constipation, and urinary retention because of the long duration of action of the medication. This can contribute to a fall in an older adult. Fish oil given for the treatment of cholesterol, although an issue after a fall with potential bleeding, is not a cause for the fall, nor is glucosamine, which is used in the treatment of joint issues. Neither of these substances are utilized for sleep. Vitamin C is used to support the immune system; it is not used for sleep and does not cause falls.

DIF: Evaluate REF: 955| 957-958

OBJ: Describe ways to evaluate sleep therapies. TOP: Evaluation

MSC: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

1. The nurse is caring for a patient who has not been able to sleep well while in the hospital. The nurse recognizes that lack of sleep can manifest in which of the following signs and symptoms? (Select all that apply.)

a.

Changes in physiological function such as temperature

b.

Decreased appetite and weight loss

c.

Anxiety, irritability, and restlessness

d.

Impaired judgment

e.

Nausea, vomiting, and diarrhea

f.

Shortness of breath and chest pain

ANS: A, B, C, D

The biological rhythm of sleep frequently becomes synchronized with other body functions. Changes in body temperature correlate with sleep pattern. When the sleep-wake cycle becomes disrupted, changes in physiological function such as temperature can occur. Patients can experience decreased appetite, loss of weight, anxiety, restlessness, irritability, and impaired judgment. Gastrointestinal and respiratory/cardiovascular symptoms such as shortness of breath and chest pain are not symptoms of a disrupted sleep cycle.

DIF: Remember REF: 939-940

OBJ: Explain the effect the 24-hour sleep-wake cycle has on biological function.

TOP: Assessment MSC: Physiological Integrity: Basic Care and Comfort

2. The nurse is caring for a patient in the intensive care unit who is having trouble sleeping. The nurse explains the purpose of sleep and its benefits. What points should the nurse include in her teaching? (Select all that apply.)

a.

NREM sleep contributes to body tissue restoration.

b.

During NREM sleep, biological functions increase.

c.

Restful sleep preserves cardiac function.

d.

Sleep contributes to cognitive restoration.

e.

REM sleep decreases cortical activity.

f.

REM sleep assists with memory storage and learning.

ANS: A, C, D, E

Sleep contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration. It allows the body to rest and conserve energy. This is beneficial for the cardiac system by allowing the heart to beat fewer times each minute. During stage 4, the body releases growth hormone for renewal and repair of specialized cells such as the brain. REM sleep is necessary for brain tissue restoration and cognitive restoration and is associated with a change in cerebral blood flow and increased cortical activity. Sleep assists with memory storage and learning.

DIF: Remember REF: 940-941 OBJ: Explain the functions of sleep.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

3. The patient and the nurse discuss the need for sleep. After the discussion, the patient is able to state factors that hinder sleep. Which statements indicate that the patient has a good understanding of sleep? (Select all that apply.)

a.

Drinking coffee at 7 PM could interrupt my sleep.

b.

Worry about work can disrupt my sleep.

c.

Exercising 2 hours before bedtime can decrease relaxation.

d.

Changing the time of day that I eat dinner can disrupt sleep.

e.

Taking an antacid can decrease sleep.

f.

Staying up late for a party can interrupt sleep patterns.

ANS: A, B, C, F

Caffeine, alcohol, and nicotine consumed late in the evening produce insomnia. Worry over personal problems or situations frequently disrupts sleep. Alterations in routines, including changing mealtimes and staying up late at night for social activities, can disrupt sleep. Exercising 2 hours before bedtime actually increases a sense of fatigue and promotes relaxation. Taking an antacid does not decrease sleep.

DIF: Understand REF: 945-946

OBJ: Identify factors that normally promote and disrupt sleep. TOP: Implementation

MSC: Physiological Integrity: Basic Care and Comfort

4. A community health nurse is providing an educational session at the senior center on how to promote sleep. Which practices should the nurse recommend? (Select all that apply.)

a.

Take a nap in the afternoon.

b.

Sleep where you sleep best.

c.

Use sedatives as a last resort.

d.

Decrease fluids 2 to 4 hours before sleep.

e.

Watch television right before sleep.

f.

Get up if unable to fall asleep in 15 to 30 minutes.

ANS: B, C, D, F

The nurse should instruct the patient to sleep where she sleeps best, to use sedatives as a last resort, to decrease fluid intake to cut down on bathroom trips, and, if unable to sleep in 15 to 30 minutes, to get up out of bed. Naps should be eliminated if not part of the individuals routine schedule, and if naps are taken, they should be limited to 20 minutes or less a day. Television can stimulate and disrupt sleep patterns.

DIF: Apply REF: 952-955

OBJ: Identify nursing interventions designed to promote normal sleep cycles for patients of all ages.

TOP: Implementation MSC: Physiological Integrity: Basic Care and Comfort

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