Sleep and Rest

1. The nurse is aware that the initial entry to deep sleep is:

a.
stage 1 nonrapid eye movement (NREM).
b.
stage 3 NREM.
c.
stage 5 NREM.
d.
rapid eye movement (REM) sleep.

ANS: B

Stage 3 NREM is the initial phase of deep sleep in which there is complete muscular relaxation and vital signs begin to decline.

DIF: Cognitive Level: Comprehension REF: 329, Box 20-1

OBJ: 1 TOP: Deep Sleep KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The phenomenon of sleep walking is most likely to occur in the sleep stage of:

a.
stage 1 NREM.
b.
stage 2 NREM.
c.
stage 4 NREM.
d.
REM sleep.

ANS: C

Stage 4 NREM is the deepest stage of sleep in which sleep walking is most likely to occur.

DIF: Cognitive Level: Comprehension REF: 329, Box 20-1

OBJ: 1 TOP: Sleep Walking

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse explains that older adults often experience a disturbed sleep-wake cycle because of hormonal changes, which include a(n) _____ level.

a.
increase in angiotensin
b.
decrease in insulin
c.
increase in growth hormone
d.
decrease in melatonin

ANS: D

A decrease in the melatonin level causes age-related sleep disturbances.

DIF: Cognitive Level: Application REF: 329 OBJ: 1

TOP: Hormonal Changes KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The older man in a long-term care facility consistently wakes at 3 AM and does not return to sleep. The nurse records this behavior as _____ insomnia.

a.
sleep initiation
b.
sleep maintenance
c.
terminal
d.
undifferentiated

ANS: C

Terminal insomnia is a sleep disturbance in which the patient consistently wakes at an early hour and cannot return to sleep.

DIF: Cognitive Level: Application REF: 330 OBJ: 2

TOP: Terminal Insomnia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The newly admitted older adult who cannot fall asleep and asks for a sedative every night is most probably experiencing a difficulty with sleep:

a.
initiation related to anxiety of relocation.
b.
maintenance related to unfamiliar environment.
c.
initiation related to depression associated with relocation.
d.
maintenance related to episodes of nocturnal movement disorders.

ANS: A

Sleep initiation issues are usually associated with anxiety.

DIF: Cognitive Level: Application REF: 330 OBJ: 2

TOP: Insomnia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

6. The home health nurse assesses that the patient is probably experiencing myoclonus when his wife says:

a.
“His loud snoring and jerking awake wakes me up, too.”
b.
“I am black and blue from his kicking me every night.”
c.
“He wakes up at 2 AM every morning and walks around the house.”
d.
“His constant leg movements tear up the covers and keep me awake.”

ANS: B

Myoclonus is a periodic kicking movement of the lower extremities, which can be severe.

DIF: Cognitive Level: Application REF: 330 OBJ: 2

TOP: Myoclonus KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. The nurse would question the order for lorazepam (Ativan), 5 mg at bedtime, for a patient with:

a.
chronic obstructive pulmonary disease (COPD).
b.
any form of dementia.
c.
hypertension.
d.
sleep apnea.

ANS: D

Sedation may prevent the patient with sleep apnea to awaken to restore respiration.

DIF: Cognitive Level: Application REF: 330, Table 20-1

OBJ: 3 TOP: Lorazepam KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. In order to assist a 75-year-old male resident in a long-term care facility to decrease his problems with sleep initiation, the nurse would:

a.
provide a heavy snack at bedtime.
b.
reschedule the 8 PM albuterol inhalation treatment to 4 PM.
c.
coach the resident in 10 minutes of exercise before bedtime.
d.
provide a cola drink, strong tea, or cocoa at bedtime.

ANS: B

Albuterol is a drug that may interfere with sleep schedules.

DIF: Cognitive Level: Analysis REF: 331, Table 20-2

OBJ: 7 TOP: Insomnia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. The nurse cautions the patient who has just started on the antidepressant trazodone hydrochloride to help relieve insomnia to:

a.
increase fluids.
b.
avoid aged cheese and red wine.
c.
decrease sodium intake.
d.
avoid excessive exposure to the sun.

ANS: D

Trazodone makes persons photosensitive.

DIF: Cognitive Level: Application REF: 330, Table 20-1

OBJ: 7 TOP: Trazodone KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. The 80-year-old man complains that when he goes to bed and cannot fall asleep, he tosses and turns and gets so frustrated that he gets up and drinks coffee all night. The nurse suggests that when he has not fallen asleep after 30 minutes, he should:

a.
take two tablets of a sedative medication.
b.
get up and do a mild stretching exercise for 15 minutes.
c.
remain in bed with his eyes closed.
d.
get up and read until he feels sleepy and then return to bed.

ANS: D

Getting up and reading or watching TV is more restful than experiencing the frustration of inability to fall asleep. Sleep-inducing drugs frequently have a negative effect on older adults, exercising is stimulating, and lying in bed may increase tension.

DIF: Cognitive Level: Application REF: 331 OBJ: 7

TOP: Insomnia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. The nurse clarifies that the continuous positive airway pressure (CPAP) machine decreases the incidence of episodes of sleep apnea by:

a.
stimulating inspiration to be deeper.
b.
taking over respiratory activity when the patient ceases to breathe.
c.
sounding an alarm if respirations have ceased.
d.
keeping alveoli from collapsing.

ANS: D

The use of CPAP keeps alveoli from collapsing and causing periodic apnea.

DIF: Cognitive Level: Comprehension REF: 332 OBJ: 7

TOP: Continuous Positive Airway Pressure Machine

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. When the patient tells the home health nurse that he has flung himself out of bed three times in the course of a violent nightmare, the nurse recognizes the cardinal indicator of:

a.
myoclonus.
b.
restless legs syndrome.
c.
rapid eye movement (REM) sleep disorder.
d.
epilepsy.

ANS: C

REM sleep disorders excite excessive muscle activity during a nightmare, which causes the patient to thrash about to the point that he or she falls out of bed.

DIF: Cognitive Level: Application REF: 332 OBJ: 5

TOP: REM Sleep Disorder KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. The nurse cautions that although activity and exercise during the day are an effective sleep aid, activity and exercise should be avoided within _____ before bedtime.

a.
30 minutes
b.
1 hour
c.
2 hours
d.
3 hours

ANS: C

Exercise should be avoided within 2 hours of bedtime because activity increases the metabolic rate and may interfere with sleep.

DIF: Cognitive Level: Knowledge REF: 334 OBJ: 7

TOP: Exercise KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. The patient is encouraged to decrease fluid intake in the late evening to prevent interruption of sleep from:

a.
increased digestive processes in the bowel.
b.
episodes of nocturia.
c.
gastroesophageal reflux.
d.
changes in body temperature.

ANS: B

Reduced fluid intake in the evening will prevent nocturia, which interrupts sleep.

DIF: Cognitive Level: Knowledge REF: 334-335 OBJ: 7

TOP: Nocturia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. The nurse makes arrangements to promote normal circadian rhythm in a long-term care facility by ensuring that all rooms have:

a.
bright lights during the daytime.
b.
dim lights to promote relaxation.
c.
appropriate environmental temperature.
d.
curtains for privacy.

ANS: A

Bright lights during the day support normal circadian rhythm. Environmental temperature control and privacy are important but do not affect circadian rhythm.

DIF: Cognitive Level: Application REF: 333 OBJ: 7

TOP: Circadian Rhythm KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

1. The nurse is aware that an older adult’s diurnal patterns can be altered by __________. (Select all that apply.)

a.
shift work
b.
time zone changes
c.
altered nutrition
d.
illness
e.
medications

ANS: A, B, D, E

Nutrition does not alter diurnal patterns. All other options have the potential to alter the diurnal patterns of the older adult.

DIF: Cognitive Level: Knowledge REF: 328 OBJ: 1

TOP: Factors That Disrupt Diurnal Patterns

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The long-term care facility nurse takes into consideration that most residents go to sleep early and awaken early because of __________. (Select all that apply.)

a.
increased blood pressure
b.
drop in core temperature
c.
diminished food intake
d.
diminished hormone production
e.
decreased exposure to light

ANS: B, E

Decrease in body temperature and diminished light exposure cause circadian changes, which result in going to bed early and rising early.

DIF: Cognitive Level: Analysis REF: 329 OBJ: 2

TOP: Age-Related Changes in Circadian Rhythm

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse gives the antihistamine diphenhydramine (Benadryl) as a sleep aid with caution because the older adult may experience side effects, such as __________. (Select all that apply.)

a.
confusion
b.
urinary retention
c.
hypotension
d.
depression of respiration
e.
diarrhea

ANS: A, B, C

Benadryl can cause confusion, urinary retention, and hypotension in the older adult.

DIF: Cognitive Level: Application REF: 330, Table 20-1

OBJ: 7 TOP: Antihistamines as Sedatives KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. When mild sedation has failed to solve the problem of insomnia in the older adult, the nurse suggests __________. (Select all that apply.)

a.
relaxation therapy
b.
taking a cool bath or shower before bedtime
c.
listening to relaxing music
d.
arranging the sleep environment to promote sleep
e.
going to bed at a regular time after observing routine “sleep rituals”

ANS: A, C, D, E

Taking a cool bath or shower will not promote relaxation. All other options listed would encourage sleep.

DIF: Cognitive Level: Comprehension REF: 331, Health Promotions

OBJ: 7 TOP: Insomnia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse explains that factors that contribute to sleep apnea include __________. (Select all that apply.)

a.
obesity
b.
diabetes
c.
hypotension
d.
African American heritage
e.
use of alcohol

ANS: A, B, D, E

Hypotension does not contribute to sleep apnea. All other options are considered to be factors that contribute to sleep apnea.

DIF: Cognitive Level: Comprehension REF: 331-332 OBJ: 5

TOP: Sleep Apnea KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. The wife of a patient tells the home health nurse that she suspects her husband has sleep apnea because he __________. (Select all that apply.)

a.
snores loudly
b.
interrupts snoring with several seconds of silence
c.
complains of daytime drowsiness
d.
frequently is incontinent of urine
e.
has episodes of myoclonus

ANS: A, B, C

Incontinence and myoclonus are not associated with sleep apnea.

DIF: Cognitive Level: Application REF: 331-332 OBJ: 5

TOP: Sleep Apnea KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. The nursing staff helps encourage sleep in long-term care facility residents by __________. (Select all that apply.)

a.
using the minimum light necessary when making rounds
b.
making necessary sleep interruptions at the same time every night
c.
keeping conversational noise at the nursing station to a minimum
d.
answering call lights promptly
e.
providing heavy blankets for warmth

ANS: A, B, C, D

Heavy blankets may initially feel warm to the resident but eventually make the resident uncomfortable and unable to sleep. All other options listed will help diminish sleep interruptions.

DIF: Cognitive Level: Comprehension REF: 332-333 OBJ: 7

TOP: Sleep Support KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

8. The nurse knows that the older adult experiences changes in patterns of sleep, which typically include __________. (Select all that apply.)

a.
inability to sleep throughout the night
b.
sleeping soundly all night
c.
increase in the number of hours asleep at night
d.
difficulty in arousing from deep sleep
e.
waking up early

ANS: A, E

The older adult has a decreased number of hours of sleep, wakes early, and rarely sleeps soundly.

DIF: Cognitive Level: Knowledge REF: 329 OBJ: 3

TOP: Effects of Disease Processes on Sleep

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The nurse assesses that the resident may be experiencing changes in sleep and rest patterns when she states__________. (Select all that apply.)

a.
“I don’t know why everything seems to bother me lately.”
b.
“I’ve been so clumsy.
c.
“I’m having trouble concentrating.”
d.
“My daughter says I talk in my sleep.”
e.
“I cry for no reason at all.”

ANS: A, B, C, E

Sleep talking occurs within the sleep cycle. Irritability, increased accidents, difficulty paying attention, and altered emotional stability are symptoms of an altered sleep and rest pattern.

DIF: Cognitive Level: Comprehension REF: 328 OBJ: 3

TOP: Changes in Sleep and Rest Patterns

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

1. The nurse reminds the CNAs that most older adults require a minimum of _____ hours of sleep per day.

ANS: 7.5; 7 1/2

DIF: Cognitive Level: Knowledge REF: 328 OBJ: 2

TOP: Sleep Requirements KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse encourages the long-term facility resident experiencing insomnia to drink a glass of milk with supper and again before bedtime because milk contains the sleep-inducing agent __________.

ANS: tryptophan

DIF: Cognitive Level: Comprehension REF: 334 OBJ: 7

TOP: Tryptophan KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse clarifies that the individual’s pattern of wakefulness and sleeping is referred to as the __________ rhythm.

ANS: circadian

diurnal

DIF: Cognitive Level: Knowledge REF: 328 OBJ: 1

TOP: Circadian Rhythm KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation