Ch. 34 Rest & Sleep Flashcards
A nurse in a provider’s office is caring for a client
who states that, for the past week, “I have felt
tired during the day and cannot sleep at night.”
Which of the following responses should the
nurse ask when collecting data about the client’s
difficulty sleeping? (Select all that apply.)
A. “Have your working hours changed recently?”
B. “Do you feel confused in the late afternoon?”
C. “Do you drink coffee, tea, or other caffeinated
drinks? If so, how many cups per day?”
D. “Has anyone ever told you that you seem to stop
breathing for a few seconds while you are asleep?”
E. “Tell me about any personal stress
you are experiencing.”
A. CORRECT: Job changes, including roles and working
hours, can affect the quality and quantity of sleep.
C. CORRECT: Caffeinated drinks act as a
stimulant and can interfere with sleep.
D. CORRECT: Periods of apnea warrant a prompt
referral for diagnostic sleep studies.
E. CORRECT: Emotional stress is a common
cause of short‑term sleep problems.
A nurse is talking with a client about ways to
help sleep and rest. Which of the following
recommendations should the nurse give to the client
to promote sleep and rest? (Select all that apply.)
A. Practice muscle relaxation techniques.
B. Exercise each morning.
C. Take an afternoon nap.
D. Alter the sleep environment for comfort.
E. Limit fluid intake at least 2 hr before bedtime
A. CORRECT: Relaxation techniques, especially muscle
relaxation, can help promote sleep and rest.
B. CORRECT: Following an exercise routine regularly, at least
2 hr prior to bedtime, can help promote rest and sleep.
D. CORRECT: For example, rather than trying to
sleep with a restless pet at the foot of the bed,
move the pet to another sleep area.
E. CORRECT: Limiting fluids for a few hours before
bedtime helps minimize getting up to urinate.
A nurse is caring for a client who has been following
the facility’s routine and bathing in the morning.
However, at home, the client always takes a
warm bath just before bedtime. Now the client is
having difficulty sleeping at night. Which of the
following actions should the nurse take first?
A. Rub the client’s back for 15 min before bedtime.
B. Offer the client warm milk and crackers at 2100.
C. Allow the client to take a bath in the evening.
D. Ask the provider for a sleeping medication
C. CORRECT: When providing care, first use the least
restrictive intervention. Of these options, allowing the
client to follow their usual bedtime routine represents
the least change, so it is the first intervention to try
A nurse is preparing a presentation at a local
community center about sleep hygiene. When
explaining rapid eye movement (REM) sleep,
which of the following characteristics should
the nurse include? (Select all that apply.)
A. REM sleep provides cognitive restoration.
B. REM sleep lasts about 90 min.
C. It is difficult to awaken a person in REM sleep.
D. Sleepwalking occurs during REM sleep.
E. Vivid dreams are common during REM sleep
A. CORRECT: Cognitive and brain tissue
restoration occur during REM sleep.
C. CORRECT: In this stage, awakening is difficult. Awakening
is relatively easy in stages 1 and 2 of non‑REM sleep.
E. CORRECT: Dreaming does occur in other stages,
but it is less vivid and possibly less colorful.
A nurse is instructing a client who has
narcolepsy about measures that might help
with self‑management. Which of the following
statements should the nurse identify as an indication
that the client understands the instructions?
A. “I’ll add plenty of carbohydrates to my meals.”
B. “I’ll take a short nap whenever I feel a little sleepy.”
C. “I’ll make sure I stay warm when
I am at my desk at work.”
D. “It’s okay to drink alcohol as long as
I limit it to one drink per day.”
B. CORRECT: Clients who have narcolepsy should take
short naps to reduce feelings of drowsiness.
A nurse on a maternity ward is teaching new mothers about the sleep patterns of infants and how to keep them safe during this stage. What comment from a parent alerts the nurse that further teaching is required?
“I can expect my newborn to sleep an average of 16 to 24 hours a day.” “If I see eye movements or groaning during my baby’s sleep I will call the pediatrician.” “I will place my infant on his back to sleep.” “I will not place pillows or blankets in the crib to prevent suffocation.”
b. Eye movements, groaning, grimacing, and moving are normal activities at this age and would not require a call to the pediatrician. Newborns sleep an average of 16 to 24 hours a day. Infants should be placed on their backs for the first year to prevent SIDS. Parents should be cautioned about placing pillows, crib bumpers, quilts, stuffed animals, and so on in the crib as it may pose a suffocation risk.
A nurse observes involuntary muscle jerking in a sleeping patient. What would be the nurse’s next action?
No action is necessary as this is a normal finding during sleep. Call the primary care provider to report possible neurologic deficit. Lower the temperature in the patient’s room. Awaken the patient as this is an indication of night terrors.
a. Involuntary muscle jerking occurs in stage I NREM sleep and is a normal finding. There are no further actions needed for this patient.
A nurse observes a slight increase in a patient’s vital signs while he is sleeping during the night. According to the patient’s stage of sleep, the nurse expects what conditions to be true? Select all that apply.
He is aware of his surroundings at this point. He is in delta sleep at this time. It would be most difficult to awaken him at this time. This is most likely an NREM stage. This stage constitutes around 20% to 25% of total sleep. The muscles are relaxed in this stage
c, e. This scenario describes REM sleep. During REM sleep, it is difficult to arouse a person, and the vital signs increase. REM sleep constitutes about 20% to 25% of sleep. In stage I NREM sleep, the person is somewhat aware of surroundings. Delta sleep is NREM stages III and IV sleep. In stage IV NREM sleep, the muscles are relaxed, whereas small muscle twitching may occur in REM sleep.
A nurse working in a sleep lab observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply.
REM sleep constitutes much of the sleep cycle of a preschool child. By the age of 8 years, most children no longer take naps. Sleep needs usually decrease when physical growth peaks. Many adolescents do not get enough sleep. Total sleep decreases in adults with a decrease in stage IV sleep. Sleep is less sound in older adults and stage IV sleep may be absent.
d, e, f. Many adolescents do not get enough sleep due to the stresses of school, activities, and part-time employment causing restless sleep. Total sleep time decreases during adult years, with a decrease in stage IV sleep. Sleep is less sound in older adults, and stage IV sleep is absent or considerably decreased. REM sleep constitutes much of the sleep cycle of a young infant, and by the age of 5 years, most children no longer nap. Sleep needs usually increase when physical growth peaks.
A nurse is discussing with an older adult patient measures to take to induce sleep. What teaching point might the nurse include?
Drinking a cup of regular tea at night induces sleep. Using alcohol moderately promotes a deep sleep. Having a small bedtime snack high in tryptophan and carbohydrates improves sleep. Exercising right before bedtime can hinder sleep.
c. The nurse would teach the patient that having a small bedtime snack high in tryptophan and carbohydrates improves sleep. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity within a 3-hour interval before normal bedtime can hinder sleep.
A nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? Select all that apply.
A patient who has uncontrolled hypothyroidism. A patient with coronary artery disease. A patient who has GERD. A patient who is HIV positive. A patient who is taking corticosteroids for arthritis. A patient with a urinary tract infection.
a, b, c. A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has GERD may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.
A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep? Select all that apply.
A patient who is taking iron supplements for anemia. A patient with Parkinson’s disease who is taking dopamine. An older adult taking diuretics for congestive heart failure. A patient who is taking antibiotics for an ear infection. A patient who is prescribed antidepressants. A patient who is taking low-dose aspirin prophylactically.
b, c, e. Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems.
A nurse working the night shift in a pediatric unit observes a 10-year-old patient who is snoring and appears to have labored breathing during sleep. Upon reporting the findings to the primary care provider, what nursing action might the nurse expect to perform?
Preparing the family for a diagnosis of insomnia and related treatments. Preparing the family for a diagnosis of narcolepsy and related treatments. Anticipating the scheduling of polysomnography to confirm OSA. No action would be taken, as this is a normal finding for hospitalized children.
c. OSA (pediatric) is defined by the presence of one of these findings: snoring, labored/obstructed breathing, enuresis, or daytime consequences (hyperactivity or other neurobehavioral problems, sleepiness, fatigue). According to the American Academy of Pediatrics children and adolescents with symptoms of OSA, including snoring, should have polysomnography to confirm the diagnosis. Although OSA may cause insomnia, this is not the primary diagnosis in this case. Narcolepsy is a condition characterized by excessive daytime sleepiness and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep. This scenario is not usually a normal finding in hospitalized children during sleep.
A nurse is performing a sleep assessment on a patient being treated for a sleep disorder. During the assessment, the patient falls asleep in the middle of a conversation. The nurse would suspect which disorder?
Circadian rhythm sleep–wake disorder Narcolepsy Enuresis Sleep apnea
b. Narcolepsy is an uncontrollable desire to sleep; the person may fall asleep in the middle of a conversation. Circadian rhythm sleep–wake disorders are characterized by a chronic or recurrent pattern of sleep–wake rhythm disruption primarily caused by an alteration in the internal circadian timing system or misalignment between the internal circadian rhythm and the sleep–wake schedule desired or required; a sleep–wake disturbance (e.g., insomnia or excessive sleepiness); and associated distress or impairment, lasting for a period of at least 3 months (except for jet lag disorder) (Sateia, 2014). Enuresis is urinating during sleep or bedwetting. Sleep apnea is a condition in which breathing ceases for a period of time between snoring.
A nurse is teaching a patient with a sleep disorder how to keep a sleep diary. Which data would the nurse have the patient document? Select all that apply.
Daily mental activities Daily physical activities Morning and evening body temperature Daily measurement of fluid intake and output Presence of anxiety or worries affecting sleep Morning and evening blood pressure readings
a, b, e. A sleep diary includes mental and physical activities performed during the day and the presence of any anxiety or worries the patient may be experiencing that affect sleep. A record of fluid intake and output, body temperature, and blood pressure is not usually kept in a sleep diary.
