Chapter 42: Sleep Review Questions

Question 1

The nurse is gathering a sleep history from a patient who is being evaluated for obstructive sleep apnea. Which common symptoms does the patient most likely report? (Select all that apply.)

1. Headache
2. Early wakening
3. Excessive daytime sleepiness
4. Difficulty falling asleep
5. Snoring

Answer 1

1.
3.
5.

Common symptoms for obstructive sleep apnea include headache, snoring, and excessive daytime sleepiness caused by poor sleep during the night. The other symptoms are not related to obstructive sleep apnea.

Question 2

The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient?

1. Have patient follow hospital routines
2. Avoid awakening patient for nonessential tasks
3. Give prescribed sleeping medications at dinner
4. Turn television on low to late-night programming.

Answer 2

Avoiding awakening patient for nonessential tasks promotes sleep. Cluster activities and allow the patient time to sleep. Do not perform tasks such as laboratory draws and bathing during the night unless absolutely essential. Patients should try to follow home routines related to sleep habits. The other tasks do not promote sleep.

Question 3

Older adults are cautioned about the long-term use of sedatives and hypnotics because these medications can:

1. Cause headaches and nausea.
2. Be expensive and difficult to obtain.
3. Cause severe depression and anxiety.
4. Lead to sleep disruption.

Answer 3

Long-term use of sleeping medications in older adults can lead to sleep disruption. Because of slower metabolism and excretion of sleep medications, the potential for sleep impairment occurs. If sleep medications are needed, the lowest dose possible should be used short term.

Question 4

The nurse is providing health teaching for a patient using herbal compounds such as melatonin for sleep. Which points need to be included? (Select all that apply.)

1. Can cause urinary retention
2. Should not be used indefinitely
3. May cause diarrhea and anxiety
4. May interfere with prescribed medications
5. Can lead to further sleep problems over time
6. Are not regulated by the U.S. Food and Drug Administration (FDA)

Answer 4

2.
4.
6.

Melatonin is a neurohormone produced in the brain that helps control circadian rhythms and promote sleep. Short-term use of melatonin has been found to be safe, with mild side effects of nausea, headache, and dizziness occurring infrequently. Caution patients about the dosage and use of herbal compounds because the FDA does not regulate them. Herbal compounds may create interactions with prescribed medication, and patients need to avoid using these together.

Question 5

The patient reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs during which sleep phase?

1`. REM sleep

2. Stage 1 NREM sleep
3. Stage 4 NREM sleep
4. Transition period from NREM to REM sleep

Answer 5

1. Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate; and some believe they are functionally important to learning, memory processing, and adaptation to stress.

Question 6

The nurse teaches a patient taking a benzodiazepine that this group of medications causes which symptom of a sleep problem?

1. Nocturia
2. Hyperactivity
3. Grogginess and feeling hung over
4. Increased sleep time

Answer 6

3.

Benzodiazepines cause a hangover effect and rebound insomnia. The other sleep problems are not related to benzodiazepines.

Question 7

Which intervention is appropriate to include on a care plan for improving sleep in the older adult?

1. Decrease fluids 2 to 4 hours before sleep
2. Exercise in the evening to increase fatigue
3. Allow the patient to sleep as late as possible
4. Take a nap during the day to make up for lost sleep

Answer 7

1.

Decreasing fluids 2 to 4 hours before sleep reduces the likelihood that the older adult’s sleep will be disrupted during the night by the need to void.

Question 8

Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching?

1. “I won’t put the baby to bed with a bottle.”
2. “For the first few weeks we’re putting the cradle in our room.”
3. “My grandmother told me that babies sleep better on their stomachs.”
4. “I know I’ll have to get up during the night to feed the baby when he wakes up.”

Answer 8

3.

Thinking that babies will sleep better on their stomachs indicates that the mother needs further teaching. She needs to be educated on the “back to bed” concept for infant sleeping. Infants’ beds need to be safe. Parents should place infants on their back to prevent suffocation and decrease the risk of sudden infant death syndrome (SIDS).

Question 9

The nurse is developing a plan of care for a patient experiencing narcolepsy. Which intervention is appropriate to include on the plan?

1. Instruct the patient to increase carbohydrates in the diet
2. Have patient limit fluid intake 2 hours before bedtime
3. Preserve energy by limiting exercise to morning hours
4. Encourage patient to take one or two 20-minute naps during the day

Answer 9

4.

A person with narcolepsy has the problem of falling asleep uncontrollably at inappropriate times. Brief daytime naps no longer than 20 minutes help reduce subjective feelings of sleepiness. Other management methods that help are following a regular exercise program, practicing good sleep habits, avoiding shifts in sleep, strategically timing daytime naps if possible, eating light meals high in protein, practicing deep breathing, chewing gum, and taking vitamins. Patients 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).

Question 10

Which nursing measure best promotes sleep in a school-age child?

1. Encourage evening exercise
2. Offer a glass of hot chocolate before bedtime
3. Make sure that the room is dark and quiet
4. Use quiet activities consistently before bedtime

Answer 10

4.

A bedtime routine (e.g., same hour for bedtime, snack, or quiet activity) used consistently helps young children avoid delaying sleep. Quiet activities such as reading stories, coloring, and allowing children to sit in a parent’s lap while listening to music or a prayer are routines that are often associated with preparing for bed. Parents need to reinforce patterns of preparing for bedtime.

Question 11

Which action by the nursing assistant at bedtime requires the nurse to intervene?

1. Giving the patient a back rub
2. Turning on quiet music
3. Dimming the lights in the patient’s room
4. Giving a patient a cup of coffee

Answer 11

4.

Encourage patients not to drink or ingest caffeine before bedtime. Coffee, tea, cola, and chocolate act as stimulants, causing a person to stay awake or awaken throughout the night. Coffee, tea, colas, and alcohol act as diuretics and cause a person to awaken in the night to void.

Question 12

Which statement made by the patient indicates a need for further teaching on sleep hygiene?

1. “I’ m going to do my exercises before I eat dinner.”
2. “I’ll have a glass of wine at bedtime to relax.”
3. “I set my alarm to get up at the same time every morning.”
4. “I moved my computer to the den to do my work.”

Answer 12

2.

Drinking alcohol before bed in an effort to relax indicates a need for further teaching. Alcohol should be avoided before bed because it speeds onset of sleep, reduces REM sleep, awakens the person during the night, and causes difficulty returning to sleep.

Question 13

Which statement made by an older adult best demonstrates understanding of taking a sleep medication?

1. “I’ll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear.”
2. “Sleep medicines won’t cause any sleep problems once I stop taking them.”
3. “I’ll talk to my health care provider before I use an over the- counter sleep medication.”
4. “I’ll contact my health care provider if I feel extreme sleepy in the mornings.”

Answer 13

3.

Talking to a health care provider before using an over-the-counter sleep medication shows an understanding of the risks of over-the-counter sleep medications. The use of nonprescription sleep medications is not advisable. Over the long term these drugs lead to further sleep disruption, even when they initially seemed to be effective. Caution older adults about using over-the-counter antihistamines because of their long duration of action, which can cause confusion, constipation, urinary retention, and increased risk of falls.

Question 14

The school nurse is teaching health-promoting behaviors that improve sleep to a group of high school students. Which points should be included in the education? (Select all that apply.)

1. Do not study in your bed.
2. Go to sleep each night whenever you feel tired.
3. Turn off your cell phone at bedtime.
4. Avoid drinking coffee or soda before bedtime.
5. Turn on the television to help you fall asleep.

Answer 14

1.
3.
4.

Adolescents need to practice good sleep hygiene practices. Beds should be used for sleeping only. Activities other than sleep should not be done in bed. A person should try to go to bed at the same time each night. Create an environment that is quiet and free of distractions. Turning off cell phones prevents sleep disruptions. Coffee or soda contains caffeine. Caffeine acts as a stimulant, causing a person to stay awake or awaken throughout the night. Coffee, tea, colas, and alcohol act as diuretics and cause a person to awaken in the night to void.

Question 15

The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up?

1. I always feel tired when I wake up in the morning.
2. I go to bed at the same time each night.
3. It takes me about 15 minutes to fall asleep.
4. Sometimes I have to get up during the night to urinate.

Answer 15

1.

This statement indicates that the patient is not experiencing quality sleep and should be followed up with more extensive questions and assessment of the problem. Patients are the best resource for describing sleep problems and how these problems are a change from their usual sleep and waking patterns. A general description of the problem followed by more focused questions usually reveals specific characteristics that are useful in planning therapies. To begin you need to understand the nature of the sleep problem, its signs and symptoms, its onset and duration, its severity, any predisposing factors or causes, and the overall effect on the patient. Ask specific questions related to the sleep problem.