Exam 2: Chapter 17 Flashcards
A client who reported “a problem sleeping” shows an understanding of good sleep hygiene by:
a. doing 10 pushups before bed to encourage a “pleasant tiredness.”
b. seldom eating a bedtime snack.
c. engaging in computer games as a pre-bed activity.
d. limiting the afternoon nap to just 30 minutes.
ANS: D
Limiting daytime napping to 30 minutes or less is a good sleep hygiene practice. Exercise should be completed at least 4 hours before retiring while a bedtime snack is acceptable if the food is light and easily digested. Computer-focused activities are not generally encouraged as a part of a bedtime routine.
When an older adult client is diagnosed with restless leg syndrome (RLS), the nurse is confident that client education on the condition’s contributing factors has been effective when the client states:
a. “A warm bath at night instead of in the morning is my new routine.”
b. “Eating a banana at breakfast assures me the potassium I need.”
c. “I’ve cut way back on my caffeinated coffee, teas, and sodas.”
d. “I elevate my legs on a pillow so as to improve circulation.”
ANS: C
Increased caffeine use can be a contributing factor to RLS. There is no research to confirm that a warm bath prior to sleep or elevating the legs will minimize/prevent RLS. A potassium deficiency has not been identified as a contributing factor to RLS.
A nurse in a long-term care facility notes that an older resident with Alzheimer’s disease awakens frequently at night and is restless and agitated. Which of the following interventions will be most effective to help manage this resident’s sleep problems?
a. Taking the resident outside in the garden for 45 minutes daily
b. Limiting fluid intake for the resident
c. Educating the resident on the association between Alzheimer’s Disease and insomnia
d. Administering a mild sedative hypnotic at bedtime
ANS: A
Behavioral strategies for persons with dementia include daily walks and exposure to light to enhance sleep. Limiting fluid intake may or may not be effective depending on whether or not the resident has nocturia. Educating the resident about the association between AD and insomnia may be feasible depending on the resident’s mental status but will not necessarily ameliorate the problem. Sedative hypnotics are not the first-line treatment for older adults with AD and sleep disturbances.
An older patient asks a nurse, “I really have trouble sleeping and my doctor does not want to prescribe a sleeping pill for me. He says they are not good for older people. I really don’t understand his response. Can you help me?” The best response by the nurse is: a. “Sleeping medications have many adverse effects in older people and only have minimal effects in improving sleep.”
b. “Prescription sleeping medications have many adverse effects in older people. Why don’t you try using an over-the-counter medication?”
c. “Sleeping medications do not provide any improvement in sleep for older people.”
d. “Sleep problems are common in older people. There really is nothing that you can do to help with that.”
ANS: A
Adverse effects of sleep medications, including over-the-counter medications, include problems with daily function, changes in mental status, motor vehicle accidents, daytime drowsiness, and increased risk of falls with only minimum improvement in sleep. Sleep problems are common in older adults; however, there are many nonpharmacologic interventions that can be utilized to improve sleep.
An older adult’s diagnosis of sleep apnea is supported by nursing assessment and history data that include: (Select all that apply.)
a. followed a vegetarian diet for last 28 years.
b. male gender.
c. a smoking history of 1 pack a day for 45 years.
d. 30 pounds over ideal weight.
e. history of Crohn’s disease.
ANS: B, C, D
Rest factors for sleep apnea include being male, a smoking habit, and excess weight. There is no current research to support a connection between a vegetarian diet (possible low protein) or Crohn’s disease to the development of sleep apnea.
An older patient asks a nurse, “It seems like all of my friends and I have difficulty sleeping. Is it common among older people?” The nurse formulates a response based on the knowledge that normal age-related changes in sleep include: (Select all that apply.)
a. total sleep time and sleep efficiency are reduced.
b. rapid eye movement (REM) sleep is shorter, less intense, and more evenly distributed.
c. sleep requirements for older adults are less than that of younger adults.
d. daytime napping is common.
e. sleep tends to be deeper in older adults than in younger adults.
ANS: A, B, D
Normal age-related changes in older adults include a reduced total sleep time and sleep efficiency and shorter, less intense, and more evenly distributed REM sleep. Older adults tend to nap during the daytime. Sleep requirements do not decrease as one ages. Sleep tends to be objectively and subjectively lighter in older adults.
An older adult tells a nurse that he is experiencing difficulty falling asleep, he routinely gets into bed at 8:30 PM and watches his favorite television shows until 11:00 PM, and often lies awake for hours after. Which of the following suggestions are appropriate for the nurse to give to this patient? (Select all that apply.)
a. Go to bed only when sleepy.
b. If unable to sleep within a reasonable time (15-20 minutes), get out of bed and pursue relaxing activities.
c. Engage in moderate exercise to induce fatigue.
d. Do not watch television or work in bed.
e. If unable to sleep, engage in enjoyable activities on the computer.
ANS: A, B, D
Some interventions to improve sleep include going to bed only when sleepy, matching the number of hours in bed to the actual hours of sleep, and reserving the bed for sleep and sex only. Engaging in exercise immediately before sleep will not assist the person in falling asleep, and use of the computer is also discouraged as it can disturb sleep.
An older patient is diagnosed with RLS. Which of the following nonpharmacologic interventions should the nurse include in the plan of care? (Select all that apply.) a. Engage in regular mild to moderate physical activity including stretching activities for the lower extremities.
b. Avoid caffeine, alcohol, and tobacco.
c. Avoid hot baths.
d. Relaxation techniques may be helpful.
e. A mild sleeping medication such as diphenhydramine (Benadryl) might be helpful.
ANS: A, B, D
Nonpharmacologic therapy includes stretching the lower extremities, mild to moderate physical activity, hot baths, massage, acupressure, relaxation techniques, and avoidance of caffeine, alcohol, and tobacco. The use of diphenhydramine (Benadryl) as a sleeping medication for older adults is not appropriate. There is also no evidence that it will decrease RLS.
A long term care facility has selected sleep promotion as its quality improvement project. Which of the following interventions would be appropriate to implement on this unit? (Select all that apply.)
a. Ensuring that all residents receive evening care and are in bed by 8:00 PM b. Taking as many residents as possible outside for 30 minutes daily
c. Instituting quiet time (keep noise down, speak in hushed tones, no overhead paging) between 9:00 PM and 6:00 AM
d. Avoiding waking residents for routine care during the night
e. Limiting caffeine and fluids before bedtime
ANS: B, C, D, E
Strategies to promote sleep for individuals in long term care and hospitals include allowing the resident to stay out of the bed and the room for as long as possible before bed, and not placing him/her in bed too early. Exposing individuals to sunlight for 30 minutes daily in a comfortable outdoor location is also helpful in promoting sleep. Limiting fluids and caffeine before bedtime is also helpful. Changing institutional routines to avoid waking residents for routine care and providing care when residents wake up are also successful strategies to promote sleep.
Which of the following is a true statement about sleep in older adults?
a. The time spent in bed increases, but the time spent asleep decreases.
b. The amount of leg movement during sleep remains steady throughout life.
c. Rapid eye movement (REM) sleep becomes more unevenly distributed with age.
d. The amount of stage III sleep increases steadily throughout life.
A- The time spent in bed increases, but the time spent asleep decreases.
Which of the following is a true statement about sleeping in older adults?
a. Older adults tend to fall asleep quickly but are awakened throughout the night.
b. Sleep disturbances in older adults can be caused by chronic illness.
c. Benzodiazepine agents are the medications of choice for sleep disorders.
d. The times of day that medications are given has no effect on sleep disturbances.
B - Sleep disturbances in older adults can be caused by chronic illness.
An older man has Alzheimer’s disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the man’s duration of sleep?
a. Instruct the wife to increase his daily physical activity.
b. Collaborate with the health care provider to administer a hypnotic medication.
c. Teach the wife how to apply a vest restraint during sleep.
d. Help the wife plan daily periods for napping and activity.
A - Instruct the wife to increase his daily physical activity.
Exercises are prescribed for older adults as therapy to improve which one of the following qualities?
a. Relative intensity
b. Muscle strength
c. Muscle retraining
d. Body sculpting
B - Muscle strength
During the night, an older woman complains to the nurse that she has not slept more than 2 hours since admission to the hospital. Which intervention should the nurse implement to increase the duration of this woman’s sleep?
a. Inquire about her sleep habits used at home.
b. Suggest that she avoid napping during the day.
c. Tell her that sleep is fragmented in older people.
d. Offer a book to her or suggest watching a movie.
A - Inquire about her sleep habits used at home.
What is the difference between rest and sleep?
a. Sleep occurs with rest.
b. Rest is an extension of sleep.
c. Rest occurs only in brief periods.
d. Sleep is restorative and recuperative.
D - Sleep is restorative and recuperative.
