sleep

Question 1

sleep hygiene

Answer 1

sleep schedule
exercise
diet
sleep environment
bedtime routine

Question 2

promote sleep hygiene inpatient setting

Answer 2

• routine - allow 90-120 mins uninterrupted sleep
• noise
• evening care

Question 3

nonpharmacologic interventions

Answer 3

• insomnia - cognitive therapy
• hypersomnia- correct underlying med cond
• narcolepsy- exercise, reg sleep routines, light meals protein/vitamins
• obstructive sleep apnea- sleep hygiene and weight-loss, CPAP
• restless leg syndrome- decrease caffeine and alcohol
• sleep terrors- schedule and sleep hygiene, hypnosis, relax and cog bx therapy

Question 4

Which pharmacologic interventions would the nurse suggest for a patient with chronic insomnia who prefers to use supplements over medications?

Answer 4

melatonin

valerian

Question 5

Which statement made by a patient after education regarding the safe administration of common sleep medications indicates a need for further teaching?

Answer 5

“Maybe I should take a higher dose of antidepressants since it is my first time taking them for my sleep problems.”

This statement shows a need for further teaching. Antidepressants used for sleep assistance are prescribed at lower, not higher, dosages for patients who are not clinically depressed and are taking them solely for sleep assistance.

Question 6

recommended time sleep

Answer 6

7 hrs

Question 7

sleep structures

Answer 7

• basal forebrain- releases adenosine, which supports the sleep drive. Caffeine blocks the action of adenosine.
• pineal gland- secretes the hormone melatonin. This hormone helps the body regulate a sleep cycle that correlates with day and night cycles.
• thalamus- relays sensory information to the cerebral cortex for conversion from short-term to long-term memory. This occurs during REM sleep; otherwise, the thalamus is quiet. The thalamus is a paired gray matter structure.
• hypothalamus- receives information from the eyes regarding light exposure. This information helps determine a sleep schedule based on day or night. The hypothalamus secretes hypocretins, which promote both wakefulness and rapid eye movement (REM) sleep.

amygdala- processing emotions. It is most active during REM sleep. The amygdala is a paired structure.

brain stem- communicates transitions between sleep and wake times with the hypothalamus. During sleep, both structures produce chemicals that reduce arousal centers, and they also send signals to relax muscles. This is in effort to keep the body still and asleep.

Question 8

neurotransmitters and hormones sleep

Answer 8

• Acetylcholine (ACh) receptors in the pons and basal forebrain are important in the initiation of REM sleep.
• Norepinephrine (NE) is an important neurotransmitter and hormone involved in the sleep-wake cycle. In high levels, it can decrease REM sleep.
• Serotonin is similar to NE in its effect on arousal and inhibiting REM sleep.
  Gamma aminobutyric acid (GABA) is released by the hypothalamus in an effort to induce sleep.
• Histamine acts as a neurotransmitter in the central nervous system to promote wakefulness.
• Adrenaline, also known as epinephrine, is a hormone released in response to stress that increases alertness.
• Cortisol is a stress hormone that helps maintain homeostasis.
• Melatonin is secreted by the pineal gland and regulated by the hypothalamus based on the amount of light in the environment.
• Hypocretins are produced by the hypothalamus and keep the brain active during wakefulness.
• Glutamate is the main excitatory neurotransmitter and is the precursor to GABA.
• Dopamine regulates motor function and can downregulate melatonin.
• Growth hormone–releasing hormone (GHRH) causes the release of growth hormone for the purpose of repairing damaged tissues.
• Corticotropin-releasing hormone (CRH) promotes wakefulness and inhibits REM sleep.
• Adenosine is a neurotransmitter that promotes sleep.

Question 9

physiologic and psychologic effects sleep

Answer 9

add card

Question 10

sleep cycle (90 min intervals)

Answer 10

2 cycles: 3 stages nonrapid eye movement (NREM) and rapid eye movement (REM)

Question 11

nrem

Answer 11

nrem 1:

• Lightest level of sleep, between sleep and wakefulness
• Vital signs and metabolism begin to decrease/slow down
• Easy arousal by external stimuli, such as noise
• Feeling of drowsiness
• Lasts a few minutes
• May occur during the day as “resting my eyes”

nrem 2:

• Relaxation increases
• Sleep becomes deeper
• Snoring may occur
• Relatively easy arousal
• Physiologic functions continue to slow
• Accompanied by occasional small muscle jerks
• Lasts 10–20 minutes

nrem 3:

• Deepest stage of sleep, called slow-wave or delta wave sleep for the type of brain waves seen during this type of sleep
• More difficult arousal and rare movement
• Muscles relaxed
• Vital signs decrease but regular rhythms/patterns maintained
• Restorative processes (such as the release of growth hormone) occur
• Sleepwalking (somnambulism) and nocturnal enuresis may occur
• Strong stimuli needed for arousal
• Amount of time spent in slow-wave sleep depends on how long since a person slept
• Lasts approximately 30–60 minutes

Question 12

rem

Answer 12

Occurrence of vivid, colorful dreaming (less vivid dreaming may occur in other stages)
Starts approximately 90 minutes after sleep is initiated
Autonomous response causes rapid eye movements, fluctuating heart rate and respirations, and increased blood pressure
Muscle tone decreased
Gastric secretions increased
Very difficult arousal
Duration of REM sleep increases with each sleep cycle and averages 20 minutes

Question 13

dreams

Answer 13

Dreams function to process memories, adapt to stress, and sort out immediate concerns.

• REM dreams are often elaborate, vivid, and emotional.
• NREM dreams, when they occur, are more conceptual and less emotional.
• Research indicates that REM sleep is not vital for human survival, but NREM sleep is essential.
• Monoamine oxidase (MAO) inhibitors may cause a person to have very little REM sleep, but these patients show no adverse effects from REM deprivation.

Question 14

factors affect sleep

Answer 14

relationships
lifestyles
diet and exercise
smoking
alcohol
stimulants and other meds
envir factos

Question 15

lifespan sleep patterns

Answer 15

add card

Question 16

circadian rhythm

Answer 16

card

Question 17

sleep structures pic

Answer 17

structures

Question 18

sleep aids meds

Answer 18

sleep aids

Question 19

physiologic and psychological effects

Answer 19

effects

Question 20

A female patient with tremors and circadian rhythm disorder complains that she is having difficulty sleeping and is often awakened. She frequently works nights during shift rotation. Which questions by the nurse are appropriate?

Answer 20

“Have you considered switching to days permanently?”
–This question is appropriate, as constant shift changes and working at night cause circadian rhythm disorders. Finding a day job may alleviate the patient’s sleep disorder because the patient’s circadian clock is set by the light-dark cycle over a 24-hour period.

“Are you taking any medications that may be causing you to have trouble sleeping?”
—This question is appropriate, as certain medications may cause circadian rhythm disorders.

“How do you feel about a care plan to reduce awakenings?”
–This question is appropriate; care activities should be planned to reduce the number of times the patient is awakened.

“Have you been tested for Parkinson disease?”
—This is an appropriate question, as tremors are a symptom of Parkinson disease. People with Parkinson disease have blunted circadian rhythms.

Question 21

Which patient is most likely in the rapid eye movement (REM) sleep stage?

Answer 21

Adolescent who awakens from a night terror

A night terror would most likely occur during the REM stage when dreams are very vivid.

Question 22

Which structures of the central nervous system are affected by a light or dark environment?

Answer 22

Hypothalamus
The hypothalamus receives information from the eyes regarding light exposure. This information helps determine a sleep schedule based on day or night.

Pineal gland
The pineal gland secretes the hormone melatonin. This hormone helps the body regulate a sleep cycle that correlates to day and night. Melatonin production increases with the onset of darkness.

Brain stem
The brain stem communicates transitions between sleep and wake times with the hypothalamus, so it would be affected by light in the environment.

Question 23

Sleep deprivation can lead to an increased risk for which diseases?

Answer 23

Depression
Lack of sleep has been connected with an increased risk for the development of depression.

Obesity
Lack of sleep has been connected with an increased risk for the development of obesity.

Cardiovascular disease
Lack of sleep has been connected with an increased risk for the development of cardiovascular disease.

Diabetes
Lack of sleep has been connected with an increased risk for the development of diabetes.

Question 24

A patient with a fluctuating heart rate is in which stage of sleep?

Answer 24

Rapid eye movement (REM)

An adult with a fluctuating heart rate is in the REM stage of sleep. Heart rates become faster and fluctuate more during REM sleep than they do during NREM deep sleep.

Question 25

A patient displaying small muscle jerks is in which stage of sleep?

Answer 25

NREM 2
In the NREM 2 stage, a transition from wakefulness to sleep occurs; therefore a person may experience small muscle spasms or jerks.

Question 26

A nurse is teaching a patient about the effects of medication on sleep. Which statement indicates a need for further teaching?

Answer 26

“Barbiturates increase REM sleep.”

This statement shows a need for further teaching. Barbiturates decrease, rather than increase, REM sleep

Question 27

Which nighttime snack is appropriate for a patient with a history of insomnia?

Answer 27

graham crackers

Question 28

Which patients would most likely suffer from sleep disturbances?

Answer 28

Young adult female with marital problems
Marital problems contribute to sleep disturbances.

Young adult male who lives alone
A person who lives alone will have fewer disturbances; therefore this patient is not likely to suffer from a sleep condition.

Child who is spending the summer away from home at camp
Children away from home can suffer homesickness and have trouble sleeping.

Adult female caring for a family member with a chronic illness
Caregivers may be sleep-deprived.

Question 29

sleep diseases

Answer 29

associations

Question 30

1. A nurse is developing a plan for a patient who was diagnosed with narcolepsy. Which interventions should the nurse include on the plan? (Select all that apply.)

Answer 30

1. Take brief, 20-minute naps no more than twice a day.
2. Establish a regular exercise program.
3. Teach the patient about the side effects of modafinil.

Question 31

2. Which statements from a patient indicate an understanding of behaviors that will promote sleep? (Select all that apply.)

Answer 31

1. “I will not watch television in bed.”
2. “I will not drink caffeine later in the day.”
3. “I will start to exercise regularly during the day.”

Question 32

3. A 72-year-old patient asks the nurse about using an over-the-counter antihistamine as a sleeping pill to help her get to sleep. What is the nurse’s best response?

Answer 32

2. “Antihistamines should not be used because they can cause confusion and increase your risk of falls.”

Question 33

4. Which nursing intervention(s) best promote(s) effective sleep in an older adult? (Select all that apply.)

Answer 33

1. Limit fluids 2 to 4 hours before sleep.
2. Ensure that the room temperature is comfortably cool.
3. Provide warm covers.

Question 34

5. Which statement made by the patient indicates an understanding of sleep-hygiene practices?

Answer 34

1. “I usually drink a cup of warm milk in the evening to help me sleep.”

Question 35

6. Which nursing interventions are appropriate to include in a plan of care to promote sleep for patients who are hospitalized? (Select all that apply.)

Answer 35

2. Plan vital signs to be taken before the patients are asleep.
3. Have patients follow at-home bedtime schedule.
4. Close the door to patients’ rooms at bedtime.

Question 36

7. The nurse is contacting the health care provider about a patient’s sleep problem. Place the steps of the SBAR (situation, background, assessment, recommendation) in the correct order.

Answer 36

2. “Dr. Smithson, this is Pam, the nurse caring for Mrs. Dodd. I’m calling because Mrs. Dodd is having difficulty sleeping.”
3. Mrs. Dodd, 46 years old, was admitted 3 days ago following a motor vehicle accident. She is in balanced skeletal traction for a fractured left femur. She is having difficulty falling asleep.
4. Mrs. Dodd is taking her pain medication every 4 hours as ordered and rates her pain as 2 out of 10. Last night she was still awake at 0100. She states that she is comfortable but just can’t fall asleep. Her vital signs are BP 124/76, P 78, R 12 and T 37.1°C (98.8°F).
5. “I’m calling to ask if you would order a hypnotic such as zolpidem to use on a prn basis.”

Question 37

8. Which statement made by a mother being discharged to home with her newborn infant indicates that she understands the discharge teaching related to best sleep practices?

Answer 37

2. “We’ll place the baby on her back to sleep.”

Question 38

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

Answer 38

3. “It takes me about 45 to 60 minutes to fall asleep.”

Question 39

10. Which sleep-hygiene actions at bedtime can the nurse delegate to assistive personnel? (Select all that apply.)

Answer 39

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