Sleep Flashcards
A client is admitted for a sleep disorder. The nurse knows that the reticular activating system (RAS) is involved in the sleep/ wake cycle. In the accompanying illustration, which letter indicates the location of the RAS?
1. A
2. B
3. C
4. D
Answer: 2. Rationale: This is the brainstem where the reticular formation (and RAS) is located and which integrates sensory information from the peripheral nervous system and relays the information to the cerebral cortex. An intact cerebral cortex and reticular formation are necessary for the regulation of sleep and waking states. Cognitive Level: Remembering. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 45-1.
A client has a history of sleep apnea. Which is the most appropriate question for the nurse to ask?
1. Do you have a history of cardiac irregularities?
2. Do you have a history of any kind of nasal obstruction?
3. Have you had chest pain with or without activity?
4. Do you have difficulty with daytime sleepiness?
Answer: 4. Rationale: Most clients with sleep apnea report excessive daytime sleepiness. If they don’t volunteer this, clients should be asked if they fall asleep or struggle to stay awake at work. Although cardiac arrhythmias may occur, they are usually only detectable during a sleep study, and thus the client would not be aware of them (option 1). Nasal obstruction is rarely the cause of sleep apnea or a complaint of clients with sleep apnea (option 2). There are many causes of chest pain, and this is unlikely to be something reported by clients with sleep apnea unless they have underlying cardiac disease (option 3). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 45-6.
Because of significant concerns about financial problems, a middle-aged client complains of difficulty sleeping. Which outcome would be the most appropriate for the nursing care plan? “By day 5, the client will:
1. Sleep 8 to 10 hours per day.”
2. Report falling asleep within 20 to 30 minutes.”
3. Have a plan to pay all the bills.”
4. Decrease worrying about financial problems and will keep busy until bedtime.”
Answer: 2. Rationale: Falling asleep within 20 to 30 minutes is normal for adults and would represent substantial improvement in the client’s difficulties. Most adults do not need to sleep 8 to 10 hours per day (option 1). Although it would be ideal to remove the source of the client’s stress, he is unlikely to have a plan to pay all his bills within 5 days (option 3). Distraction or keeping busy until bedtime will not prevent the client from worrying about his bills at bedtime (option 4). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Planning. Learning Outcome: 45-7.
A client reports to the nurse that she has been taking barbiturate sleeping pills every night for several months and now wishes to stop taking them. Which statement is the most appropriate advice for the nurse to provide the client?
1. Take the last pill on a Friday night so disrupted sleep can be compensated on the weekend.
2. Continue to take the pills since sleeping without them after such a long time will be difficult and perhaps impossible.
3. Discontinue taking the pills.
4. Continue taking the pills and discuss tapering the dose with the primary care provider.
- Answer: 4. Rationale: Suddenly stopping barbiturate sleeping pills can precipitate a dangerous withdrawal. Doses should be tapered gradually and the tapering process supervised by the client’s primary care provider. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 45-4.
During a well-child visit, a mother tells the nurse that her 4-yearold daughter typically goes to bed at 10:30 pm and awakens each morning at 7 am. She does not take a nap in the afternoon. Which is the best response by the nurse?
1. Encourage the mother to consider putting her daughter to bed between 8 and 9 pm.
2. Reassure the mother that it is normal for 4-year-olds to resist napping, but encourage her to insist that she rest quietly each afternoon. 3. Recommend that her daughter be allowed to sleep later in the morning. 4. Reassure her that her daughter’s sleep pattern is normal and that she has outgrown her need for an afternoon nap.
- Answer: 1. Rationale: Preschool children require 10 to 12 hours of sleep per night. Young children often rise early, so it is more appropriate to put the child to bed earlier in the evening. Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 45-3.
A college student was referred to the campus health service because of difficulty staying awake in class. What should be included in the nurse’s assessment? Select all that apply.
1. Amount of sleep he usually obtains during the week and on weekends
2. How much alcohol he usually consumes
3. Onset and duration of symptoms
4. Whether or not his classes are boring
5. What medications, including herbal remedies, he is taking
- Answer: 1, 3, and 5. Rationale: It is important to find out if he is obtaining sufficient sleep. If he gets more sleep on weekends than weekdays, insufficient sleep may be the cause of his difficulties staying awake in class. It is important to determine if his symptoms are chronic (e.g., longer than 3 months) or if they are of recent onset. Some prescribed and over-the-counter medications and herbal remedies can cause sleep disturbances. Although alcohol abuse or binge drinking can cause health problems, neither is likely to cause excessive daytime sleepiness (option 2). Unless the person is sleep deprived, boring classes will not induce sleep (option 4). Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Assessment. Learning Outcome: 45-6.
During a yearly physical, a 52-year-old male client mentions that his wife frequently complains about his snoring. During the physical exam, the nurse notes that his neck size is 18 inches, his soft palate and uvula are reddened and swollen, and he is overweight. What is the most appropriate nursing intervention for the nurse to recommend to this client?
1. Recommend that he and his wife sleep in separate bedrooms so that his snoring does not disturb his wife. 2. Refer him to a dietitian for a weight loss program.
3. Caution him not to drink or take sleeping pills since they may make his snoring worse.
4. Refer him to a sleep disorders center for evaluation and treatment of his symptoms.
- Answer: 4. Rationale: The client’s symptoms, combined with his weight, suggest that he has obstructive sleep apnea and should be referred to a sleep disorders specialist for further evaluation. It would not be wrong to refer him to a dietitian for weight loss counseling (option 2), but being evaluated by a sleep disorders specialist is more critical. Drinking alcohol or taking sleeping pills is not advised in clients with sleep apnea because they disrupt the client’s sleep patterns (option 3). Cognitive Level: Analyzing. Client Needs: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 45-5.
A new nursing graduate’s first job requires 12-hour night shifts. Which strategy will make it easier for the graduate to sleep during the day and remain awake at night?
1. Wear dark wrap-around sunglasses when driving home in the morning, and sleep in a darkened bedroom.
2. Exercise on the way home to avoid having to stand around waiting for equipment at the gym.
3. Drink several cups of strong coffee or 16 oz of caffeinated soda when beginning the shift.
4. Try to stay in a brightly lit area when working at night.
- Answer: 1. Rationale: Reducing exposure to bright light in the morning, when driving home, and when going to sleep will make it easier to fall asleep after work. Exercising before going to bed will increase arousal (option 2). Caffeine consumed at the beginning of a 12-hour shift will not assist the nurse in remaining awake during the latter part of the shift (option 3). Although working in a brightly lit area will reduce drowsiness, this strategy is rarely available to nurses working the night shift; lights are often dimmed in hospital corridors and client rooms (option 4). Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 45-7.
The nurse is answering questions after a presentation on sleep at a local senior citizens center. A woman in her late 70s asks for an opinion about the advisability of allowing her husband to nap for 15 to 20 minutes each afternoon. Which is the nurse’s best response?
1. “Taking an afternoon nap will interfere with his being able to sleep at night. If he’s tired in the afternoon, see if you can interest him in some type of stimulating activity to keep him awake.”
2. “He shouldn’t need to take an afternoon nap if he’s getting enough sleep at night.”
3. “Unless your husband has trouble falling asleep at night, a brief afternoon nap is fine.”
4. “Encourage him to consume coffee or some other caffeinated beverage at lunch to prevent drowsiness in the afternoon.”
- Answer: 3. Rationale: Napping frequently reappears in older adults. Unless the person has difficulty falling asleep at night, there is no reason an individual should not be allowed to take a 15- to 20-minute nap in the early afternoon. Cognitive Level: Analyzing. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 45-3.
During admission to a hospital unit, the client tells the nurse that her sleep tends to be very light and that it is difficult for her to get back to sleep if she’s awakened at night. Which interventions should the nurse implement? Select all that apply. 1. Remind colleagues to keep their conversation to a minimum at night.
2. Encourage the client’s family members to bring in a radio to play soft music at night.
3. Deliver necessary medications and procedures at 1.5- or 3-hour intervals between 11 pm and 6 am.
4. Encourage the client to ask family members to bring in a fan to provide white noise.
5. Increase the temperature in the room.
- Answer: 1, 3, and 4. Rationale: Reducing environmental noise, as well as the number of times she is disturbed for medications and vital signs, will reduce the likelihood that she will awaken during the night. Delivering necessary care at 1.5- or 3-hour intervals is consistent with multiples of the 90-minute sleep cycle. Since it is unlikely that all of the noise in the environment can be eliminated, using a fan to generate a steady background noise may help mask sounds of people talking, carts being moved through the halls, and other noise. Music is not usually recommended because it can be interesting to listen to, thus encouraging wakefulness (option 2). The room temperature needs to be satisfactory for the client. A room that is too warm is not usually conducive for sleep (option 5). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 45-8.
