Sleep and Rest Chapter 33

Question 1

Sleep Versus Rest

Answer 1

Sleep
		 Cyclical states/altered consciousness
		 Decreased motor activity/perception
		 Selective response to external stimuli
Rest
		 Mild to no activity
		 Relaxation; stress-free
		 Leads to feeling refreshed

Question 2

Sleep

Answer 2

Cyclical states/altered consciousness
Decreased motor activity/perception
Selective response to external stimuli

Question 3

Rest

Answer 3

Mild to no activity
Relaxation; stress-free
Leads to feeling refreshed

Question 4

Benefits of Sleep

Answer 4

	 Increases mental performance
	•	Improves learning
	•	Helps the storage of long-term memory
		 Restores energy
		 Improves ability to cope
		 Strengthens the immune system

Question 5

Sleep Requirements

Answer 5

 Varies among individuals and age group.
 Infants
 16-20 hours/day (Minimum 14 hours/day)
 Older adults
 Spend less time sleeping, but need more rest

Question 6

Circadian rhythm

Answer 6

Internal clock
24-hour day-night sleep/wake pattern/cycle
Affects overall level of functioning

Question 7

Reticular activating system

Answer 7

RAS

Question 8

Stages of sleep

NREM

Answer 8

NREM – Non rapid eye movement
Stage I
Stage II
Stage III
Stage IV

Question 9

REM

Answer 9

Rapid eye movement

Question 10

Light sleep and slowing brain and body processes are associated with which stage of NREM sleep?

a. I
b. II
c. III
d. IV

Answer 10

a. I

Question 11

Factors Affecting Sleep

Answer 11

	Age
		Lifestyle factors
	•	Physical activity
	•	Food and alcohol
	•	Medications
	•	Caffeine
	•	Sleep habits
		An illness
		Environmental factors
	•	Temperature and  humidity
	•	Noise and light
	•	Noxious odor
	•	Comfort of bedding

Question 12

Sleep Disorders

Answer 12

 Classified by signs and symptoms
 Most common are in two groups
 Dyssomnias
 Characterized by insomnia or excessive sleepiness
 Parasomnias
 Waking behavior that appear during sleep

Question 13

Dyssomnias

Answer 13

Characterized by insomnia or excessive sleepiness

Question 14

Parasomnias

Answer 14

Waking behavior that appear during sleep

Sleepwalking/talking
Bruxism
Night terrors
REM sleep behavior disturbances
Nocturnal Enuresis

Question 15

Insomnia

Answer 15

Inability to fall asleep, or remain asleep or go back to sleep (Most common disorder)

Question 16

Circadian disorders

Answer 16

Abnormality in sleep/wake times

(e.g., jet lag, working night shift, rotating shifts)

Question 17

Question
The nurse is caring for a hospitalized client who normally works the night shift at his job. The client states, “I don’t know what is wrong with me. I have been napping all day and can’t seem to think clearly.” The nurse’s best response is

“You are sleep deprived, but that will resolve in a few days.”
“You are experiencing hypersomnia, so it will be important for you to walk in the hall more often.”
“There has been a disruption in your circadian rhythm. What can I do to help you sleep better at night?”
“I will notify the doctor and ask him to prescribe a hypnotic medication to help you sleep.”

Answer 17

“There has been a disruption in your circadian rhythm. What can I do to help you sleep better at night?”

Question 18

Sleep Apnea

Answer 18

Periodic breathing cessation for at least 10 seconds during sleep

Question 19

Narcolepsy

Answer 19

Chronic disorder caused by the brain’s ineffectiveness in regulating sleep-wake cycles normally
Uncontrollable episodes of sleep during the day

Question 20

Restless Leg Syndrome

Answer 20

Uncontrollable movement of legs during sleep/rest

Question 21

Sleep Deprivation

Answer 21

Result of prolonged sleep disturbances

Question 22

Hypersomnia

Answer 22

Excessive sleeping (especially during daytime)
Sleep-related or disease-related
Can be related to depression

Question 23

Secondary Sleep Disorders

Answer 23

	Occur when a disease causes changes in sleep stages or quality/quantity of sleep.  
		Depression
		Hyperthyroidism
		Hypothyroidism
		Pain
		Sleep Apnea

Question 24

Disorders provoked by Sleep

Answer 24

	Signs and symptoms of disease appear or become worse during sleep
		Coronary Artery Disease
		Asthma
		COPD
		Diabetes
		Gastric/Intestinal ulcers

Question 25

Question

For which sleep disorder would the nurse most likely need to include safety measures in the client’s plan of care?

snoring
enuresis
narcolepsy
hypersomnia

Answer 25

narcolepsy

Question 26

Assessment

Answer 26

 Ask about sleep habits
 Sleep history
 Sleep diary
 Sleep study

Question 27

Promoting Sleep: Nursing Interventions

Answer 27

 Offer foods that help promote sleep
 Maintain safety of the client
 Teach about sleep hygiene
 Administer/complete client teaching about
sleep-inducing medications
 Cluster/schedule nursing 
care to avoid interrupting sleep
 Create a comfortable/restful 
environment
 Promote comfort/relaxation
 Support bedtime rituals/routines

Question 28

Compare and contrast insomnia and hypersomnia. How are they different? How are they alike?

Answer 28

Insomnia
Inability to fall asleep, or remain asleep or go back to sleep (Most common disorder)

Hypersomnia
Excessive sleeping (especially during daytime)
Sleep-related or disease-related
Can be related to depression

Question 29

Compare and contrast sleep and rest. How are they different? Alike?

Answer 29

Answer:
Sleep is a state of rest accompanied by altered consciousness and relative inactivity. Sleep is characterized by reduced skeletal muscle activity. Blood pressure and pulse rate decrease, and skin vessels dilate. The metabolism falls by 20% to 30%, so energy is conserved. At rest, the body is disturbed by all exterior noises, whereas in sleep, it is screened from them by altered consciousness. Rest is a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed. Although necessary and beneficial, rest without sleep is inadequate. Sleep restores the normal levels of normal brain activity and “balance” in the central nervous system; rest alone cannot do this. Many organs that function during rest suspend their activities in sleep.

Question 30

Why is promoting sleep an important nursing intervention?

Answer 30

Answer:
Sleep is an important nursing intervention because it enhances wellness and speeds recovery from illness. Sleep and illness are interrelated. Prolonged lack of sleep can result in illness, and illness interferes with sleep. Sleep and rest are both essential to life and for keeping the body, mind, and spirit in excellent physiological shape. Rest and sleep restore energy, improve learning, and strengthen the immune system. Without the proper amount of sleep, the body ceases to function efficiently.

Question 31

List the five stages of sleep.

Answer 31

Answer:
Sleep includes the following stages of NREM and REM sleep:
• NREM (non–rapid eye movement, also called slow-wave sleep) is stages I, II, III, and IV
• REM (rapid eye movement) is stage V

Question 32

Describe the progression of a typical sleep cycle for a young adult.

Answer 32

Answer:
A sleeping young adult progresses back and forth through lighter and deeper stages of sleep, about six times during an 8-hour sleep period. After falling asleep in stage I, a person progresses through successively deeper stages of NREM sleep from stage I to stage IV. Then the sequence reverses, and the person progresses through successively lighter stages to stage II, but instead of proceeding to stage I, the person enters the REM stage. After REM sleep, the person cycles back through NREM stages II, III, and IV and back again from IV to II to REM. If awakened at any time, however, the sleeper starts the cycle again at stage I.

Question 33

Describe the physiological activity characteristic of each stage of sleep.

Answer 33

Answer:
The following physiological activity is characteristic of each stage of sleep:
• Stage I is a light sleep in which the sleeper can easily be awakened. The person is relaxed; breathing is regular and deep; the eyelids slowly open and close, and the eyes roll from side to side. The person feels groggy, the eyelids feel heavy, and suddenly without notice the person falls asleep. Within 5 to 10 minutes, sleep progresses to stage II. Stage I accounts for about 5% of our total sleep during the night. Brain activity consists of alpha waves with occasional low-frequency theta waves.
• Stage II is also light sleep. Brain activity slows. The eyes are still, and body processes begin to slow down (e.g., temperature, pulse, and blood pressure decrease). The sleeper is easily aroused. Stage II, which usually lasts for 10 to 15 minutes, helps us disconnect from the outside world.
• Stage III is a deeper sleep. Slow-wave activity begins to occur in this stage. The person is difficult to arouse, slow eye movement stops, skeletal muscles are very relaxed, and snoring may occur. This stage may last 5 to 15 minutes. A young adult spends about 8% of sleep time in stage III.
• Stage IV is the deepest sleep. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. The heart rate is about 25% lower than when awake. It is difficult to awaken someone in stage IV slow-wave sleep, and if awakened, the person may appear confused and react slowly. Some dreaming may occur in stage IV, but dreams are less vivid than those that occur in REM sleep. A young adult spends about 11% of sleep time in stage IV. Stage IV sleep appears to be especially important for restorative processes such as protein synthesis, cell division, and tissue renewal. During this stage, the body releases human growth hormone, which is essential for repair and renewal of brain and other cells.
• Stage V, REM sleep, is named because of its characteristic rapid eye movements, which can often be detected even though the sleeper’s eyelids are closed. Metabolism, temperature, pulse, heart rate, and blood pressure increase, but muscle activity and deep tendon reflexes are depressed. Because most people awakened during REM sleep report that they have been dreaming, this loss of muscle tone is thought to be a protective response, to prevent the person from acting out the dreams. People are more difficult to arouse during REM sleep than during any other stage of sleep; however, more spontaneous awakenings occur during this stage than any other. When sleepers are successfully awakened during this stage, they are usually alert and can react normally, whereas those awakened during stages III or IV of slow-wave (NREM) sleep take a few moments to wake up and react

Question 34

What is the stage that must be “made up” if not enough time is spent in it?

Answer 34

Answer:

REM (stage V) sleep must be made up.

Question 35

For each of the following patients, propose at least two factors that might affect sleep:
A newborn in the NICU

Answer 35

Answer:
The following factors may affect the sleep of newborns in the NICU:
• Lights and noise and other unfamiliar stimuli
• Pain and other noxious stimuli, such as needlestick and suctioning.
• Physical illness symptoms (e.g., dyspnea, fever)
• Handling by caregiver or parent

Question 36

For each of the following patients, propose at least two factors that might affect sleep:A preschooler being treated for pneumonia

Answer 36

Answer:
The following factors may affect the sleep of a preschooler being treated for pneumonia:
• Difficulty breathing, need to be awakened for treatments, experiencing new environmental stimuli, and so on
• Usual factors associated with toddlers and preschoolers (e.g., frightened to go to bed because of imagined monsters or intruders or may waken frequently at night because of bad dreams, the need to use the bathroom, illness, heavy snoring, tossing off the bedclothes, or falling out of bed)

Question 37

For each of the following patients, propose at least two factors that might affect sleep: An adolescent with cancer

Answer 37

Answer:
The following factors may affect the sleep of an adolescent with cancer:
• Anxiety
• Various medications that might interfere with sleep (e.g., opioids for pain)
• Lifestyle factors commonly associated with adolescence (e.g., keeping up with the academic demands and other pressures at school; staying up late to watch television, text friends, surf the Internet, or study; dating; using alcohol or drugs; consuming large amounts of caffeinated colas and other beverages) can interfere with the quality or amount of sleep.

Question 38

For each of the following patients, propose at least two factors that might affect sleep :A breastfeeding mother of a newborn

Answer 38

Answer:
A breastfeeding mother typically suffers some degree of sleep deprivation because of nighttime feedings. Breastfed infants usually will feed every two to four hours in the first months of life before taking solid foods.

Question 39

For each of the following patients, propose at least two factors that might affect sleep: An older man who has fractured his hip

Answer 39

Answer:
The following factors may affect the sleep of an older man who has a fractured hip:
• Nocturia and discomfort or pain
• Medications, such as opioids for pain
• Unfamiliar environment

Question 40

Identify at least three types of environmental stimuli that can disturb sleep.

Answer 40

Answer:
Answers may include any three of the following environmental stimuli that can disturb sleep:
• Room temperature (too cool, too warm)
• Bedclothes (too heavy, too light)
• Noise
• Not having one’s usual environment (e.g., no music)
• Amount of light
• Sleeping alone (or with someone)

Question 41

What is the most common dyssomnia?

Answer 41

Answer:

Insomnia is the most common dyssomnia.

Question 42

What factors in the hospital environment may contribute to sleep deprivation?

Answer 42

Answer:
Illness and hospital care are common causes of sleep deprivation, especially for patients in critical care units (CCUs). In the CCU, lights, equipment noise, and frequent interruptions for treatments and assessments, in addition to the client’s fragile physical condition, combine to create sleep deprivation.

Question 43

What are the clinical signs of sleep deprivation in patients?

Answer 43

Answer:
The following are clinical signs of sleep deprivation:
•    Daytime drowsiness
•    Restlessness
•    Perceptual disorders
•    Impaired cognitive functioning
•    Irritability
•    Slowed reaction time
•    Somatic (body) complaints
•    General feeling of malaise
•    Changes in IgG, IgM, IgAm
If sleep deprivation is severe and prolonged, delusions, paranoia, and other psychotic behaviors may occur.

Question 44

Why are sleeping pills not recommended for chronic insomnia?

Answer 44

Answer:
Chronic use of sleeping medications is not recommended for the following reasons:
• They are habit-forming.
• They become less effective with long-term use.
• They can have serious side-effects.
However, sedative–hypnotic treatment is justified in short-term insomnia to avoid the known consequences of insomnia on mood and performance. Short-term, aggressive treatment may prevent the development of chronic insomnia.

Question 45

Why is snoring significant?

Answer 45

Answer:

Snoring is a physical sign of obstructive sleep apnea. Also, snoring can significantly reduce the quality of sleep.

Question 46

List and define at least three parasomnias.

Answer 46

Answer:
Answers may include any three of the following parasomnias:
• Sleepwalking (somnambulism) occurs during stages III and IV of NREM sleep, usually 1 to 2 hours after falling asleep. The person who is sleeping leaves the bed and walks about with little awareness of surroundings. He may perform what appear to be conscious motor activities (e.g., opening doors, walking) but does not wake up. The person is not aware of sleepwalking and has no memory of the event on awakening. The event may last 3 to 4 minutes or longer. Children sleepwalk more often than adults. If the child does not outgrow the condition or serious safety risks exist, medications may be given to suppress stage IV sleep. Stress, fatigue, and some medications can cause sleepwalking.
• Sleeptalking occurs during NREM sleep, just before the REM stage. It does not usually interfere with the person’s rest. Speech is often nonsensical and garbled..
• Bruxism, grinding and clenching of the teeth, usually occurs during stage II NREM sleep. It can eventually erode tooth enamel, loosen the teeth, and lead to misalignment.
• Night terrors are sudden arousals in which the person (usually a child) is physically active and expresses fear or strong emotion. The child is not awake, though, and is difficult to awaken. Once awakened, the child has no memory of the event. Unlike nightmares or highly disturbing state of confusion, which occur during REM, night terrors occur during stage IV (deep NREM) sleep.
• REM sleep behavior disorders are associated with REM (or dreaming period) sleep, in which the sleeper violently acts out the dream. People have actually injured themselves or others without waking.
• Enuresis (bedwetting) is nighttime incontinence. It has incorrectly been associated with dreaming; however, most incidents occur during NREM sleep, during the first third of the night when the child is difficult to arouse. It is distressing because of the stress society places on continence, the inconvenience of keeping bed linens clean, and the misconception that the child is bedwetting to act out against parents.

Question 47

Describe ways in which depression can affect sleep.

Answer 47

Answer:
Depression can affect sleep in the following ways:
•    Difficulty falling asleep
•    Less slow-wave (deep) sleep
•    Less time in REM sleep
•    Awaken early
•    Less total sleep time
•    Hypersomnia (excessive sleeping)

Question 48

List two sleep-provoked disorders, and explain how the sleep stage affects the disease.

Answer 48

Answer:
Answers may include any two of the following sleep-provoked disorders:
• Coronary artery disease. During REM sleep, dreams may increase heart rate and provoke angina and ECG changes.
• Bronchial asthma. People with asthma may experience bronchospasm during REM sleep. In adults, asthma attacks may occur at any time during the night. In children, they occur mostly during the final two-thirds of the night, when there is less stage IV sleep.
• Chronic obstructive pulmonary disease (COPD). Persons with COPD experience lowered oxygen tension and increased carbon dioxide retention during sleep, especially during REM sleep when neuromuscular control is normally depressed. This can result in pulmonary spasm and transient pulmonary hypertension.
• Diabetes. Blood glucose levels vary during sleep. When diabetes is uncontrolled, it may profoundly affect the blood sugar during sleep when the person is not alert enough to deal with it. Therefore, a person with uncontrolled diabetes may need to have blood glucose levels monitored during sleep.
• Duodenal ulcers. During REM sleep, people with duodenal ulcers secrete up to 20 times more gastric acid than do people who do not have duodenal ulcers. This increased acid often produces nocturnal epigastric pain and sleep loss.

Question 49

For a chronic, long-term sleep problem would you use a diagnosis of Sleep Pattern Disturbance, Sleep Deprivation, or Readiness for Enhanced Sleep?

Answer 49

Answer:
• Sleep Pattern Disturbance is NANDA nursing diagnosis defining a time-limited interruption in sleep resulting from external factors, such as room temperature and humidity, noise, lighting, noxious odors, sleep partner, unfamiliar sleep surroundings or bed, interruptions, lack of privacy, and physical restraints. A Sleep Pattern Disturbance can be reported as difficulty falling asleep, awakening with trouble getting back asleep, verbal complaint of not feeling rested after awakening, or dissatisfaction with sleep in general.
• Sleep Deprivation is the NANDA nursing diagnosis when the patient has a decreased amount, consistency, or quality of sleep over prolonged periods of time. Defining characteristics of Sleep Deprivation are more severe than those for Sleep Pattern Disturbance, so nursing activities may focus as much on relieving symptoms (e.g., confusion, paranoia) as on sleep promotion.
• Readiness for Enhanced Sleep is the NANDA diagnosis when a client has no particular sleep problem but desires improved quality of sleep.

Question 50

Name at least two nursing diagnoses that might have a sleep problem as the cause.

Answer 50

Answer:
Answers may include any two of the following nursing diagnoses for a sleep problem:
• Risk for Injury or Falls related to sleepwalking (or REM sleep behavior disorder or narcolepsy)
• Fatigue (or Activity Intolerance) related to chronic insufficient quality or quantity of sleep (e.g., secondary to insomnia)
• Ineffective Coping related to decreased cognitive functioning and awareness, secondary to lack of sleep
• Disturbed Thought Processes related to decreased cognitive functioning, secondary to lack of sleep
• Anxiety (or Fear) related to fear of death from sleep apnea

Question 51

Name at least one nursing diagnosis that might have a sleep problem as the defining characteristic.

Answer 51

Answer:
The following nursing diagnoses might have a sleep problem as the defining characteristic:
•    Spiritual Distress related to challenges to belief system as manifested by nightmares, sleep disturbances, and verbalization of inner conflict about beliefs
Other diagnoses that might cause symptoms of sleep difficulties include the following:
•    Anxiety
•    Chronic Sorrow
•    Death Anxiety
•    Decisional Conflict
•    Diarrhea
•    Dysfunctional Grieving
•    Impaired Gas Exchange
•    Nausea
•    Pain
•    Relocation Stress Syndrome

Question 52

What is the classification of zolpidem (Ambien)? Why is it an especially desirable medication for sleep?

Answer 52

Answer:
Zolpidem (Ambien) is classified as a sedative/hypnotic, nonbarbiturate. It is an especially desirable medication for sleep because it is short-acting and does not produce a hangover effect.

Question 53

What are two other classes of medications that are sometimes prescribed for sleep?

Answer 53

Answer:
Answers may include the following classes of medications (other than sedatives/hypnotic, nonbarbiturate) prescribed for sleep:
•    Benzodiazepines
•    Tricyclic antidepressants
•    Barbiturates

Question 54

Describe three independent nursing interventions to promote sleep.

Answer 54

Answer:
Answers may include any three of the following nursing interventions:
• Encourage use of relaxation exercise.
• Allow visitors when needed for emotional security and relaxation, but limit visitors if the patient requires rest/sleep.
• Explain procedures to decrease anxiety and promote healthy coping.
• Listen attentively to decrease anxiety and convey compassion and caring.
• Schedule nursing care to avoid interruption of sleep (e.g., don’t awaken a patient to administer a sleeping pill, provide for rest periods).
• Use nursing judgment to decide when a procedure must be done and when it is more important for your patient to sleep.
• Alter routines; for example, allow the patient to sleep as long as he can in the morning and bring his breakfast later.
• Unless the patient is critically ill, do not awaken him for morning vital signs when he is sleeping.
• Create a restful environment; for example, be sure the bed linens are tight on the bottom and loose on top to allow movement; keep linens clean and free of irritants; use extra pillows, a blanket from home, or any other item that may help the patient rest; keep the patient in good body alignment; keep the room dark and quiet, unless the patient prefers a light; as much as possible, control the temperature of the room and provide good ventilation.
• Promote comfort (e.g., be sure to offer pain medications at their scheduled times and before time to sleep; offer fluids, cool cloths, massage, or backrub).
• Support bedtime rituals and routines (e.g., reading, watching TV, or praying; having warm milk, a favorite doll, blanket, or bedtime story; brushing teeth or hair).
• Offer appropriate bedtime snacks/beverages (e.g., juice, crackers).
• Teach the client to avoid alcohol and caffeine (e.g., tea, coffee, chocolate, colas.)
• Advise the client to drink plenty of fluids during the day, but restrict large amounts of fluid close to bedtime.
• Advise the person to not smoke after the evening meal.
• Promote relaxation (e.g., guided imagery, progressive muscle relaxation, music therapy).

Question 55

Why should people contact their prescriber before taking nonprescription sleep aids?

Answer 55

Answer:
People should contact their healthcare provider before taking nonprescription (over the counter) sleep medications because they can interact with other medicines they may be taking. Also, they do have side effects, which may be dangerous for people with certain health conditions.

Question 56

Katie is a new graduate nurse who has just begun working the night shift. She complains that she feels very irritable and is experiencing general malaise. An experienced coworker explains that
A. This problem is a result of hypersomnia.
B. This problem will resolve as Katie’s body adjusts to the new day/night schedule.
C. Katie should try medication to help alleviate her symptoms.
D. Katie should try cutting down the number of hours she is sleeping during the day.

Answer 56

Answer:
B. This problem will resolve as Katie’s body adjusts to the new day/night schedule.

Rationale:
Katie is experiencing some mild symptoms of sleep deprivation, which are affecting her circadian rhythm. Hypersomnia may result from sleep deprivation. Medication will not adjust circadian rhythms; cutting down on sleep will exacerbate the problem.

Question 57

Mr. Martinez has had extensive abdominal surgery. In terms of promoting wound healing and tissue growth, which stage of sleep is most important for him?
A.  Stage I
B.  Stage II
C.  Stage V (REM) sleep
D.  Stage IV

Answer 57

Answer:

D. Stage IV

Question 58

For which of the following sleep disorders would the nurse most likely need to include safety measures in the plan of care?
A.  Narcolepsy
B.  Restless leg syndrome
C.  Sleep deprivation
D.  Bruxism

Answer 58

Answer:
A. Narcolepsy

Rationale:
Persons with narcolepsy experience sudden, uncontrollable episodes of sleep that may lead to various forms of injury even in the hospital environment.

Question 59

Mrs. Sebink has been in the acute care facility for 4 days. It is 0100 and she tells the nurse that this is the third night that she has not been able to get to sleep. The nurse’s most appropriate action is to do which of the following?
A. Have the patient begin a sleep diary.
B. Provide the patient with a warm cup of tea.
C. Obtain the patient’s sleep history.
D. Obtain a prescription from the physician for a sleeping pill.

Answer 59

Answer:
D. Obtain an order from the physician for a sleeping pill.

Rationale:
Other responses are incorrect. Although the information gathered from a sleep diary and/or sleep history would be helpful, the patient’s problem is most likely a temporary problem related to the strange hospital environment. A brief sleep history should be available on Mrs. Sebink’s admission assessment. Most teas contain caffeine, which might exacerbate the problem of difficulty falling asleep.

Question 60

_________________________ is the most common sleep disorder.

Answer 60

Answer:

Insomnia

Question 61

The instrument that records the electrical activity in the brain is a/an ________________________.

Answer 61

Answer:

Electroencephalograph (EEG)

Question 62

_________________________ is a substance that disrupts REM sleep, causes spontaneous awakenings, and can induce nocturia.

Answer 62

Answer:

Alcohol

Question 63

Persons who are depressed have a heightened ability to fall asleep rapidly.

Answer 63

Answer:

False

Question 64

The nursing diagnosis Disturbed Sleep Pattern would be appropriate in the case of a patient who must be awakened every two hours for blood glucose monitoring.

Answer 64

Answer:

True

Question 65

All medications that produce sleep are habit forming and therefore should be avoided as long as possible.

Answer 65

All medications that produce sleep are habit forming and therefore should be avoided as long as possible.

Question 66

The duration of sleep is regulated by the:

1) electrical impulses transmitted to the cerebellum.
2) person’s innate biorhythms.
3) amount of sleep a person usually requires.
4) reticular activating system.

Answer 66

Answer:
4) reticular activating system.

Rationale:
In the morning, with an increase in environmental light, the hypothalamus is signaled to induce gradual arousal from sleep. The reticular formation is then activated by the stimuli from the cerebral cortex. The reticular formation is responsible for maintaining wakefulness. Together, the reticular formation and cortical neurons are called the reticular activating system (RAS). The RAS regulates the duration of sleep.

Question 67

The nurse in the hospital has a prescription to administer medication at 0400 to Mrs. Giovanni. Mrs. Giovanni is asleep when the nurse enters the room. She is difficult to arouse and confused. Identify the stage of sleep Mrs. Giovanni was likely in when the nurse awakened her.

1) Stage II
2) Stage III
3) Stage IV
4) REM

Answer 67

Answer:
3) Stage IV

Rationale:
Stage IV is the deepest sleep and the most restorative. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage IV sleep, and if awakened, the person may appear confused and react slowly.

Question 68

Depression, hyperthyroidism, hypothyroidism, pain, and sleep apnea are examples of:

1) disorders that are provoked by sleep.
2) conditions known as parasomnias.
3) conditions that cause secondary sleep disorders.
4) disorders associated with narcolepsy.

Answer 68

Answer:
3) conditions that cause secondary sleep disorders.

Rationale:
Secondary sleep disorders occur when a disease causes alterations in sleep stages or in quantity of sleep. Depressed people may spend more time in bed; however, in general, they have difficulty falling asleep, experience less slow-wave (deep) sleep, spend less time in REM sleep, awaken early, and have less total sleep time. An increase in thyroid secretion causes an increase in stage III and IV sleep. Hypothyroidism causes a decrease in those stages. Hyperthyroidism creates increased metabolic rate, making it difficult to fall asleep. Acute pain and chronic pain interfere with sleep. They inhibit sleep, increase arousals during sleep, and cause longer awake intervals during the night. During periods of sleep apnea, O2 level in the blood drops, and the CO2 level rises, causing the person to wake up frequently.

Question 69

What is the hormone that promotes sleep?

1) Melatonin
2) L-tryptophan
3) Progesterone
4) Oxytocin

Answer 69

Answer:
1) Melatonin

Rationale:
The levels of melatonin, which is the natural hormone that promotes sleep, decline in the latter decades of life. It is produced at night by the pineal gland in the brain.

Question 70

What are prevailing characteristics of narcolepsy? Select all that apply.

1) Involuntary
2) Cataplexy
3) Hallucinations
4) Temporary paralysis

Answer 70

Answer:

1) Involuntary
3) Hallucinations

Rationale:
The person with narcolepsy experiences a sudden, uncontrollable urge to sleep lasting from seconds to minutes, even though the person sleeps well at night. The person cannot avoid the “sleep attacks” but awakens easily. Narcolepsy is characterized by involuntary episodes of sleepiness, slurred speech, slackening of the facial muscles, a feeling of impending weakness of the knees, paralysis, and hallucinations. Some have other symptoms, such as cataplexy, a sudden loss of muscle tone usually triggered by an emotional event (e.g., laughter, surprise, or anger), but most only have hypersomnia.

Question 71

How would the nurse be able to identify the person with narcolepsy from one with seizures?

1) Episodes are short in duration.
2) Episodes come on suddenly.
3) The patient can be aroused from the episode.
4) The patient loses voluntary control of his muscles.

Answer 71

Answer:
3) The patient can be aroused from the episode.

Rationale:
The patient with narcolepsy can be aroused from the sleep episode. A person with seizure activity is unresponsive to stimulus and does not resolve in relationship to arousing. Narcolepsy and seizures are triggered suddenly. Both involve involuntary control of motor function with paralysis and cataplexy. Typical seizures last less than 8 minutes. Most narcoleptic episodes are also brief with microactivity lasting only a few minutes. Infrequently, the uncontrollable urge to sleep goes on for up to an hour.