1.

The client is reporting difficulty sleeping. The nurse assesses the client for contributing factors, including: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. Vitamin C supplementation. b. Medication history. c. Caffeine. d. Sleep habits. e. Current stressors. Grade: User Responses: Feedback: 1 b.Medication history.,c.Caffeine.,d.Sleep habits.,e.Current stressors. a.Rationale: Cognitive Level: Understanding Nursing Process: Assessment Client Need: Health Promotion and Maintenance Caffeine may disrupt REM sleep, delay onset of sleep, or decrease sleep time. Vitamin C supplementation does not impact sleep. Sleep habits such as time of sleep, who the client sleeps with, or how soon after eating the client goes to bed can contribute to sleep problems. Stressors can impact the ability to fall asleep or to stay asleep. Medications can impact sleep and should be assessed.

2.

A client is scheduled to have an electroencephalogram (EEG) during sleep. The nurse expects brain activity during REM sleep to: a. Have mostly delta waves. b. Be identical to NREM sleep. c. Resemble wakefulness. d. Reflect limited activity. Grade: User Responses: Feedback: 1 c.Resemble wakefulness. a.Rationale: The brain activity during REM sleep is similar to that during wakefulness. Cognitive Level: Understanding Nursing Process: Assessment Client Need: Physiological Integrity

3.

Click to view the animation, Stages of Sleep: Introduction. The nurse is teaching students about brain activity during sleep. In which stages of sleep do theta waves occur? a. Stage III and REM b. Stage I and REM c. Stage I and II d. Stage III and IV Grade: User Responses: Feedback: 1 b.Stage I and REM a.Rationale: Theta waves occur in stage I and REM sleep. Cognitive Level: Remembering Nursing Process: Assessment Client Need: Physiological Integrity

4.

When discussing healthy sleep patterns with a client, the nurse discusses the influence of melatonin. The nurse is aware that melatonin is at its lowest level in the body at: a. 9 am. b. 3 pm. c. 6 am. d. 8 pm. Grade: User Responses: Feedback: 1 c.6 am. a.Rationale: With the beginning of daylight, melatonin is at its lowest level in the body. Cognitive Level: Understanding Nursing Process: Assessment Client Need: Physiological Integrity

5.

The nurse explains that REM sleep: a. Is a cycle consisting of four stages. b. Is characterized by slow brain waves. c. Is 75% of the sleep cycle. d. Involves increased brain metabolism. Grade: User Responses: Feedback: 1 d.Involves increased brain metabolism. a.Rationale: During REM sleep, the brain is highly active and brain metabolism may increase as much as 20%. Cognitive Level: Remembering Nursing Process: Assessment Client Need: Health Promotion and Maintenance

6.

A nurse working in the sleep lab teaches her clients the clinical changes of NREM sleep, and includes the following changes: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. Cardiac output increases. b. Peripheral blood vessels dilate. c. Intracranial pressure decreases. d. Skeletal muscles tense. e. Pulse rate slows. Grade: User Responses: Feedback: 1 b.Peripheral blood vessels dilate.,c.Intracranial pressure decreases.,e. Pulse rate slows. a.Rationale:Cognitive Level: Understanding Nursing Process: Implementation Client Need: Health Promotion and Maintenance During NREM sleep, the clients pulse slows and continues to slow as deeper sleep is achieved. Cardiac output is reduced during NREM sleep, with greater reduction as the client progresses into deeper stages of sleep. Skeletal muscles relax in NREM sleep. Intracranial pressure decreases. Blood vessels dilate and blood pressure declines.

7.

The first question asked by the nurse when collecting a detailed sleep history is: a. Do you snore, have difficulty falling asleep, or wake up frequently during the night? b. How would you describe your sleep? c. What kind of sleep problems do you have? d. What is your concern about sleep? How often does this happen? What have you done about the problem? Grade: User Responses: Feedback: 1 b.How would you describe your sleep? a.Rationale: A question that elicits the client's perception of the problem is the most appropriate initial question. It is important to then follow the cues of the client once the problem is identified. Asking clients an open-ended question that asks them to describe their sleep is a good opening to determine if they feel their sleep is adequate. Cognitive Level: Applying Nursing Process: Assessment Client Need: Health Promotion and Maintenance

8.

Parents ask the nurse, Is sleepwalking something we need to be worried about with our 9-year-old child? The nurses best response is: a. Sleepwalking is just the childs way of getting attention. b. Sleepwalking is of no concern and is generally outgrown. c. The child should be protected from injury during sleepwalking episodes. d. Sleepwalking generally occurs when the child is ready to arise anyway, so it is not a big problem. Grade: User Responses: Feedback: 1 c.The child should be protected from injury during sleepwalking episodes. a.Rationale: Sleepwalking presents a risk for injury because the individual may not be aware of risks. Cognitive Level: Applying Nursing Process: Implementation Client Need: Safe, Effective Care Environment

9.

A client tells the nurse of jaw pain and stiffness upon awakening. The nurse identifies that this client is likely: a. Grinding his teeth during sleep. b. Having periods of apnea at night. c. Getting up and walking in his sleep. d. Having periodic limb movements at night. Grade: User Responses: Feedback: 1 a.Grinding his teeth during sleep. a.Rationale: Bruxism, or grinding of the teeth, can cause jaw discomfort and dental problems. Cognitive Level: Applying Nursing Process: Assessment Client Need: Physiological Integrity

10.

A new nursing graduates first job requires 12-hour night shifts. In order to get the best sleep during the day and remain awake at night, the nurse: a. Drinks several cups of strong coffee or 16 oz of caffeinated soda when beginning the shift. b. Wears dark, wraparound sunglasses when driving home in the morning, and sleeps in a darkened bedroom. c. Exercises on the way home at the gym. d. Tries to stay in a brightly lit area when working at night. Grade: User Responses: Feedback: 1 b.Wears dark, wraparound sunglasses when driving home in the morning, and sleeps in a darkened bedroom. a.Rationale: Reducing exposure to bright light in the morning while driving home and when going to sleep will make it easier to fall asleep after work. Cognitive Level: Understanding Nursing Process: Implementation Client Need: Health Promotion and Maintenance

11.

The nurse plans care for the hospitalized client and appropriately includes what interventions? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. Avoid staff conversations at night. b. Reduce volume on equipment alarms. c. Lower the ring tone of nearby telephones. d. Discontinue or reduce the volume of paging systems at night. e. Plan care to reduce sleep interruptions when possible. Grade: User Responses: Feedback: 1 c.Lower the ring tone of nearby telephones.,d.Discontinue or reduce the volume of paging systems at night.,e.Plan care to reduce sleep interruptions when possible. a.Rationale: Cognitive Level: Applying Nursing Process: Planning Client Need: Health Promotion and Maintenance Reducing the volume of ring tones on telephones is an appropriate action as long as they are audible. Paging system volume can be reduced, or other communication systems such as pagers can be used. Staff conversations at night cannot be eliminated, but the conversations can be held away from client rooms. Care can be grouped to minimize interruptions at night as much as possible. Equipment alarms cannot be lowered because nurses must be aware of an alarm when it occurs.

12.

A client who has taken a barbiturate sleep medication for several months wants to discontinue the medication. What information is important for the nurse to give to the client about this medication? a. It is best to taper the medication dose gradually. b. Medication should be replaced with a nonbarbiturate medication. c. It is best to stop the medication completely. d. Sleep will be disturbed when discontinuing the medication.

Grade: User Responses: Feedback:

1 a.It is best to taper the medication dose gradually. a.Rationale: When this medication is no longer needed, it is best tapered gradually with supervision to avoid withdrawal symptoms. Cognitive Level: Applying Nursing Process: Planning Client Need: Safe, Effective Care Environment

13.

Click to view the video, Geriatric: Sleep. An older adult client has been prescribed a drug to induce sleep. When teaching the client about the medication, the nurse appropriately explains: a. Once started, it will be unlikely you will be able to sleep without the medication. b. The medication should only be taken when needed. c. Do not take this medication after midnight. d. Increased dosages may be required over time. Grade: User Responses: Feedback: 1 b.The medication should only be taken when needed. a.Rationale: It is important to teach the client to use the medication only on sleepless nights, rather than as a daily medication. Cognitive Level: Applying Nursing Process: Implementation Client Need: Health Promotion and Maintenance

14.

The nurse finds a client walking in the hallways at 3 am because of insomnia. Which intervention does the nurse implement to assist the client? a. Prepare the client a glass of warm milk. b. Ask the client if he would like a sleeping pill. c. Tell the client to continue walking until he feels sleepy. d. Suggest the client try turning on the television while he returns to bed. Grade: User Responses: Feedback: 1 a.Prepare the client a glass of warm milk. a.Rationale: L-tryptophan that is found in milk is thought to help induce sleep. This is an independent nursing action and is the first strategy to try. Cognitive Level: Applying Nursing Process: Implementation Client Need: Health Promotion and Maintenance