Chapter 11: Rest, Sleep, and Activity My Nursing Test Banks

Chapter 11: Rest, Sleep, and Activity

Test Bank

MULTIPLE CHOICE

1. 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.

ANS: A

Older persons tend to spend less time asleep than younger persons, although they spend more time in bed. This statement is true because sleep takes longer to arrive and is more fragmented. Leg movements during sleep often tend to increase with age. REM sleep becomes more evenly distributed with age. Stage III sleep decreases with age and virtually disappears in older adults.

PTS:1DIF:RememberREF:172

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

2. 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 the older adult can be caused by cardiovascular disease, arthritis, or diabetes.

c.

Benzodiazepine agents are the medications of choice for sleep disorders.

d.

Selective serotonin-reuptake inhibitors (SSRIs) can alleviate sleep disturbances caused by depression.

ANS: B

All of these physical problems, as well as arthritis, can contribute to sleep disorders. It takes older adults more time to fall asleep, and older adults are awakened throughout the night more frequently than younger people. Benzodiazepines should not be used to induce sleep; these substances are highly addictive, and if their administration is suddenly withdrawn, then rebound insomnia can occur. In addition, older adults who take benzodiazepines for sleeping are more likely to experience a hangover after waking that can increase the risk of accidents and injuries. In addition to alleviating depression that causes sleep disorders, SSRIs can have a stimulating effect that, in itself, interferes with the sleep cycle.

PTS:1DIF:RememberREF:172

TOP: Nursing Process: Assessment MSC: Physiological Integrity

3. An older man has Alzheimer disease, and his wife says he is up and wandering around the house at night. Which intervention should the nurse implement to increase the mans 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.

ANS: A

Regular exercise can help increase the duration of sleep during the night. Adding a new medication to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Administering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of injury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hostility and combativeness. Excessive napping during the day may be contributing to the problem.

PTS:1DIF:ApplyREF:176

TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

4. Exercises are prescribed for older adults as therapy to improve which one of the following qualities?

a.

Relative intensity

c.

Muscle retraining

b.

Muscle strength

d.

Body sculpting

ANS: B

Exercises that improve muscle strength are important for balance, strong bones, and metabolic processes. Relative intensity is the level of effort required by a person to an activity. When using relative intensity, people pay attention to how physical activity affects heart rate and breathing. Muscle strength is not a therapeutic concern. Muscle retraining refers to muscles that have been trained, detrained, and trained again and is not a therapeutic concern. Muscle definition is a quality valued by bodybuilders, but it is not a therapeutic concern.

PTS: 1 DIF: Remember REF: 179 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

5. Which of the following is important to include in the initial assessment for older adults who are frail and beginning an exercise program?

a.

Exercise tolerance testing (ETT)

b.

Financial ability to pay for training sessions

c.

Medical history and physical examination

d.

Pulmonary function tests (PFTs)

ANS: C

Any aspect of the patients current and past physical and psychological condition can be important in designing the exercise program to suit the patient. Fitness tests such as the ETT are warranted in older adults who are beginning a moderately intense or vigorous exercise program. The ETT is not recommended for the frail older adult. Expensive training programs are not usually needed. Although aerobic capability must be carefully observed, PFTs, specifically, are not necessary unless pulmonary function is a parameter that the therapeutic program is targeting for improvement.

PTS:1DIF:UnderstandREF:176-179

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

6. 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 womans 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.

ANS: A

Hospitalization often disrupts normal sleeping patterns; therefore reestablishing those patterns is the best first step to improving the quality of sleep in the hospital. Avoiding napping during the day is a reasonable approach to complaints of sleeplessness, but it may not be this womans problem. Sleep is increasingly fragmented in older adults; however, understanding that issue may or may not help this woman sleep for longer periods. A book or movie can help some people become drowsy, but becoming drowsy will not usually increase the quality or duration of sleep. In fact, books and movies can be stimulating and decrease the ability to fall asleep.

PTS:1DIF:ApplyREF:174-175

TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

7. 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.

ANS: D

Sleep provides an important survival tool to rest, restore, and rejuvenate the body. Rest occurs during sleep. Sleep is an extension of rest. Rest can occur in brief periods and in extended cycles during sleep.

PTS: 1 DIF: Remember REF: 170-171|  181

TOP: Nursing Process: Assessment MSC: Physiological Integrity

8. An older woman maintains an active lifestyle playing various games with friends. She reports to the nurse that she experiences wakefulness during the night and an inability to fall asleep after waking up at night. Which intervention should the nurse implement to improve the quality of this womans sleep?

a.

Recommend preparation for sleep.

b.

Suggest trying a cup of warm milk at bedtime.

c.

Inquire about her nightly sleep rituals.

d.

Propose volunteer work at a thrift shop.

ANS: C

The nurse completes an assessment of the womans sleeping habits and other pertinent information before planning care and implementing nursing interventions to individualize therapy. Preparing for sleep is a reasonable intervention to propose after completing an assessment. Sipping warm milk is also a reasonable intervention to suggest after completing an assessment. Engaging in meaningful activities can improve the quality of sleep and is a reasonable intervention to propose after the assessment.

PTS:1DIF:ApplyREF:174-175

TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

9. The nurse completes an admission assessment on an older adult patient. The nurse identifies which factor that may contribute to sleep problems?

a.

Exposure to sunlight

c.

Use of a sleep aid

b.

Polypharmacy

d.

Decreased fluid intake

ANS: B

Polypharmacy contributes to sleep problems as a result of medication side effects and drug interactions. Decreased exposure to sunlight contributes to sleep problems. Sleep aids may assist with sleep issues. Decreased fluid intake may lead to dehydration, which may result in lethargy.

PTS: 1 DIF: Understand REF: 171-173 TOP: Nursing Process: Planning

MSC: Physiological Integrity

10. The nurse expresses concern about a female nursing home resident in the team meeting. Which resident information determines the teams priority in planning her care?

a.

Experiences several interruptions with sleep

b.

Has had coronary bypass graft surgery during the last year

c.

Needs increasing help with personal hygiene

d.

Eats insufficient calories to maintain her weight

ANS: C

The residents ability for self-care is deteriorating, and needing help with personal hygiene is an indicator of declining health because the level of activity is an indicator of an individuals health and wellness. Thus declining health is the nurses priority in planning care. Assessing and addressing medical problems, such as heart disease and nutrition, and improving sleep are among the aspects of care to restore health and well-being for which the nurse will plan. Improving sleep patterns is part of the overall plan to restore her health and wellness. A history of coronary artery disease is important information to use to plan care; however, it is part of the plan to improve the womans overall health. Improving nutrition is part of the overall plan to restore her health and wellness.

PTS: 1 DIF: Analyze REF: 177-182 TOP: Nursing Process: Diagnosis

MSC:Health Promotion and Maintenance

11. A nursing home resident who has type 1 diabetes mellitus is gradually requiring more and more insulin on an as-needed (PRN) basis to treat hyperglycemia. Which of the following should the nurse assess to plan care for improving this individuals glucose metabolism?

a.

New-onset urinary tract infection

b.

Trends over time in activity level

c.

Sudden increase in caloric intake

d.

Big change in diabetic medication use

ANS: B

Standard diabetic therapy includes diet, hypoglycemic agents, and exercise. If one aspect of the therapy changes, then the other two aspects must be adjusted to avoid hyperglycemia. Improving glucose metabolism is a huge benefit of exercise for the person with diabetes. In all people, exercise helps maintain aerobic conditioning, stabilizes mood, improves the quality of sleep, and is especially important for those with diabetes to promote and maintain collateral circulation. For this resident, a slow decline in physical activity will necessitate a change in the amount of insulin given or the total amount of daily calories to prevent hyperglycemia; however, the best solution for this resident is to increase daily physical activity. A new event is likely to cause an abrupt change in the serum glucose. Although infections are frequently detected in an individual with diabetes, infections are more closely associated with sudden-onset hyperglycemia. A sudden increase in caloric intake is likely to cause a sudden increase in blood glucose. A big change in medication use is likely to cause an abrupt change in the serum glucose.

PTS:1DIF:ApplyREF:178-182

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

12. The nurse at an assisted-living facility uses the Exercise and Screening for You (EASY) tool to plan an exercise program for a female resident who is in good health except that her height has decreased inch. Which exercise safety tip from EASY calls for the nurse to assess the resident before planning care?

a.

Do not exercise a red, warm, or swollen joint.

b.

Avoid stretches that cause you to bend at the waist.

c.

Evaluate your surroundings for outdoor exercising.

d.

Begin by warming up with low-to-moderate exercises.

ANS: B

The nurse needs more information because the reason the residents height has decreased is not known. Therefore to obtain the information, the nurse decides to complete a resident assessment before planning an exercise program. The shrinkage can be due to atrophy of intervertebral discs, compression fractures, or changes in the curvature of the spine, any of which can be aggravated by incorrectly exercising. With a complete assessment, however, the nurse can plan a suitable exercise program for the resident. Red, warm, swollen joints are usually due to gout or rheumatoid arthritis; fortunately, the resident does not have these health problems. However, this is a good recommendation for anyone who exercises. Evaluating an individuals surroundings when exercising does not alert the nurse who is considering an exercise plan for this resident; however, this is a good, general recommendation for anyone who exercises. Warming up with low-to-moderate exercises is a good recommendation for anyone who exercises.

PTS:1DIF:ApplyREF:177-178

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

13. The older adult residents of an assisted-living facility are preparing for a 14-day trip to Europe. Which is the most important exercise for the nurse to recommend for the group?

a.

Practice standing on one foot for 30 seconds.

b.

Move light weights in a rowing motion eight times.

c.

Stretch the hips by pulling the knee to the chest.

d.

Swim laps in the pool for 10 minutes continuously.

ANS: D

The nurse should recommend endurance exercises for the group to improve cardiovascular and respiratory conditioning. Endurance training is suitable to prepare the residents to withstand the rigors of travel. Standing on one foot for 30 seconds is a reasonable exercise to recommend because balance tends to decrease with age; however, the cornerstone of the groups exercise must be endurance. Moving light weights is also a reasonable exercise to recommend because muscle bulk tends to decrease with age; however, the cornerstone of the groups exercise must be endurance. Stretching the hips is a reasonable exercise to recommend because joint flexibility tends to decrease with age; however, the cornerstone of the groups exercise must be endurance.

PTS:1DIF:AnalyzeREF:180

TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

14. Which of the following should the nurse recommend for a moderate-intensity exercise for older adults who are ambulatory and in good health?

a.

Walk 4 miles in 60 minutes.

b.

Work in the garden for 45 minutes.

c.

Swim laps in the pool for 20 minutes.

d.

Wash and wax the car for 75 minutes.

ANS: C

According to the American Geriatrics Society, the nurse can safely recommend swimming laps for 20 minutes consecutively to older adults. The nurse can safely recommend walking 2 miles in 30 minutes, but walking for 60 minutes is excessive. Older adults should limit gardening to 35 to 40 minutes at a time. The older adult can wash and wax a car for a combined 45 to 60 minutes.

PTS:1DIF:RememberREF:180

TOP: Nursing Process: Implementation MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Residents of a nursing home taking which of the following medication(s) are at risk for sleep disturbances as an adverse effect of the medication? (Select all that apply.)

a.

Celecoxib (Celebrex)

b.

Diltiazem (Cardizem)

c.

Venlafaxine (Effexor)

d.

Ipratropium (Atrovent)

e.

Oxycodone (Oxycontin)

f.

Guaifenesin (Robitussin)

ANS: A, B, C, D, E

Celecoxib (Celebrex), a cyclooxygenase-2 (COX-2) inhibitor; diltiazem (Cardizem), a calcium-channel blocker; venlafaxine (Effexor), an antidepressant; ipratropium (Atrovent), an anticholinergic bronchodilator; and oxycodone (Oxycontin), an opioid analgesic, can all cause insomnia. Guaifenesin (Robitussin) is not known to cause insomnia.

PTS:1DIF:UnderstandREF:172

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

2. The nurse observes that a male patient is snoring every night. Which should the nurse assess in this patient to diagnose the potential for sleep apnea? (Select all that apply.)

a.

Change in appetite

b.

Rituals for sleeping

c.

Number of daytime naps

d.

Headaches in the morning

e.

Irritability during the day

f.

Awakening during the night

ANS: C, D, E, F

The nurse asks the patient to evaluate how restorative or refreshing sleeping is for him; awakening unrefreshed is a risk factor for sleep apnea. In addition, morning headaches, daytime irritability and personality changes, and periods of nighttime wakefulness are all risk factors for sleep apnea. Changes in appetite and rituals for sleeping are rarely associated with an increased risk for sleep apnea.

PTS:1DIF:UnderstandREF:172-174

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

3. A nurse will be conducting an education session at the local senior citizens center on the importance of physical activity. Which activities should the nurse include as an example of moderate-intensity aerobic activity? (Select all that apply.)

a.

Biking

c.

Weight lifting

b.

Range of motion (ROM)

d.

Dancing

ANS: A, D

Biking and dancing incorporate large muscle groups and are classified as moderate-intensity aerobic activity. ROM exercises are classified as stretching activities. Weight lifting is considered an exercise that uses body weight and is a muscle-strengthening activity.

PTS: 1 DIF: Understand REF: 180 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

4. The nurse should encourage which of the following exercise(s) to assist with balance for a patient who is at high risk for falls? (Select all that apply.)

a.

Tai chi

c.

ROM activities

b.

Use of resistance bands

d.

Walking heel to toe

ANS: A, D

Tai chi and walking heel to toe are considered balance exercises. The use of resistance bands is considered muscle strengthening, and ROM activities are considered stretching exercises.

PTS: 1 DIF: Understand REF: 180 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

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