Chapter 11: Sleep and Activity My Nursing Test Banks

Chapter 11: Sleep and Activity

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. A patient reports to the nurse that he seems to be sleeping less at night but now regularly requires at least two short naps a day. He expresses a concern that something is wrong. The nurse responds that:

a.

Aging alters our sleep patterns, so what you describe is really quite common.

b.

Circadian sleep rhythms are controlled by the hypothalamus, which is affected by age.

c.

Sleep patterns are affected by so many things; have you been under a lot of stress lately?

d.

Can you be more specific about what you think is wrong with your sleep pattern?

ANS: A

The decrease in nighttime sleep and the increase in daytime napping that accompanies normal aging may result from changes in the circadian aspect of sleep regulation.

DIF: Understanding (Comprehension) REF: Page 203-4 OBJ: 11-1

TOP: Teaching-Learning MSC: Physiologic Integrity

2. What is the best bedtime snack for older adult patients with failure to thrive and insomnia?

a.

Ice cream in a waffle cone

b.

Bowl of grapes

c.

Glass of milk and a macaroon cookie

d.

Cup of cream of broccoli and cheese soup

ANS: D

This patient will benefit from a snack that includes protein and is warm while not providing excessive liquids.

DIF: Remembering (Knowledge) REF: Page 206 OBJ: 11-1

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

3. An older patient is being admitted to an acute care unit after surgical repair of a fractured tibia. To minimize any negative factors affecting the patients ability to sleep, the nurses initial intervention is to:

a.

be sure postoperative pain is being well managed.

b.

manipulate the environment to manage light and noise.

c.

plan care to minimize the number of times the patient is disturbed.

d.

ask the patient about usual sleeping habits.

ANS: D

Nurses can promote sleep by first assessing the patients usual sleep habits and satisfaction with sleep. Managing postoperative pain, minimizing environmental stimuli, and encouraging undisturbed rest are also important, but the first step in the nursing process is assessment.

DIF: Applying (Application) REF: N/A OBJ: 11-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. A confused older patient has been hospitalized for a cardiac problem that requires both antihypertensive and diuretic therapies. The nurse minimizes the patients risk of disturbed sleep by:

a.

keeping the door shut so noise from the hallway is not disruptive.

b.

organizing care to minimize the number of times the patient is awakened.

c.

administering medications at least 4 hours before bedtime.

d.

offering to toilet the patient whenever the nurse finds the patient awake during the night.

ANS: C

The diuretic is likely to cause the patient to urinate frequently during the night if not administered appropriately. Because the patient is confused, the door should be left open. Clustering cares is a good idea to promote sleep but is not the most important for this patient. Offering to assist the patient to the bathroom when awake is also a good idea, but it is preferable to decrease the number of times the patient is awake.

DIF: Applying (Application) REF: N/A OBJ: 11-3

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

5. An older frail adult patient has begun displaying symptoms of sleep disturbance while being hospitalized. Since these symptoms were observed, the nurse has arranged for a bed alarm to be placed near the patient because:

a.

lack of adequate sleep can result in delirium.

b.

the patient has difficulty using the call light.

c.

lack of sleep make the patient at risk for falls.

d.

the patient will remember not to get out of bed.

ANS: A

One consequence of lack of sleep for elders is delirium; the bed alarm is an intervention often used to alert staff when a patient is likely to make an ill-advised attempt at getting out of bed. The patient may or may not be able to use the call light. The risk of falling increases with delirium. The alarm may or may not remind the patient not to get out of bed, but it will alert the staff to go into the room.

DIF: Applying (Application) REF: N/A OBJ: 11-3

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

6. An older patient reports that sleep was being severely affected by the need to urinate frequently. The patient states he has begun restricting his fluid intake after 5 PM to help with the problem. The nurse responds:

a.

Have you seen a decrease in waking up since you cut back on fluids?

b.

You need sufficient fluids, so dont be too restrictive.

c.

You need the same amount over 24 hours, so drink enough by dinnertime.

d.

Have you had your prostate checked by your health care provider?

ANS: C

It is important that older adults, who as a group are at risk for inadequate fluid intake and dehydration, not reduce the total amount of liquids drunk in 24 hours. This is a common issue in the older population, so the nurse educates the patient on the amount of fluid he or she needs in a 24-hour period. Telling the patient dont be too restrictive does not give the patient information to make an informed decision on fluids. The other two questions are good assessment questions, but physiologic safety and maintenance are more important.

DIF: Understanding (Comprehension) REF: Page 206 OBJ: 11-7

TOP: Teaching-Learning MSC: Health Promotion

7. An older patient being treated for symptoms of seasonal allergies reports to the nurse that although she is careful about her caffeine intake, she has been having trouble getting to sleep at night. The nurse responds most appropriately to this patient when stating:

a.

Allergy reactions such as nasal stuffiness can cause sleep problems.

b.

If you are using over-the-counter nasal decongestants, that could be the problem.

c.

Many different foods contain hidden caffeine; be sure to check the labels.

d.

There are many different causes of sleep disturbances besides caffeine intake.

ANS: B

Over-the-counter medications that interfere with sleep include nasal decongestants containing amphetamine-like substances. This is most important for this patient who has allergies. Food labels do not always contain information on caffeine. Although there are different causes of sleep disturbances, this options does not really give the patient useful information.

DIF: Understanding (Comprehension) REF: Page 207 OBJ: 11-3

TOP: Teaching-Learning MSC: Physiologic Integrity

8. The daughter of an older cognitively impaired patient responds to the nurses suggestion to keep her father physically active by stating, Dad is so easily agitated it would be a major battle to take him on a walk. The nurses initial response is based on the understanding that:

a.

caregivers are often overwhelmed by the challenges of caring for such patients.

b.

physical exercise has been proven helpful in managing anger in such patients.

c.

exercise such as walking is likely to appeal to patients such as her father.

d.

her fathers general health and wellness will be positively affected by walking.

ANS: B

Physical exercise for the older adult with dementia is important for general physical well-being, but for this patient exercise may also reduce agitation. Exercise may also cause fatigue, leading to better sleep.

DIF: Understanding (Comprehension) REF: Page 211| Page 213

OBJ: 11-9 TOP: Teaching-Learning MSC: Physiologic Integrity

9. The nurse is preparing to instruct a family member regarding how to appropriately assist a 76-year-old patient incorporate a healthy daily walk into the familys routine. The nurse includes a suggestion that:

a.

a 30-minute walk after dinner is the best form of exercise for someone that age.

b.

if the patient appears to be having difficulty talking while walking, it is time to stop.

c.

the patient should be encouraged to walk a few feet farther each evening.

d.

the family member selects a flat, easily accessible walking path to follow.

ANS: B

To measure the appropriate intensity while walking for exercise, many apply the talk test: the person exercising should be able to carry on a conversation while walking. Breathing may be slightly labored, but a conversation should still be possible. The walker should not be out of breath. The other suggestions may or may not be appropriate for individual patients.

DIF: Understanding (Comprehension) REF: Page 213 OBJ: 11-9

TOP: Teaching-Learning MSC: Health Promotion

10. An older adult patient who has been seen at a neighborhood clinic for years tells the nurse that he will be moving to live with his son in a neighboring state. The nurse impacts the patients health and wellness the most therapeutically when stating:

a.

Be sure to reestablish with a health care provider as soon as you get settled.

b.

You seem to have a good relationship with your son; Im sure this will be a good move.

c.

You need to continue to be compliant with your plan of care regardless of where you live.

d.

Moving often causes temporary sleep disturbances, so stick to your evening routine.

ANS: D

Relocation often causes sleep disturbances as the person adjusts to a new environment. Maintaining an established evening routine will help the patient sleep better. The other statements do not affect sleep.

DIF: Understanding (Comprehension) REF: Page 205 OBJ: 11-7

TOP: Teaching-Learning MSC: Health Promotion

11. A patient in the early stage of Alzheimer disease is being admitted to an assisted living facility. The admitting nurse best addresses the patients need for appropriate physical activity when:

a.

asking the patient about activities done for recreation.

b.

showing the patient the exercise equipment available.

c.

having the activity coordinator visit with the patient.

d.

teaching the patient the connection between activity and memory.

ANS: A

The activity preferences of each resident should be assessed on admission in order to identify activities that the patient is likely to participate in. Keeping the patient busy and active will promote sleep. The other options are also appropriate, but assessing the patients preferences for leisure activity is the first step.

DIF: Applying (Application) REF: N/A OBJ: 11-10

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

12. A patient with moderate dementia has been admitted to a long-term care facility. To address the patients need to be engaged in purposeful activity, the nurse arranges for the patient to:

a.

fold some of the units freshly washed washcloths and towels each afternoon.

b.

help decide what television programs will be on in the dayroom.

c.

be responsible for changing the day calendar each morning.

d.

remind other diabetic patients when it is time for their finger sticks.

ANS: A

A meaningful activity has a purpose. The purpose may be to exercise arthritic joints or simply to have fun, but the activity should not be aimless or inappropriate for the patients ability. With dementia, the other activities are not appropriate and could lead to frustration.

DIF: Applying (Application) REF: N/A OBJ: 11-10

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

13. An older patient reported to the clinic nurse that since a grandson moved in a few months ago, the patient has had problems sleeping. Which question by the nurse is most appropriate?

a.

How do you feel about having a roommate?

b.

Was it your decision to invite him to move in?

c.

Has your sleep pattern changed since he moved in?

d.

Can you be more specific about the trouble you have sleeping?

ANS: C

The introduction of a new roommate often disrupts established sleep patterns, causing sleep disturbances. The nurse should also gather information on the specifics of the problem but should start with the event that the patient relates as the start of the issue.

DIF: Applying (Application) REF: N/A

14. The nurse is caring for a hospitalized patient who needs vital signs and assessments every 4 hours. The nurse last assessed the patient at midnight, and at 2 AM the nurse answers the call light and helps the patient to the bathroom. To promote good sleep, what action by the nurse is best?

a.

Ask the patient if a sleeping medication is needed.

b.

Assess the patient now and again at 6 AM.

c.

Tell the patient you will be back in 2 hours.

d.

Assess the patient at 4 AM while being very quiet.

ANS: B

The nurse can use judgment to assess the patient more often than ordered. In this case, assessing the patient 2 hours early and rescheduling the next assessment conforms to the prescribed maximum time between assessments and allows the patient 4 hours of uninterrupted rest. The patient may or may not want a sleeping pill, but sleep without medication is best.

DIF: Applying (Application) REF: N/A OBJ: 11-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

15. A patient is discussing retirement with a nurse. What suggestion pertaining to sleep does the nurse offer?

a.

Keep your same bedtime and nighttime routines.

b.

If you nap during the day you can stay up later.

c.

You wont need so much sleep to be rested for work.

d.

Sleeping in will help revitalize your energy level.

ANS: A

For some, retirement comes with loss of daily structure, which can affect bedtime and nighttime routines, making sleeping difficult. For best sleep the nurse suggests the patient maintain the familiar schedule.

DIF: Understanding (Comprehension) REF: Page 205 OBJ: 11-6

TOP: Teaching-Learning MSC: Physiologic Integrity

16. The nurse caring for older patients would prepare to administer which medication as a short-term sleep aid?

a.

Diazepam (Valium)

b.

Diphenhydramine (Benadryl)

c.

Chloral hydrate (Somnote)

d.

The nurse would try other measures first

ANS: D

Benzodiazepines, hypnotics, and antihistamines all have serious side effects when taken by the older population. Especially in the confused patient, the nurse should try other comfort measures first, like sticking to an established nighttime routine to cue the patient to bedtime.

DIF: Applying (Application) REF: N/A OBJ: 11-6

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

17. A patient reports waking up with frequent headaches and sore throat. What question by the nurse is most appropriate?

a.

Does acetaminophen (Tylenol) provide relief?

b.

Does your partner say you snore at night?

c.

Do you drink enough water during the day?

d.

Do you ever wake up with night sweats?

ANS: B

Waking up with headaches and sore throat are manifestations of sleep apnea. Family members often say the patient snores loudly during the night and wakes up gasping. The nurse should assess for these other signs of the disorder. The other questions may or may not be appropriate if the patient does not snore at night.

DIF: Applying (Application) REF: N/A OBJ: 11-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

18. A patient wants to use an herbal preparation to help with decreased sleep. What response by the nurse is best?

a.

There are no research studies on these herbal preparations.

b.

Why dont you try exercise during the day first?

c.

Have you had a physical exam any time recently?

d.

Why do you want to use an herbal product for insomnia?

ANS: C

Sleep disturbances, especially new ones, may signify a physical illness. Before simply taking medications or supplements to treat the sleep disorder, the patient should have a physical exam to rule out a physical cause for the problem. The other statements are not appropriate because for patient safety, he or she should have a checkup.

DIF: Applying (Application) REF: N/A OBJ: 11-6

TOP: Communication and Documentation MSC: Physiologic Integrity

19. The nurse needs to awaken a patient to take medication in the middle of the night. The patient has not had any sleeping medications or other preparations that would cause drowsiness. The nurse has to use vigorous stimulation to awaken the patient. What stage of sleep is this patient most likely in?

a.

Stage 1, nonrapid eye movement (REM)

b.

Stage 2, non-REM

c.

Stage 3, non-REM

d.

Stage 4, non-REM

ANS: D

In stage 4 of non-REM sleep, the person needs vigorous stimulation to be awakened. In stage 1, the person is awakened easily, as in stage 2. Stage 3 requires moderate stimulation.

DIF: Remembering (Knowledge) REF: Page 203-4 OBJ: 11-3

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

20. A patient has chronic, severe asthma and takes many medications during the day. The patient reports difficulty falling asleep at night. What medication does the nurse ask about the patient taking?

a.

Barbiturates

b.

Theophylline (Theo-24)

c.

Furosemide (Lasix)

d.

Haloperidol (Haldol)

ANS: B

Theophylline is associated with difficulty falling asleep and is sometimes used in patients with asthma. The other medications are not associated with this sleep disorder or with asthma.

DIF: Applying (Application) REF: N/A OBJ: 11-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

21. The nurse has instituted bedtime routines for patients with dementia in a long-term care facility. What assessment findings best indicate the program is effective?

a.

Patients are more alert and oriented during the day.

b.

Patients fall asleep within 20 to 30 minutes of going to bed.

c.

Patients appear happier and more interested in activities.

d.

Patients on diuretics awake less often during the night.

ANS: B

People should be able to fall asleep within 20 to 30 minutes after going to bed, so this assessment finding best indicates the program is working.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 11-6

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

MULTIPLE RESPONSE

1. When assessing a patients report of experiencing problems sleeping, the nurse gathers data related to which of the following? (Select all that apply.)

a.

The patient has difficulty falling asleep.

b.

The patient wakes up frequently during the night.

c.

The patient finds it difficult to stay asleep.

d.

The patient experiences vivid dreams while sleeping.

e.

The patient has taken sleeping medication in the past.

ANS: A, B, C

Characteristics of the sleep disturbance include difficulty falling asleep, difficulty staying, asleep, frequent nocturnal awakenings, early morning awakening, and daytime sleepiness. An assessment should include questions related to the presence of these symptoms. Vivid dreams and sleeping medication are also part of a sleep history but are not characteristics of sleep disorders.

DIF: Understanding (Comprehension) REF: Page 209 OBJ: 11-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

2. The nurse who works with older patients explains the age-related changes in sleep to a student. Which statements are consistent with this knowledge? (Select all that apply.)

a.

The amount of time spent in REM sleep increases.

b.

REM sleep is interrupted more by awakening at night.

c.

People spend more time in the lightest stage of sleep.

d.

Stages 3 and 4 of non-REM sleep are not as deep.

e.

Changes in circadian rhythm can affect sleep.

ANS: B, C, D, E

As people age, the amount of time spent in REM sleep decreases, and this stage of sleep is interrupted more often by waking up at night. Stage 1 is the lightest stage of sleep and people tend to spend more sleep time in this stage as they age. Stages 3 and 4 are not as deep. The decrease in nighttime sleeping and increase in daytime napping can be attributed to alterations in circadian rhythms.

DIF: Understanding (Comprehension) REF: Page 203-4 OBJ: 11-1

TOP: Teaching-Learning MSC: Physiologic Integrity

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