Chapter 33: Sleep and Rest My Nursing Test Banks

Chapter 33: Sleep and Rest

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A person who is deprived of REM sleep for several nights in succession will usually experience:

1)

Extended NREM sleep.

2)

Paradoxical sleep.

3)

REM rebound.

4)

Insomnia.

____ 2. A patient states that many of his friends told him to ask for Valium or Ativan to help him sleep while hospitalized. The nurse knows that nonbenzodiazepines (such as Ambien) are often preferred over benzodiazepines (Ativan or Valium). Why is this?

1)

Benzodiazepines are eliminated from the body faster than are nonbenzodiazepines, so they do not provide a full night of sleep.

2)

Nonbenzodiazepines cause daytime sleepiness, allowing people to rest throughout the day.

3)

Benzodiazepines produce daytime sleepiness and alter the sleep cycle.

4)

Nonbenzodiazepines linger in the body longer than do benzodiazepines.

____ 3. Which of the following factors has the greatest positive effect on sleep quality?

1)

Sleeping hours in synchrony with the persons circadian rhythm

2)

Sleeping in a quiet environment

3)

Spending additional time in stage IV of the sleep cycle

4)

Napping on and off during the daytime

____ 4. Which is a major factor regulating sleep?

1)

Electrical impulses transmitted to the cerebellum

2)

Level of sympathetic nervous system stimulation

3)

Amount of sleep a person has become accustomed

4)

Amount of light received through the eyes

____ 5. Which of the following is the main difference between sleep and rest?

1)

In sleep, the body may respond to external stimuli.

2)

Short periods of sleep do not restore the body as much as do short periods of rest.

3)

Sleep is characterized by an altered level of consciousness.

4)

The metabolism slows less during sleep than during rest.

____ 6. A patient tells you that she has trouble falling asleep at night, even though she is very tired. A review of symptoms reveals no physical problems and she takes no medication. She has recently quit smoking, is trying to eat healthier foods, and has started a moderate-intensity exercise program. Her sleep history reveals no changes in bedtime routine, stress level, or environment. Based on this information, the most appropriate nursing diagnosis would be Disturbed Sleep Pattern related to:

1)

Increased exercise.

2)

Nicotine withdrawal.

3)

Caffeine intake.

4)

Environmental changes.

____ 7. Which patient teaching would be most therapeutic for someone with sleep disturbance?

1)

Give yourself at least 60 minutes to fall asleep.

2)

Avoid eating carbohydrates before going to sleep.

3)

Catch up on sleep by napping or sleeping in when possible.

4)

Do not go to bed feeling upset about a conflict.

____ 8. The expected outcome (goal) for a patient with Disturbed Sleep Pattern is that she will:

1)

Limit exercise to 1 hour per day early in the day.

2)

Consume only one caffeinated beverage per day.

3)

Demonstrate effective guided imagery to aid relaxation.

4)

Verbalize that she is sleeping better and feels less fatigued.

____ 9. When making rounds on the night shift, the nurse observes her patient to be in deep sleep. His muscles are very relaxed. When he arouses as the nurse changes the IV tubing, he is confused. What stage of sleep was the patient most likely experiencing?

1)

Stage V

2)

Stage IV

3)

Stage III

4)

REM

____ 10. What is the purpose of using a sleep diary?

1)

Identify sleeprest patterns over a 1-year period.

2)

Note the trend in sleepwakefulness patterns over a 2-week period.

3)

Note typical sleep habits and most common daily routines.

4)

Examine the patterns of sleep during the night and naps during the day.

____ 11. What are patterns of waking behavior that appear during sleep are known as?

1)

Parasomnias

2)

Dyssomnias

3)

Insomnia

4)

Hypersomnia

____ 12. A 6-year-old boy admitted to the hospital for a surgical procedure associated with a hospital stay. When the nurse asks his mother about the boys sleep patterns, she says, Sometimes he will get out of bed, walk into the kitchen, and get the cereal out of the cabinet. Then he just turns around and goes back to bed. The nurse explains that he is sleepwalking. The best nursing diagnosis for Tad would be:

1)

Risk for Insomnia related to sleepwalking.

2)

Risk for Fatigue related to sleepwalking.

3)

Disturbed Sleep Pattern related to dyssomnia.

4)

Risk for Injury related to sleepwalking.

____ 13. The primary focus of your interventions for a 6-year-old child who sleepwalks would be to:

1)

Maintain patient safety during episodes of somnambulation.

2)

Administer and teach about medications to suppress stage IV sleep.

3)

Encourage the child to verbalize feelings regarding sleep pattern.

4)

Provide a quiet environment for nighttime sleep.

____ 14. From what stage of sleep are people typically most difficult to arouse?

1)

NREM, alpha waves

2)

NREM, sleep spindles

3)

NREM, delta waves

4)

REM

____ 15. During which of the following developmental stages does a person tend to need the most hours of sleep?

1)

Toddler

2)

Adolescence

3)

Middle adulthood

4)

Older adulthood

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Select the factors known to affect sleep. Choose all that apply.

1)

Age

2)

Environment

3)

Lifestyle

4)

State of health

____ 2. A mother expresses concern that her 7-year-old has episodes of enuresis approximately 3 to 4 times per week. The nurses best response would be which of the following? Choose all that apply.

1)

Your daughters bladder is still developing at this point in her life.

2)

Be patient; most children outgrow enuresis.

3)

Wake your daughter every 4 hours to use the bathroom.

4)

You might consider purchasing protective pads for the bed.

____ 3. The patient is diagnosed with obstructive sleep apnea. Identify the symptoms you would expect the client to exhibit. Choose all that apply.

1)

Bruxism

2)

Enuresis

3)

Daytime fatigue

4)

Snoring

Completion

Complete each statement.

1. ____________________ disorders are those that occur when signs and symptoms of a disease appear or become worse during sleep.

Chapter 33: Sleep and Rest

Answer Section

MULTIPLE CHOICE

1. ANS: 3

A person who is deprived of REM sleep for several nights will usually experience REM rebound. The person will spend a greater amount of time in REM sleep on successive nights, generally keeping the total amount of REM sleep constant over time.

PTS: 1 DIF: Moderate REF: V1, p. 817

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Comprehension

2. ANS: 3

Nonbenzodiazepines (such as Ambien) have a short half-life, which means that they are eliminated from the body quickly and do not cause daytime sleepiness. Ativan is a long-acting benzodiazepine and lingers in the body longer than Ambien, causing daytime sleepiness.

PTS: 1 DIF: Moderate REF: V1, p. 819 | V1, p. 828

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Analysis

3. ANS: 1

A circadian rhythm is a biorhythm based on the day-night pattern in a 24-hour cycle. Sleep quality is best when the time at which the person goes to sleep and awakens is in synchrony with his circadian rhythm. Not all people require a quiet environment for sleep. Time spent in stage IV of the sleep cycle is affected by the total time spent asleep. Napping on and off throughout the day might disrupt the natural circadian rhythm with uninterrupted periods of sleep that cycle through the various stages of the sleep cycle.

PTS: 1 DIF: Moderate REF: V1, p. 815

KEY: Client need: HPM | Cognitive level: Analysis

4. ANS: 4

The circadian rhythm is a biorhythm based on the day-night pattern in a 24-hour cycle. A persons circadian rhythm is regulated by a cluster of cells in the hypothalamus of the brainstem that respond to changing levels of light. A major factor in regulating sleep is the amount is the amount of light received through the eyesnot the typical amount of sleep the person has within a 24-hour period. The autonomic nervous system (rather than central nervous system) controls the involuntary processes of the body, such as sleep, digestion, immune function, and so on.

PTS: 1 DIF: Moderate REF: V1, p. 815

KEY: Client need: HPM | Cognitive level: Comprehension

5. ANS: 3

During rest, the mind remains active and conscious; sleep is characterized by altered consciousness. Sleep is a cyclic state of decreased motor activity and perception. A sleeping person is unaware of the environment and does respond selectively to certain external stimuli. However, at rest, the body is disturbed by all external stimuli; sleep restores the body more than does rest. The metabolism decreases more during sleep than during rest.

PTS: 1 DIF: Easy REF: V1, p. 813

KEY: Client need: HPM | Cognitive level: Analysis

6. ANS: 2

Based on the information given, the patient is not experiencing significant stress, or change in sleep routine or environment, which commonly leads to insomnia. People who use nicotine tend to have more difficulty falling asleep and are more easily aroused than those who are nicotine free. People who stop smoking often experience temporary sleep disturbances during the withdrawal period.

PTS: 1 DIF: Moderate REF: V1, p. 819

KEY: Nursing process: Diagnosis | Client need: PHSI | Cognitive level: Analysis

7. ANS: 4

Intense emotion before bedtime can interfere with rest and sleep. Lying awake longer than 30 minutes is counterproductive. Eating a small amount of a complex carbohydrate can aid in falling asleep. Avoid simple sugars because sucrose can lead to a short-term energy boost instead of relaxation. Taking naps during the day and sleeping late on some mornings can actually exacerbate a sleep disturbance. Its better to establish a consistent routine for wake and sleep. The extra sleep during the day can interfere with the bodys readiness for sleep at night.

PTS: 1 DIF: Easy REF: V1, p. 820

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

8. ANS: 4

The expected outcome (goal) is based on the nursing diagnosis, and its achievement should reflect resolution of the problem. The other options are outcomes that demonstrate only that the patient took certain actions. They would not, if achieved, demonstrate that the problem of Disturbed Sleep Pattern had been resolved.

PTS: 1 DIF: Moderate REF: V1, p. 825

KEY: Nursing process: Planning | Client need: PHSI | Cognitive level: Synthesis

9. ANS: 2

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. It is difficult to awaken someone in stage IV sleep; if awakened, the person may appear confused and react slowly. During this stage, the body releases human growth hormone, which is essential for repair and renewal of brain and other cells.

PTS: 1 DIF: Easy REF: V1, p. 816

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

10. ANS: 2

A sleep diary provides specific information about the patients sleepwakefulness patterns over a certain period of time. It allows identification of trends in sleepwakefulness patterns and associates specific behaviors interfering with sleep. The diary is typically kept for 14 days.

PTS: 1 DIF: Moderate REF: V1, p. 824 | V2, p. 766

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Recall

11. ANS: 1

Parasomnias are patterns of waking behavior that appear during sleep. Sleepwalking, sleep talking, and bruxism are parasomnias.

PTS: 1 DIF: Easy REF: V1, p. 820 | V1, p. 823

KEY: Client need: PHSI | Cognitive level: Comprehension

12. ANS: 4

Sleepwalking occurs during stages III and IV of NREM sleep. The sleeper leaves the bed and walks about with little awareness of surroundings. He may perform what appear to be conscious motor activities but does not wake up and has no memory of the event on awakening. The boy is at high risk for injury when sleepwalking because of his lack of awareness of his surroundings. Insomnia is a medical diagnosis rather than a nursing diagnosis. Certainly his sleep pattern is disturbed; however, there is little in the way of independent actions that the nurse could take for either the problem or etiology of this diagnosis, so it would not be useful. The boy does not awaken while sleepwalking and is not likely to experience fatigue from the event.

PTS: 1 DIF: Moderate REF: V1, p. 825

KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Analysis

13. ANS: 1

Sleepwalking places the patient at Risk for Injury because of his lack of awareness of the surroundings. The nurses primary intervention would be to protect the patient from injury (e.g., falls) while sleepwalking, also called somnambulation. Because the child is only 6 years old, administering and teaching about medications and having him verbalize feelings would not be useful. Providing a quiet environment would likely be ineffective and certainly not the focus of interventions.

PTS: 1 DIF: Moderate REF: V1, p. 823

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

14. ANS: 4

Contrary to previous beliefs, stage III and IV of NREM (delta wave) are the deepest stage of sleepnot REM. It is difficult to awaken someone in stage IV slow wave NREM sleep, and if she is awakened, the person may appear confused and react slowly. Stage I NREM is a light sleep from which the sleeper can easily be awakened. Stage II (sleep spindles) is also light sleep; the sleeper in this stage is easily roused. REM sleep is the stage at which most dream activity occurs.

PTS: 1 DIF: Easy REF: V1, p. 816

KEY: Client need: HPM | Cognitive level: Recall

15. ANS: 1

Toddlers (ages 1 to 3 years) require 12 to 14 hours of sleep in a 24-hour period. Adolescents (ages 12 to 18 years) usually need 8 to 9 hours in a 24-hour period. Middle-aged adults (ages 40 to 65 years) typically require 7 hours in a 24-hour period. Older adults (age 65 years and older) often need 5 to 7 hours of sleep in a 24-hour period.

PTS: 1 DIF: Easy REF: V1, p. 814

KEY: Client need: HPM | Cognitive level: Recall

MULTIPLE RESPONSE

1. ANS: 1, 2, 3, 4

Age, environment, lifestyle, and state of health are factors affecting sleep. Older adults sleep less but require more rest. Alcohol usage is an example of a lifestyle factor that affects sleep. When a person is ill, she may sleep more or find that she cannot sleep because of pain or other factors associated with illness. Changes in environment also affect sleep.

PTS: 1 DIF: Easy REF: V1, pp. 818-819

KEY: Client need: PHSI | Cognitive level: Comprehension

2. ANS: 2, 4

Enuresis is nighttime incontinence past the stage at which toilet training has been well established. Most incidents occur during NREM sleep when the child is difficult to arouse. As the great majority of children outgrow enuresis, the best strategy is patience. In the meantime, protecting the mattress from moisture and odor will help reduce frustration and embarrassment.

PTS: 1 DIF: Moderate REF: V1, p. 823

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

3. ANS: 3, 4

Obstructive sleep apnea is caused by partial airway occlusion (usually by the tongue or palate) during sleep. The patient experiences interrupted sleep as he arouses frequently to clear the airway. As a result, the patient has episodes of snoring and daytime fatigue.

PTS: 1 DIF: Moderate REF: V1, p. 822

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Comprehension

COMPLETION

1. ANS: Sleep-provoked

PTS: 1 DIF: Moderate REF: V1, p. 823

KEY: Client need: HPM | Cognitive level: Comprehension

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