Chapter 9: Sleep and Sleep Disorders My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 9: Sleep and Sleep Disorders

Test Bank

MULTIPLE CHOICE

1. To assist in determining whether a patient seen in the ambulatory care setting has chronic insomnia, the nurse will initially

a.

schedule a polysomnography (PSG) study.

b.

arrange for the patient to have a sleep study.

c.

ask the patient to keep a 2-week sleep diary.

d.

teach the patient about the use of an actigraph.

ANS: C

The diagnosis of insomnia is made on the basis of subjective complaints and an evaluation of a 1- to 2-week sleep diary completed by the patient. Actigraphy and PSG studies/sleep studies may be used for determining specific sleep disorders, but are not necessary to make an initial insomnia diagnosis.

DIF: Cognitive Level: Application REF: 116

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

2. Which instruction will the nurse include when teaching a patient with chronic insomnia about ways to improve sleep quality?

a.

Avoid aerobic exercise during the day.

b.

Read in bed for a few minutes each night.

c.

Keep the bedroom temperature slightly warm.

d.

Try to go to bed at the same time every evening.

ANS: D

A regular evening schedule is recommended to improve sleep time and quality. Aerobic exercise may improve sleep quality, but should occur at least 6 hours before bedtime. Reading in bed is discouraged for patients with insomnia. The bedroom temperature should be slightly cool.

DIF: Cognitive Level: Application REF: 116

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

3. After the nurse has taught a patient about the use of extended-release zolpidem (Ambien CR) for insomnia, which patient statement indicates a need for further teaching?

a.

I will take the medication an hour before bedtime.

b.

I should take the medication on an empty stomach.

c.

I should not take this medication unless I can sleep for at least 6 hours.

d.

I will schedule activities that require mental alertness for later in the day.

ANS: A

Benzodiazepine receptor agonists such as zolpidem work quickly and should be taken immediately before bedtime. The other patient statements are correct.

DIF: Cognitive Level: Application REF: 116 | 119 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

4. Which action is best for the nurse to include in the plan of care in order to improve sleep quality for a critically ill patient in the intensive care unit (ICU)?

a.

Ask all visitors to leave the ICU for the night.

b.

Lower the level of light from 8:00 PM until 7:00 AM.

c.

Avoid the use of opioids for pain relief during the evening hours.

d.

Schedule assessments to allow at least 4 hours of uninterrupted sleep.

ANS: B

Lowering the level of light will help mimic normal day/night patterns and maximize the opportunity for sleep. Although frequent assessments and opioid use can disturb sleep patterns, these actions are necessary for the care of critically ill patients. For some patients, having a family member or friend at the bedside may decrease anxiety and improve sleep.

DIF: Cognitive Level: Application REF: 119 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

5. Which information will the nurse plan to include when teaching a patient with narcolepsy about management of the disorder?

a.

Stimulant drugs should be used for only a short time because of the risk for abuse.

b.

Driving an automobile may be possible with appropriate treatment of narcolepsy.

c.

Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.

d.

Antidepressant drugs are prescribed to treat the depression caused by the disorder.

ANS: B

The accident rate for patients with narcolepsy who are receiving appropriate treatment is similar to the general population. Stimulant medications are used on an ongoing basis for patients with narcolepsy. The purpose of antidepressant drugs in the treatment of narcolepsy is the management of cataplexy, not to treat depression. Changes in sleep hygiene are recommended for patients with narcolepsy to improve sleep quality.

DIF: Cognitive Level: Application REF: 119-120 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

6. Which action by the nurse manager of an acute care unit will improve the alertness of nurses who must work the night shift?

a.

Arrange for older staff members to work most night shifts.

b.

Provide a sleeping area for staff to use for napping at night.

c.

Post reminders about the relationship of sleep and alertness.

d.

Schedule nursing staff to rotate day and night shifts monthly.

ANS: B

Short on-site naps will improve alertness. Rotating shifts causes the most disruption in sleep habits. Reminding staff members about the impact of lack of sleep on alertness will not improve sleep or alertness.

DIF: Cognitive Level: Application REF: 123-124

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

7. The nurse takes the health history for four patients in the clinic. Which information regarding the patients sleep is most important to communicate to the health care provider?

a.

A 21-year-old student takes melatonin to assist in sleeping when traveling from the United States to Europe.

b.

A 32-year-old who is experiencing a stressful week uses diphenhydramine (Benadryl) for several nights.

c.

A 41-year-old with a body mass index (BMI) of 42 kg/m2 says that the spouse complains about the patients snoring.

d.

A 64-year-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning.

ANS: C

The patients BMI and snoring suggest possible sleep apnea, which can cause complications such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to be affecting this patients sleep quality.

DIF: Cognitive Level: Analysis REF: 120-121

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

8. Which of these actions should the nurse take first for a patient in the clinic who is complaining of insomnia and daytime fatigue?

a.

Question the patient about the use of over-the-counter (OTC) sleep aids.

b.

Suggest that the patient decrease intake of caffeine-containing beverages.

c.

Advise the patient to get out of bed if unable to fall asleep in 10 to 20 minutes.

d.

Recommend that the patient use any prescribed sleep aids for only 2 to 3 weeks.

ANS: A

The nurses first action should be assessment of the patient for factors that may contribute to poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions may be appropriate, but assessment is needed first to choose appropriate interventions to improve the patients sleep.

DIF: Cognitive Level: Application REF: 118

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9. A patient with sleep apnea who received a new prescription for a continuous positive airway pressure (CPAP) device a week ago returns to the clinic and says that severe daytime fatigue is still a problem. Which action should the nurse take first?

a.

Teach about radiofrequency ablation.

b.

Plan to schedule a night time PSG study.

c.

Ask the patient whether the CPAP is being used every night.

d.

Discuss the possible surgical approaches used for sleep apnea.

ANS: C

CPAP is very effective in reducing sleep apnea, but compliance is frequently a problem. Surgery, radiofrequency ablation, or a follow-up PSG study may be indicated, but the nurses first action should be to assess whether the CPAP is being used as prescribed.

DIF: Cognitive Level: Application REF: 121-122

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

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