1. Which statement about sleep is accurate?
a. Lack of sleep causes medical and psychiatric disorders.
b. Adults generally require at least 5 hours of sleep every 24 hours.
c. During sleep an individual is not consciously aware of his or her environment.
d. Less than 10% of adults report at least one sleep problem, such as difficulty falling asleep.
2. What are clinical manifestations of insomnia (select all that apply)?
a. Narcolepsy b. Fragmented sleep c. Long sleep latency d. Morning headache e. Daytime sleepiness f. Difficulty concentrating 3. What is a typical parasomnia?
a. Cataplexy b. Hypopnea c. Sleep apnea d. Sleep terrors
4. What controls the cyclic changes between waking and sleep?
a. Fluctuating levels of melatonin b. The environmental light-dark cycles c. Suprachiasmatic nucleus in hypothalamus
d. A variety of neurotransmitters released from the nervous system
5. Match the descriptions to the stages of sleep. Some descriptions may have more than one stage, and some stages may be used more than once.
_____ a. Brain waves resemble wakefulness 1. NREM stage 1 2. NREM stage 2 3. NREM stage 3 4. REM _____ b. Deepest sleep
_____ c. Associated with specific EEG waveforms _____ d. Most vivid dreaming occurs _____ e. 20% to 25% of sleep _____ f. Person easily awakened _____ g. Most of the night of sleep _____ h. Slow eye movements
_____ i. Slowed heart rate, decreased body temperature _____ j. Decreased occurrence in older adults
6. List at least three behaviors or practices that can contribute to insomnia.
a.
b.
c.
7. A polysomnography (PSG) may be performed on a patient with signs and symptoms of a sleep disorder. What measures and observations does this study include (select all that apply)?
a. Heart rate monitoring
b. Noninvasive oxygen saturation (SpO2) c. Surface body temperature fluctuations d. Blood pressure monitoring (noninvasive)
e. Airflow measured at the nose and mouth
f. Muscle tone measured by electromyogram (EMG) g. Respiratory effort around the chest and abdomen h. Eye movements recorded by electrooculogram (EOG) i. Brain activity recorded by electroencephalogram (EEG) j. Actigraph watch worn on the wrist to monitor motor activity k. Gross body movements monitored via cameras and microphones 8. What is the best therapy to try first for insomnia?
a. Complementary therapies such as melatonin
b. Cognitive-behavioral therapies such as relaxation therapy c. Benzodiazepine-receptor agents (e.g., zolpidem [Ambien]) d. Over-the-counter medications such as diphenhydramine
9. The nurse knows that a patient taught sleep hygiene practices needs further instruction when he says
a. “Once I go to bed, I should get up if I am not asleep after 20 minutes.”
b. “It's okay to have my usual two glasses of wine in the evening before bed.”
c. “A couple of crackers with cheese and a glass of milk may help to relax before bed.”
d. “I should go to the gym earlier in the day so that I'm done at least 6 hours before bedtime.”
10. Patient-Centered Care: The patient is complaining of insomnia and daytime fatigue. Which beverage would be the best option for this patient with an afternoon snack?
a. Diet Coke b. Dr. Pepper
c. Decaffeinated coffee d. A&W root beer float
11. A nurse caring for a patient in the intensive care unit (ICU) implements strategies to create an environment conducive to sleep. Which strategy would be most effective?
a. Turning off the lights in the room during the night
b. Having the television on at all times for background noise c. Silencing the alarms on the bedside monitor and infusion pumps
d. Administering ordered analgesics around the clock, even if the patient denies pain
12. Which medication is a nonamphetamine wake-promotion drug that may be used for narcolepsy?
a. Modafinil (Provigil) b. Suvorexant (Belsomra) c. Protriptyline (Vivactil) d. Desipramine (Norpramin)
13. The nurse in a clinic is talking with a patient who will be traveling from the Midwest time zone to Moscow to attend a 4-day conference. The patient asks the nurse how he can minimize the effects of jet lag. What are at least two recommendations that the nurse could give to the patient?
14. Place the events below in the order they occur in the patient with obstructive sleep apnea (beginning with 1).
_____ a. Apnea lasting 10 to 90 seconds _____ b. Brief arousal and airway opened
_____ c. Generalized startle response, snorting, or gasping _____ d. Hypoxemia and hypercapnia
_____ e. Narrowing of air passages with muscle relaxation during sleep
_____ f. Risk factors: obesity, large neck circumference, craniofacial abnormalities, acromegaly, smoking
_____ g. Occurs 180 to 400 times during 6 to 8 hours of sleep
_____ h. Tongue and soft palate obstruct pharynx
15. The health care provider has ordered continuous positive airway pressure (CPAP) for a patient with serious obstructive sleep apnea. How will CPAP help the patient?
a. Prevent airway occlusion by bringing the tongue forward b. Be easily tolerated by both the patient and patient's bed partner
c. Provide enough positive pressure in the airway to prevent airway collapse
d. Deliver a high inspiratory pressure and a low expiratory pressure to prevent airway collapse 16. While caring for a patient following an uvulopalatopharyngoplasty (UPPP), the nurse monitors
the patient for which complications in the immediate postoperative period?
a. Snoring and foul-smelling breath b. Infection and electrolyte imbalance c. Loss of voice and severe sore throat d. Airway obstruction and hemorrhage
17. Patient-Centered Care: An older patient asks the nurse why she has so much trouble sleeping.
What is the most appropriate response by the nurse?
a. “Disturbed sleep is a normal result of aging.”
b. “Have you tried any over-the-counter medications to help you sleep?”
c. “Don't worry. You don't need as much sleep as you did when you were younger.”
d. “Tell me more about the trouble you are having. There may be some things we can do to help.”
18. Nurses who rotate shifts or work nights are at risk for developing shift work sleep disorder characterized by insomnia, sleepiness, and fatigue. Identify at least three negative implications for the nurse.
19. What strategies could decrease the distress of rotating shifts for nurses (select all that apply)?
a. Take a brief onsite nap.
b. Use sleep hygiene practices.
c. Sleep just before going to work.
d. Maintain consistent sleep/wake schedules even on days off (if possible).
e. Negotiate to control work schedule rather than having someone else impose the schedule.
Case Study
Sleep Disturbance
(©Rauluminate/iStock/Thinkstock)
Patient Profile
W.D., a 75-yr-old man with Parkinson's disease, was admitted to the hospital for surgical repair of a fractured hip. He fell when he slipped on a bathroom rug. He has a history of osteoarthritis, hypertension, heart failure, and type 2 diabetes mellitus.
Subjective Data
• States that his pain has increased over the past few hours
• Has a history of chronic insomnia and uses various over-the-counter sleep aids without relief
• Usually drinks a few glasses of wine at night while watching TV in his bed
• Lives alone and is very anxious about who will take care of him after surgery Interprofessional Care
• Surgery: Total hip replacement this afternoon
• Physical therapy: Visit presurgery to explain postoperative exercise routine
• Social worker: Determine social support available postoperatively Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What physiologic, psychologic, and lifestyle factors affected W.D.'s normal sleep?
2. What further assessments should the nurse complete?
3. What additional factors may now affect W.D.'s sleep?
4. When the HCP orders flurazepam 30 mg for sleep the night before surgery, how should the nurse respond?
5. What complications can occur related to W.D.'s chronic difficulty sleeping and his surgery?
6. Patient-Centered Care: Describe priority nursing interventions that can be implemented for W.D.
to enhance his sleep?
7. Priority Decision: Based on the assessment data and his upcoming total hip replacement, what should the nurse expect for nursing diagnoses postoperatively? Are there any collaborative problems?
8. Patient-Centered Care: What should be included in W.D.'s discharge teaching?