Chapter 43 Sleep-Fundamentals of Nursing

Chapter 43: Sleep ra ra




MULTIPLE CHOICE ra



1. The nursing attendant is caring for a young-
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adult hospital client on the medical surgical unit. When doing midnight checks, the nursing atte
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ndant observes the hospit ra ra ra



al client awake, putting a puzzle together. Which information will the nursing attenda
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nt consider to best explain this finding?
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a. The hospital client misses family and is lonely.
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b. The hospital client was waiting to talk with the nursing attendant .
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c. The hospital client has been kept up with the noise on the unit.
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d. The hospital client ’s sleep-wake cycle preference is late evening.
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ACCURATE ANSWER:-D ra



This hospital client is awake and alert enough to do a puzzle. The individual’s sleepwake prefere
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nce is probably late evening. All persons have biological clocks that synchronize
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their sleepwake cycle. This explains why some individuals fall asleep in the early evening, where
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as oth ra



ers go to bed at midnight or early morning. Waiting to talk with the nursing attendant , bein
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g lonely, and noise on the unit may contribute to lack of sleep, but the best explanation for t
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he hospital client being awake is the biological clock.
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DIF:Analyze (analysis) ra



OBJ:Explain the effects that the 24- ra ra ra ra ra



hour sleepwake cycle has on biological function. TOP:Evaluation
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MSC: Basic Care and Comfort ra ra ra ra




2. The nursing attendant is providing an educational session on sleep regulation for new nursin
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g attendant s in the Sleep Disorder Treatment Center. Which statement by the nursing atten
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dant s will best indicate that the teaching is effective?
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a. ―If the hospital client has a disease process in the central nervous system, it can in
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fluence the functions of sleep.‖ ra ra ra ra




b. ―If the hospital client has a disease process in the cranial nerves, it can in
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fluence the functions of sleep.‖ ra ra ra ra




c. ―If the hospital client has an interruption in the urinary pathways, it can i
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nfluence the functions of sleep.‖ ra ra ra ra




d. ―If the hospital client has an interruption in the spinal reflexes, it can i
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nfluence the functions of sleep.‖ ra ra ra ra




ACCURATE ANSWER:-A ra



Sleep involves a sequence of physiological states maintained by the central nervous system. It is
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associated with changes in the peripheral nervous, endocrine, cardiovascular, respiratory, an
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d muscular systems. A disease process associated with the cranial nerves, urinary pathway, or
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spinal reflexes may influence a person’s ability to sleep, but the best answer is the central ner
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vous system. ra




DIF:Analyze (analysis) OBJ:Summarize mechanisms that regulate sleep. TOP:Teaching/Learning
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MSC: Physiological Adaptation ra ra

,3. The nursing attendant is caring for a hospital client who reports having difficulty sleeping.
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Which action will the nursing attendant take? a. Suggest snug-fitting nightwear.
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b. Provide a favorite beverage. ra ra ra




c. Encourage deep breathing. ra ra




d. Walk with the hospital client . ra ra ra ra ra




ACCURATE ANSWER:-C ra



Relaxation exercises such as slow, deep breathing for 1 or 2 minutes relieve tension and
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prepare the body for rest. Instruct hospital client s to wear loosefitting nightwear. Walking and
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drinking a favorite beverage would not necessarily enco urage sleep.
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DIF:Apply (application) ra



OBJ:Summarize mechanisms that regulate sleep. TOP:Implemen tation MSC: ra ra ra ra ar



Basic Care and Comfort ra ra ra




4. The nursing attendant is caring for a hospital client in the sleep lab. Which assessment
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finding indicates to the nursing attendant that the hospital client is in stage 4 NREM? a.
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The hospital client awakens easily.
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b. The hospital client ’s eyes rapidly move.
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c. The hospital client is difficult to awaken.
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d. The hospital client ’s vital signs are elevated.
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ACCURATE ANSWER:-C ra



The quality of sleep from stage 1 through stage 3 becomes increasingly deep. Lighter sleep is cha
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racteristic of stages 1 and 2, when a person is more easily arousable. Stage 3 (former stages 3 a
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nd 4) involves a deeper sleep called slowwave sleep, from which a person is more difficult to arou
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se.

DIF:Apply (application) ra



OBJ:Outline the stages of a normal sleep cycle. TOP:Assessment ra ra ra ra ra ra ra ar



MSC: Basic Care and Comfort ra ra ra ra




5. A nursing attendant is teaching the staff about the sleep cycle. Which period lasts 10 to 3
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0 minutes?
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a. NREM Stage 2 ra ra




b. NREM Stage 1 ra ra




c. REM
d. Pre-sleep
ACCURATE ANSWER:-D ra



Normally an adult’s routine sleep pattern begins with a presleep period during which the per
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son is aware only of a gradually developing sleepiness. This period normally lasts 10 to 30 minu
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tes. Once asleep a person usually passes through four to six complete sleep cycles, each cycle
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consisting of three stages of NREM sleep and a period of REM sleep, for a total of 90 to 110 min
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utes.

DIF:Understand (comprehension) ra



OBJ:Outline the stages of a normal sleep cycle. T OP:Teaching/Learning MSC: ra ra ra ra ra ra ra ar ra



Physiological Adaptation ra

, 6. Which nursing observation of the hospital client in intensive care indicates the hospital
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client is sleeping comfortably during NREM sleep?
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a. Eyes closed, lying quietly, respirations 12, heart rate 60
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b. Eyes closed, tossing in bed, respirations 18, heart rate 80
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c. Eyes closed, mumbling to self, respirations 16, heart rate 68
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d. Eyes closed, lying supine in bed, respirations 22, heart rate 66
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ACCURATE ANSWER:-A ra



During NREM sleep, biological functions slow. During sleep, the heart rate decreases to 60
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beats/min or less. The hospital client experiences decreased respirations, blood pressure, an
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d muscle tone. Heart rates above 60 are too high and respirations of 22 are too high to indicat
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e comfortable NREM sleep.
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DIF:Analyze (analysis) ra



OBJ:Explain the functions of sleep. TOP:Assessment ra ra ra ra ar



MSC: Basic Care and Comfort ra ra ra ra




7. The nursing attendant is teaching a new mother about the sleep requirements of a n
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eonate. Which comment by the hospital client indicates a correct understanding of the teaching?
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a. ―I can’t wait to get the baby home to play with the brothers and sisters.‖
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b. ―I will ask my mom to come after the first week, when the baby is more alert.‖
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c. ―I can get the baby on a sleeping schedule the first week while my mom is here.‖
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d. ―I won’t be able to nap during the day because the baby will be awake.‖
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ACCURATE ANSWER:-B ra



The hospital client indicates an understanding when asking the mother to come after the firs
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t week. The neonate up to the age of 3 months averages about 16 hours of sleep a day, sleeping al
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most constantly during the first week. The baby will sleep rather than play. The baby will no
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t be on a sleeping schedule the first week home. The mother will be able to nap since the baby
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sleeps 16 hours a day.
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DIF:Analyze (analysis) ra



OBJ:Compare and contrast the sleep requirements of different agegroups. TOP:Teaching/Learning
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MSC: Health Promotion and Maintenanc e ra ra ra ra




8. The nursing attendant is discussing lack of sleep with a middleaged adult. Which area s
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hould the nursing attendant ar ra ra



most likely assess to determine a possible cause of the lack of sleep? a. Anxiety
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b. Loud teenagers ra




c. Caring for pets ra ra




d. Late night television ra ra




ACCURATE ANSWER:-A ra



During middle adulthood, the total time spent sleeping at night begins to decline. Anxiety, de
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pression, and certain physical illnesses can affect sleep, and women can experience menopaus
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al symptoms. Insomnia is common because of the changes and stresses associated with middl
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e age. Teenagers, caring for pets, and latenight television can influence the amount of sleep; howe
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ver, these are not the most common ca uses of insomnia in this age-group.
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DIF:Apply (application) ra



OBJ:Compare and contrast the sleep requirements of different agegroups. TOP:Assessme
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nt MSC: Basic Care and Comfort ra ra ra ra