ELIOPOULOS , GERONTOLOGICAL NURSING 8TH EDITION REST AND SLEEP EXAM Q&A WITH CORRECT SOLUTIONS

ELIOPOULOS , GERONTOLOGICAL NURSING 8TH EDITION REST AND SLEEP EXAM Q&A WITH CORRECT SOLUTIONS The nurse is identifying the different sleep patterns of assigned patients on a geriatric care unit. Which patient is demonstrating the typical sleep pattern of a patient who is older? A) Age 82 patient sleeps a total of more than 12 hours out of 24B) Age 90 patient describes the quality of sleep as "better than it ever was"C) Age 80 patient falls asleep early in the evening but wakes up before dawnD) Age 79 patient sleeps in until 9 o'clock each morning despite a lifetime of early rising - CORRECT ANSWER-Ans: C Feedback:The patient who falls asleep early in the evening but wakes up before dawn is demonstrating the behavior of phase advance. The other patients are not demonstrating typical sleep patterns of an older person. An older patient suffering from chronic exhaustion has an EEG that shows little time is spent in REM sleep. After reviewing the patient's history, what does the nurse suspect might be contributing to the patient's sleep problem? A) Has two or three glasses of wine near bedtime B) Obese and diagnosed with type 2 diabetes 6 years ago C) Takes low-dose aspirin for the prevention of heart disease D) Stressed due to the spouse's new diagnosis of Alzheimer disease - CORRECT ANSWER-Ans: A Feedback:Certain drugs can decrease REM sleep, including alcohol. The use of aspirin has not been associated with decreased REM sleep. Obesity, type 2 diabetes, and stress have not been linked to specifically reducing the amount of REM sleep although these health problems can negatively impact sleep overall. An older patient hospitalized for pneumonia is having difficulty sleeping and is frustrated with the noises at night. What should the nurse do about this situation? A) Obtain an order for a benzodiazepine to be taken at bedtime B) Change the temperature of the client's room to be more conducive to sleep C) Provide a form of white noise and plan to minimize noise during caregiving activities D) Teach the client about the normal changes in sleep quality and quantity that accompany aging - CORRECT ANSWER-Ans: C Feedback:Reorganizing care to avoid awakening and providing white noise can facilitate sleep. These actions would be preferable to pharmacologic measures while changing the temperature does not specifically address the patient's concerns. Teaching on sleep changes would be inappropriate given the nature and context of the patient's concerns. An older patient is experiencing restless legs that are interfering with sleep. What should the nurse respond to this patient's problem? A) "Some people find that daily exercise helps with this problem." B) "Most often restless legs can be traced to a deficiency in dietary calcium." C) "There are prescription drugs that nearly always provide relief from this problem." D) "There are a number of different medications that can cause this problem or make it worse." - CORRECT ANSWER-Ans: D Feedback:Antidepressants, antihistamines, antipsychotics, alcohol, caffeine, hypoglycemia, and simple and refined carbohydrates can contribute to restless legs syndrome. Exercise and medications are not noted to provide a solution and calcium is not noted to be implicated in the etiology. An older patient complains of overwhelming daytime fatigue, which the spouse attributes to loud snoring and erratic breathing patterns during the night. Which health problem should the nurse suspect as causing this patient's fatigue? A) Insomnia B) Central sleep apnea C) Nocturnal myoclonus D) Obstructive sleep apnea - CORRECT ANSWER-Ans: D Feedback:Obstructive sleep apnea is characterized by periods without breathing during sleep and is most often accompanied by snoring. Central sleep apnea is not as frequently marked by snoring and neither insomnia nor nocturnal myoclonus is suggested by the patient's particular signs and symptoms. Which patient on a geriatric medicine unit would the nurse recognize as being most prone to sleep problems? A) An obese female patient receiving IV antibiotics for the treatment of a urinary tract infection B) A 74-year-old female receiving transfusions of packed red blood cells for an upper GI bleed C) A 78-year-old male recovering from an ischemic stroke and has skin breakdown on the coccyx D) A male patient admitted for exacerbation of chronic obstructive pulmonary disease (COPD) with a history of angina - CORRECT ANSWER-Ans: D Feedback:COPD and conditions involving cardiac ischemia are often associated with sleep problems. Infections, ischemic stroke, skin breakdown, and GI bleeds are not noted to be specifically associated with sleep difficulties. An older patient with multiple health problems asks the nurse for advice about recurrent insomnia. Which statement made by the nurse is most accurate? A) "Caffeine obviously makes it hard for you to sleep, while a moderate amount of alcohol at bedtime is useful." B) "You should try over-the-counter sleep aides for several weeks before you move on to prescription options." C) "It's very normal for the quality of sleep to decrease with age, so this is usually a problem that requires accommodation rather than treatment." D) "A lot of medications have the potential to interfere with sleep, so it would be useful to review your medications with your physician or a pharmacist." - CORRECT ANSWER-Ans: D Feedback:Numerous medications are noted to be detrimental to sleep in older adults. Nonprescription sleep aides carry risks, and alcohol is not a recommended intervention. While sleep quality does decrease with age, this does not mean that measure cannot be taken to address the problem. An older resident of a long-term care facility has recently been prescribed a nonbarbiturate sedative. For which effect should the nurse assess in this patient? A) Anticholinergic effects B) Daytime sedation and confusion C) Respiratory depression and sleep apnea D) Changes in blood pressure and heart rate - CORRECT ANSWER-Ans: B Feedback:Patients who are receiving sedation should be monitored for daytime sluggishness and confusion. Heart rate and blood pressure are not noted to be affected by these drugs and they are not associated with anticholinergic effects. Respiratory depression and sleep apnea are not noted to result from non-barbiturate sedati Because many residents in a long-term care facility are experiencing sleep problems, which routine should the nurse reevaluate? A) Offering a light snack at bedtime B) Bathing residents in the evening rather than first thing in the morning C) Activities are concentrated in the morning to ensure evenings are free D) Encouraging residents to refrain from going to bed when they first feel drowsy in the evening - CORRECT ANSWER-Ans: C Feedback:It is preferable to intersperse activities throughout the day rather than concentrating them in the morning. A bath and a snack in the evening are both conducive to sleep and going to bed too early is not conducive to sustained sleep. What should the nurse keep in mind when determining the relationship between pain and sleep in an older patient? A) Nonpharmacologic measures to control pain and enhance sleep are preferable to analgesics. B) Analgesic drugs should be administered to older adults to prevent potential episodes of pain. C) Older adults are more sensitive to pain than younger adults, and more at risk of having pain interfere with sleep. D) The availability of alternative forms of pain control such as massage and diversion means that pharmacologic pain medications are inappropriate and unnecessary. - CORRECT ANSWER-Ans: A