Deck 22: Clients with Sleep and Rest Disorders and Fatigue

Question 1

When a client who has severe gastroesophageal reflux during sleep asks how to improve sleep, the nurse would suggest that the client

A) avoid antacid use.
B) decrease caffeine intake.
C) eat six small meals a day.
D) raise the head of the bed on blocks.

Answer 1

raise the head of the bed on blocks.

Question 2

After a client's discharge from the critical care unit to the step-down unit after a myocardial infarction, the nurse assesses the client carefully during sleep because

A) anxiety relative to the recent myocardial infarct may cause sleep disorders.
B) apnea is more common immediately after myocardial infarction.
C) breathing abnormalities may result in hypoxia.
D) REM rebound may occur, placing greater demands on the heart.

Answer 2

REM rebound may occur, placing greater demands on the heart.

Question 3

A nurse is teaching a community group good sleep hygiene practices. Steps that individuals can take to improve their sleep include (Select all that apply)

A) allowing for one or two restful daytime naps per day.
B) avoiding vigorous exercise within 3 hours of bedtime.
C) establishing a regular bedtime routine associated with preparing for sleep.
D) if you wake at night, work quietly in bed and avoid getting up.
E) maintaining a regular sleep-wake pattern throughout the week.

Answer 3

avoiding vigorous exercise within 3 hours of bedtime.
establishing a regular bedtime routine associated with preparing for sleep.
maintaining a regular sleep-wake pattern throughout the week.

Question 4

During rapid eye movement (REM) sleep, there is an increase in the neurotransmitter

A) acetylcholine.
B) dopamine.
C) norepinephrine.
D) serotonin.

Question 5

The nurse explains to a client with severe depression and who takes tricyclic antidepressants that the effectiveness of this type of medication may be a result of

A) increased stage 4 sleep.
B) prevention of night awakenings.
C) prevention of sleep terrors.
D) suppression of REM sleep.

Question 6

A hospitalized client complains that the loud noise and activity outside the room hinders sleep. The physician leaves an order for a hypnotic agent. The night nurse administering this medication needs to monitor client safety afterwards because these medications may cause (Select all that apply)

A) antegrade amnesia.
B) hangover effects.
C) increased falls and hip fractures.
D) less time in REM sleep.
E) restless leg syndrome.

Question 7

Most sleeping time is spent in

A) REM sleep.
B) stages 1 and 2 sleep.
C) stage 4 sleep.
D) very light sleep.

Question 8

A client with emphysema reports fatigue and non-refreshing sleep. The nurse explains that emphysema will affect sleep in that the client will have

A) a longer sleep latency period.
B) limited time spent in slow-wave sleep.
C) difficulty in maintaining slow-wave sleep.
D) difficulty in maintaining REM sleep.

Question 9

When a client tells the nurse that she has been experiencing early-morning awakening, the nurse should assess the client for manifestations of

A) depression.
B) psychophysiologic insomnia.
C) respiratory problems.
D) sleep deprivation.

Question 10

The nurse would explain to a client with a sleep disorder that alcohol intoxication

A) decreases REM sleep.
B) increases sleep latency.
C) increases stage 4 sleep.
D) promotes periodic limb movements.

Question 11

A client has mild obstructive sleep apnea syndrome (OSAS). The nursing teaching plan should include information regarding

A) alternate sleeping positions.
B) breathing exercises.
C) foods high in vitamin B2.
D) scheduling regular naps.

Question 12

The nurse explains that clients with narcolepsy often also experience cataplexy, which is a/an

A) inability to move for several minutes on awakening.
B) seizure-like episode with tonic and clonic movements.
C) sudden loss of muscle tone that lasts for several minutes.
D) trance-like period of 5 minutes or more.

Question 13

The nurse arranges the client care to prevent waking the older adult because the sleep patterns of older clients are characterized by

A) increased REM sleep.
B) increased time spent in stage 1 sleep.
C) increased time spent in stage 4 sleep.
D) decrease in time to fall asleep.

Question 14

A client with severe emphysema had a myocardial infarction and is hospitalized on the telemetry unit. The night nurse notices that the client has frequent dysrhythmias. The priority action for the nurse would be to check the client's

A) cardiac enzymes.
B) electrocardiogram.
C) electrolyte values.
D) oxygen saturation.

Question 15

The substance produced in the body that acts a strong sleep inducer is

A) acetylcholine.
B) melanin.
C) melatonin.
D) serotonin.

Question 16

The nurse explains to a client with periodic limb movement disorder that the drug that might be helpful in alleviating the clinical manifestations of this sleeping disorder is

A) amitriptyline (Elavil).
B) carbidopa/levodopa (Sinemet).
C) fluoxetine (Prozac).
D) haloperidol (Haldol).

Question 17

To best promote improved sleep patterns for the hospitalized client, the nurse should

A) administer mild sleeping medications.
B) limit television and radio music during the night.
C) provide a light, complex-carbohydrate snack.
D) wake the client only during REM sleep.

Question 18

The nurse teaching a client with narcolepsy should include the

A) importance of avoiding caffeine.
B) need to increase exercise.
C) proper way to use continuous positive-airway pressure (CPAP).
D) recommendation to take regular naps.

Question 19

During assessment of a client who complains of frequent sleep starts, the nurse should question the client regarding

A) alcohol intake.
B) caffeine intake.
C) food intake before bedtime.
D) medication intake.

Question 20

A client with chronic fatigue syndrome is crying and says "I can't do anything anymore. I can't even walk up a flight of stairs because I am so tired all the time. My spouse thinks I am just lazy, but I simply can't do anything that requires physical activity." Nursing interventions for this client should focus on

A) discovering the cause of the fatigue and correcting it.
B) helping the client manage and cope effectively.
C) showing the client how to plan and group activities.
D) working with the client to improve communicating needs to the spouse.