The nurse is aware that the initial entry to deep sleep is:
stage 1 nonrapid eye movement (NREM).
stage 3 NREM.
stage 5 NREM.
rapid eye movement (REM) sleep.
The phenomenon of sleep walking is most likely to occur in the sleep stage of:
stage 1 NREM.
stage 2 NREM.
stage 4 NREM.
REM sleep.
The nurse explains that older adults often experience a disturbed sleep-wake cycle because of hormonal changes, which include a(n) _____ level.
increase in angiotensin
decrease in insulin
increase in growth hormone
decrease in melatonin
The older man in a long-term care facility consistently wakes at 3 AM and does not return to sleep. The nurse records this behavior as _____ insomnia.
sleep initiation
sleep maintenance
terminal
undifferentiated
The newly admitted older adult who cannot fall asleep and asks for a sedative every night is most probably experiencing a difficulty with sleep:
initiation related to anxiety of relocation.
maintenance related to unfamiliar environment.
initiation related to depression associated with relocation.
maintenance related to episodes of nocturnal movement disorders.
The home health nurse assesses that the patient is probably experiencing myoclonus when his wife says:
“His loud snoring and jerking awake wakes me up, too.”
“I am black and blue from his kicking me every night.”
“He wakes up at 2 AM every morning and walks around the house.”
“His constant leg movements tear up the covers and keep me awake.”
The nurse would question the order for lorazepam (Ativan), 5 mg at bedtime, for a patient with:
chronic obstructive pulmonary disease (COPD).
any form of dementia.
hypertension.
sleep apnea.
In order to assist a 75-year-old male resident in a long-term care facility to decrease his problems with sleep initiation, the nurse would:
provide a heavy snack at bedtime.
reschedule the 8 PM albuterol inhalation treatment to 4 PM.
coach the resident in 10 minutes of exercise before bedtime.
provide a cola drink, strong tea, or cocoa at bedtime.
The nurse cautions the patient who has just started on the antidepressant trazodone hydrochloride to help relieve insomnia to:
increase fluids.
avoid aged cheese and red wine.
decrease sodium intake.
avoid excessive exposure to the sun.
The 80-year-old man complains that when he goes to bed and cannot fall asleep, he tosses and turns and gets so frustrated that he gets up and drinks coffee all night. The nurse suggests that when he has not fallen asleep after 30 minutes, he should:
take two tablets of a sedative medication.
get up and do a mild stretching exercise for 15 minutes.
remain in bed with his eyes closed.
get up and read until he feels sleepy and then return to bed.
The nurse clarifies that the continuous positive airway pressure (CPAP) machine decreases the incidence of episodes of sleep apnea by:
stimulating inspiration to be deeper.
taking over respiratory activity when the patient ceases to breathe.
sounding an alarm if respirations have ceased.
keeping alveoli from collapsing.
When the patient tells the home health nurse that he has flung himself out of bed three times in the course of a violent nightmare, the nurse recognizes the cardinal indicator of:
myoclonus.
restless legs syndrome.
rapid eye movement (REM) sleep disorder.
epilepsy.
The nurse cautions that although activity and exercise during the day are an effective sleep aid, activity and exercise should be avoided within _____ before bedtime.
30 minutes
1 hour
2 hours
3 hours
The patient is encouraged to decrease fluid intake in the late evening to prevent interruption of sleep from:
increased digestive processes in the bowel.
episodes of nocturia.
gastroesophageal reflux.
changes in body temperature.
The nurse makes arrangements to promote normal circadian rhythm in a long-term care facility by ensuring that all rooms have:
bright lights during the daytime.
dim lights to promote relaxation.
appropriate environmental temperature.
curtains for privacy.
The nurse is aware that an older adult’s diurnal patterns can be altered by __________. (Select all that apply.)
shift work
time zone changes
altered nutrition
illness
medications
The long-term care facility nurse takes into consideration that most residents go to sleep early and awaken early because of __________. (Select all that apply.)
increased blood pressure
drop in core temperature
diminished food intake
diminished hormone production
decreased exposure to light
The nurse gives the antihistamine diphenhydramine (Benadryl) as a sleep aid with caution because the older adult may experience side effects, such as __________. (Select all that apply.)
confusion
urinary retention
hypotension
depression of respiration
diarrhea
When mild sedation has failed to solve the problem of insomnia in the older adult, the nurse suggests __________. (Select all that apply.)
relaxation therapy
taking a cool bath or shower before bedtime
listening to relaxing music
arranging the sleep environment to promote sleep
going to bed at a regular time after observing routine “sleep rituals”
The nurse explains that factors that contribute to sleep apnea include __________. (Select all that apply.)
obesity
diabetes
African American heritage
use of alcohol
The wife of a patient tells the home health nurse that she suspects her husband has sleep apnea because he __________. (Select all that apply.)
snores loudly
interrupts snoring with several seconds of silence
complains of daytime drowsiness
frequently is incontinent of urine
has episodes of myoclonus
The nursing staff helps encourage sleep in long-term care facility residents by __________. (Select all that apply.)
using the minimum light necessary when making rounds
making necessary sleep interruptions at the same time every night
keeping conversational noise at the nursing station to a minimum
answering call lights promptly
providing heavy blankets for warmth
Heavy blankets may initially feel warm to the resident but eventually make the resident uncomfortable and unable to sleep. All other options listed will help diminish sleep interruptions. DIF: Cognitive Level: Comprehension REF: 332-333 OBJ: 7 TOP: Sleep Support KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
inability to sleep throughout the night
sleeping soundly all night
increase in the number of hours asleep at night
difficulty in arousing from deep sleep
waking up early
The nurse assesses that the resident may be experiencing changes in sleep and rest patterns when she states__________. (Select all that apply.)
“I don’t know why everything seems to bother me lately.”
“I’ve been so clumsy."
“I’m having trouble concentrating.”
“My daughter says I talk in my sleep.”
“I cry for no reason at all.”
