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Urden: Priorities in Critical Care Nursing, 6th Edition
Chapter 05: Sleep Alterations
Test Bank
MULTIPLE CHOICE
1. Which stage of non-rapid eye movement sleep is associated with anabolic processes?
| a. | 1 |
| b. | 2 |
| c. | Slow wave sleep |
| d. | REM |
ANS: D
The release of other hormones, such as prolactin and testosterone, suggests that anabolism is occurring during the slow-wave sleep.
DIF:Cognitive Level: KnowledgeREF:38
OBJ:Nursing Process: DiagnosisTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
2. What occurs physiologically during rapid eye movement (REM) sleep?
| a. | Growth hormone is secreted. |
| b. | Metabolic needs are decreased. |
| c. | Sympathetic nervous system predominates. |
| d. | Heart rate and blood pressure decrease. |
ANS: C
The sympathetic nervous system predominates during REM sleep. Oxygen consumption increases, and cardiac output, blood pressure, heart rate, and respiratory rate may become erratic.
DIF:Cognitive Level: KnowledgeREF:38
OBJ:Nursing Process: AssessmentTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
3. Interventions to help with sleep disruptions include:
| a. | opening the window blinds. |
| b. | encouraging the patient to take frequent naps during the day. |
| c. | administering sedatives at bedtime. |
| d. | keeping the patient awake during the early morning hours. |
ANS: A
Nursing interventions that maintain normal rhythm of the day-night cycle, such as opening window blinds, should be encouraged.
DIF:Cognitive Level: ApplicationREF:37
OBJ:Nursing Process: InterventionTOP:Sleep
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
4. Ms. C has been in the critical care unit for 3 weeks and has been on the intra-aortic balloon pump for the past 3 days. Her condition has been serious, and hourly assessments and vital signs have been necessary. The nursing staff has noted that she has been unable to achieve sleep for more than 30 minutes at a time. She has been given diazepam (Valium) as needed. The anticipated effect of diazepam on Ms. C’s sleep is
| a. | a decrease in NREM stage 1. |
| b. | an increase in NREM stages 3 and 4. |
| c. | total NREM suppression. |
| d. | REM suppression in larger doses. |
ANS: D
Diazepam increases NREM stage 1 and reduces NREM stages 3 and 4 and REM. REM suppression is dose related.
DIF:Cognitive Level: ApplicationREF:Table 5-1
OBJ:Nursing Process: EvaluationTOP:Sleep Alterations
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. Ms. C has been in the critical care unit for 3 weeks and has been on the intra-aortic balloon pump for the past 3 days. Her condition has been serious, and hourly assessments and vital signs have been necessary. The nursing staff has noted that she has been unable to achieve sleep for more than 30 minutes at a time. She has been given diazepam (Valium) as needed. Which techniques may assist in assessing Ms. C’s sleep pattern?
| a. | Correlating sleep time with vital signs |
| b. | Documenting sleep periods of more than 90 minutes |
| c. | Assessing degree of arousal on hourly checks |
| d. | Observing the length of NREM sleep periods |
ANS: B
Keeping a sleep chart for 48 to 72 hours and documenting sleep periods greater than 90 minutes, number and length of awakenings, and total possible sleep time can help assess sleep patterns in the critical care unit.
DIF:Cognitive Level: ApplicationREF:39
OBJ:Nursing Process: InterventionTOP:Sleep
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
6. Which stage of sleep is associated with muscle atonia?
| a. | NREM sleep |
| b. | REM sleep |
| c. | Stage 1 |
| d. | Stage 2 |
ANS: B
REM sleep is associated with paralysis of the skeletal muscles.
DIF:Cognitive Level: KnowledgeREF:38
OBJ:Nursing Process: DiagnosisTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
7. Sedative hypnotics:
| a. | promote deeper sleep stages. |
| b. | can produce prolonged effects in older adults. |
| c. | are metabolized more rapidly in the presence of steroids. |
| d. | enhance short-term recall. |
ANS: B
Sedative-hypnotics have a higher lipophilicity, resulting in increased half-life in older adults. They also promote lighter sleep stages, are potentiated by steroids, and cause memory failure.
DIF:Cognitive Level: KnowledgeREF:Table 5-1
OBJ:Nursing Process: InterventionTOP:Sleep Alterations
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. Which of the following patients would the nurse most strongly suspect of having obstructive sleep apnea?
| a. | A severely obese woman with diabetes |
| b. | A moderately obese man who snores |
| c. | A non-obese woman with hypertension |
| d. | A severely obese man with renal dysfunction |
ANS: B
Obesity associated with snoring is a hallmark of obstructive sleep apnea.
DIF:Cognitive Level: AnalysisREF:39
OBJ:Nursing Process: AssessmentTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Physiological Adaptation
9. Which of the following factors is the most important regulator of circadian rhythm?
| a. | Social activity |
| b. | Exercise |
| c. | Meals |
| d. | Light |
ANS: D
Light is the most important regulator of circadian rhythms.
DIF:Cognitive Level: KnowledgeREF:37
OBJ:Nursing Process: InterventionTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
10. Which of the following older patients demonstrates changes in sleep patterns not attributable to normal aging?
| a. | J, who wakes up two to three times per night and is tired during the day |
| b. | K, who reports sleeping less soundly and not feeling rested |
| c. | L, who consistently awakens at 4 AM and goes to bed at 7 PM |
| d. | M, who has irregular respiration during sleep and whose inspiratory muscles intermittently fail |
ANS: D
Inspiratory muscle paralysis is a symptom of central sleep apnea. This is not a normal consequence of aging.
DIF:Cognitive Level: AnalysisREF:39
OBJ:Nursing Process: AssessmentTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
11. Sleep deprivation can result in which of the following?
| a. | Decreased cortisol production |
| b. | Decreased glucose tolerance |
| c. | Hyperactivity |
| d. | Somnolence |
ANS: B
Sleep debt was found to produce glucose intolerance, decreased thyrotropin concentrations, increased cortisol production, and increased nervous system activity.
DIF:Cognitive Level: ComprehensionREF:38
OBJ:Nursing Process: DiagnosisTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
12. During a sleep study, which of the following groups of information are gathered?
| a. | Airflow, snoring, tonsil size |
| b. | Electroencephalogram, electrocardiogram, end-tidal carbon dioxide |
| c. | Oxygen saturation, number of arousals, airflow |
| d. | Frequency of awakenings, REM speed, apnea-hypopnea index |
ANS: C
Polysomnography is used to determine the number and length of apnea episodes and sleep stages, number of arousals, airflow, respiratory effort, and oxygen desaturation.
DIF:Cognitive Level: ComprehensionREF:42
OBJ:Nursing Process: DiagnosisTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
13. A patient with mild obstructive sleep apnea (OSA) can expect treatment to consist of:
| a. | medical management with protriptyline. |
| b. | weight loss, elimination of alcohol before bedtime, side sleeping. |
| c. | immediate use of continuous positive airway pressure (CPAP). |
| d. | surgical intervention with uvulopalatopharyngoplasty (UPPP). |
ANS: B
For patients with mild OSA (apnea-hypopnea index of 5 to 10), weight loss, sleeping on the side (if apnea is associated with sleeping on the back), avoidance of sedative medications and alcohol before bedtime, and avoidance of sleep deprivation may be all that is necessary. CPAP would be the next treatment choice.
DIF:Cognitive Level: ComprehensionREF:42
OBJ:Nursing Process: PlanningTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Physiological Adaptation
14. The primary determinant in the efficacy of CPAP in the patient with OSA is:
| a. | compliance. |
| b. | weight. |
| c. | tonsil size. |
| d. | respiratory effort. |
ANS: A
CPAP, although the treatment of choice, is effective only if the patient is compliant with therapy. Regular attendance at CPAP clinics can improve patient compliance.
DIF:Cognitive Level: ComprehensionREF:42
OBJ:Nursing Process: EvaluationTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Physiological Adaptation
15. Mr. D was given the diagnosis of congestive heart failure (CHF) 2 years ago. He complains of increased daytime sleepiness and states that his wife has been complaining to him more and more about his snoring. Central sleep apnea (CSA) is suspected. Treatment is dependent on whether Mr. D has hypercapnic or nonhypercapnic CSA. Which of the following best indicates a diagnosis of nonhypercapnic CSA?
| a. | Polysomnography with absence of airflow for 10 seconds |
| b. | Apnea-hypopnea index of 10 |
| c. | Peripheral edema, polycythemia, and obesity |
| d. | Insomnia, awakenings accompanied by choking, normal body mass index |
ANS: D
Nonhypercapnic CSA characteristics include daytime sleepiness, insomnia or poor sleep, mild or intermittent snoring, and awakenings accompanied by choking or feeling short of breath; frequently, the patients are of normal body weight. CSA can be seen on polysomnography as an absence of airflow and respiratory effort for at least 10 seconds.
DIF:Cognitive Level: ComprehensionREF:44
OBJ:Nursing Process: DiagnosisTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Physiological Adaptation
16. Mr. D was given the diagnosis of congestive heart failure (CHF) 2 years ago. He complains of increased daytime sleepiness and states that his wife has been complaining to him more and more about his snoring. Central sleep apnea (CSA) is suspected. Treatment is dependent on whether Mr. D has hypercapnic or nonhypercapnic CSA. Mr. D’s primary treatment plan should include:
| a. | initiation of CPAP. |
| b. | preparation for UPPP. |
| c. | administration of acetazolamide and medroxyprogesterone. |
| d. | administration of modafinil and zolpidem. |
ANS: A
One treatment for patients with nonhypercapnic CSA or heart failure is nasal CPAP, which may also provide a beneficial cardiovascular effect. Nocturnal oxygen supplementation may be effective as well. If CPAP is not tolerated, pharmacological management may be tried.
DIF:Cognitive Level: ApplicationREF:44
OBJ:Nursing Process: PlanningTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Physiological Adaptation
17. A patient for whom CPAP has been prescribed says, “It’s not worth the trouble to wear that contraption. I’ll just get along with a little less sleep.” The nurse correctly explains to the patient:
| a. | “You can get used to it pretty quickly if you just stick with it.” |
| b. | “Sleep apnea is associated with serious illnesses like high blood pressure and stroke.” |
| c. | “Naps during the day can make up for your lost sleep at night.” |
| d. | “We can give you medication that will help you get quality sleep.” |
ANS: B
Consequences of sleep apnea include chronic hypoventilation syndrome, arousals that fragment sleep, and cardiovascular changes such as hypertension, cerebrovascular accident (stroke), ischemic heart disease, insulin resistance, ventricular hypertrophy, and nocturnal angina.
DIF:Cognitive Level: ApplicationREF:44
OBJ:Nursing Process: ImplementationTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Physiological Adaptation
18. The nurse will be sure to evaluate the elderly patient’s sleep history in order to:
| a. | schedule basic care activities. |
| b. | plan for visitors. |
| c. | assess indicators of mental health. |
| d. | arrange times for rest and for activity. |
ANS: C
Assessment of elderly clients must always include sleep history as an indicator of mental health, because depression is a common struggle in this population.
DIF:Cognitive Level: ComprehensionREF:39
OBJ:Nursing Process: AssessmentTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
MULTIPLE RESPONSE
1. Which of the following occur during REM sleep stages? (Select all that apply)
| a. | Vital signs remain at basal levels. |
| b. | Dreams occur. |
| c. | Sympathetic tone predominates. |
| d. | Sweating or shivering is common. |
| e. | Growth hormone is released. |
ANS: B, C
The sympathetic nervous system predominates during REM sleep.
DIF:Cognitive Level: AnalysisREF:38
OBJ:Nursing Process: AssessmentTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
2. Which of the following are characteristic of sleep in the elderly? (Select all that apply)
| a. | Insomnia |
| b. | Less sleep required |
| c. | Altered circadian rhythms |
| d. | Higher incidence of sleep apnea |
| e. | Longer periods of non-REM sleep |
ANS: A, C
Insomnia and altered circadian rhythms are characteristic of the older adult; however, it is a misconception that older adults require less sleep than their younger counterparts.
DIF:Cognitive Level: ComprehensionREF:39
OBJ:Nursing Process: DiagnosisTOP:Sleep Alterations
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
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