Chapter 19: Sleep–Wake Disorders

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. A nurse cares for these four patients. Which patient has the highest risk for problems with sleep physiology?

a. Retiree who volunteers twice a week at Habitat for Humanity b. Corporate accountant who travels frequently c. Parent with three teenagers d. Lawn care worker

ANS: B

The corporate accountant is likely to work long hours and have significant stress associated with work demands. Compounded by travel, these factors are likely to precipitate unstable sleep patterns and inadequate sleep time. The retiree and lawn care worker engage in physical activity during the day, which will promote natural fatigue and sleep. The parent’s sleep is unlikely to be disturbed; teenagers sleep through the night.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 19-12 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. “I turn on the television every night to get to sleep. I set the timer so it goes off in 30 minutes.” b. “I have diarrhea frequently and not much energy, so I stay at home most of the time.” c. “I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours.” d. “When my alarm clock goes off every morning, it seems like I am dreaming.”

2. Which comment is most likely from a patient with chronic sleep deprivation?

ANS: B

A discrepancy between hours of sleep obtained and hours required leads to sleep deprivation. Adults with less than 6 hours of sleep per night often suffer from chronic sleep deprivation. Common complaints include poor general health, physical and mental distress, limitations in ADLs, depressive or anxious symptoms, and pain. One distracter indicates a problem with sleep hygiene (television). The remaining distracters do not indicate a problem.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 19-3, 4, 22, 23 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. “It’s important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents.” b. “Sleep deprivation is usually self-limiting. See your health care provider if it lasts more than a year.” c. “Turn the radio on with a soft volume as you prepare for bed each evening. It will help you relax.” d. “Three glasses of wine each evening helps many patients who suffer from sleep deprivation.”

3. The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority?

ANS: A

Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. Alcohol compounds problems associated with sleep deprivation. Sleep deprivation should be evaluated and treated; a 1-year delay is too long.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 19-2 (Health Policy), 3, 4, 24

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

4. A nurse provides health education for an adult with sleep deprivation. It is most important for the nurse to encourage caution when the patient engages in a. using a vacuum cleaner. b. cooking a meal. c. driving a car. d. bathing.

ANS: C

Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. The distracters are less likely to be associated with serious injury.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 19-2 (Health Policy), 3, 4, 24

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment a. Skull x-rays b. Electroencephalogram (EEG) c. Positron emission tomography (PET) d. Single photon emission computed tomography (SPECT)

5. A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems?

ANS: B

EEG measures nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. The distracters represent ways to diagnose structural and metabolic problems.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 19-5, 6 TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

6. A patient says, “It takes me about 15 minutes to go to sleep each night.” This comment describes a. delta sleep. b. parasomnia. c. sleep latency. d. REM sleep.

ANS: C

Sleep latency refers to the amount of time it takes a person to fall asleep. The distracters represent other phases of the sleep cycle.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 19-6 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Sleep architecture changes during the sleep period, resulting in increased slow-wave sleep at the end of the cycle. b. Cycles of REM sleep increase in the second half of sleep and occupy longer periods. c. Dreams occur more frequently when a person is experiencing unresolved conflicts or depression. d. Dream content relates directly to developmental tasks. The person is likely feeling autonomous.

7. A person says, “I often feel like I have been dreaming just before I awake in the morning.” Which rationale correctly explains the comment?

ANS: B

Cycles of REM sleep increase in the second half of sleep and occupy longer periods, up to 1 hour. Dreaming occurs during REM sleep. The question relates to sleep architecture rather than dream content.

PTS: 1

DIF: Cognitive Level: Understand (Comprehension)

REF: Page 19-6 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. An obese adult b. A toddler who attends day care c. A person diagnosed with mild osteoarthritis d. An adolescent diagnosed with anorexia nervosa

8. Which person would be most likely to experience sleep fragmentation?

ANS: A

Obese adults experience more disruption of sleep stages, resulting in fragmentation. Obesity is the leading factor for obstructive sleep apnea, which causes sleep fragmentation. These changes are also associated with illness and some medications. The changes are evident on a hypnogram. An adolescent with anorexia nervosa would have a low body weight and therefore decreased risk for sleep fragmentation. Persons with arthritis have pain that may sometimes interrupt sleep, but it would not have as high risk as would obesity. Toddlers do not generally experience sleep fragmentation.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 19-7, 14 TOP: Nursing Process: Assessment