There are four adult clients who see the nurse for complaints of fatigue. The adult client at greatest risk is the one who gets:
A. 10 hours of sleep
Rationale: Data from over one million adult Americans revealed that the group that slept more than 8.5 hours each night had the greatest mortality.
The nurse knows that the client understands education about promoting restful sleep when the client says:
D. "I bought some flannel sheets to help me stay warm at night."
Rationale: A comfortable, quiet, and calm environment induces sleep. Mental and physical exercise stimulate the mind and body, preventing sleep. Diuretics taken earlier in the day will prevent nocturia.
During a preschool screening, a parent asks how many hours of sleep a child of 3 years requires each night. What is the correct answer?
C. 10-12 hours
Rationale: Growing children require more sleep than adults. Toddlers need 10-12 hours per day. About 20-30% is REM sleep. Children of this age usually spend about 50% or a little less sleeping at night. Bedtime is disliked, but is facilitated with rituals.
A client complains of inadequate sleep quantity and quality for the past month. The client wakes in the morning feeling tired. Which question provides the nurse with the best information about factors that may be contributing to this
D. Disturbed Sleep Pattern, difficulty falling asleep related to fear
Rationale: Fear is the etiology of difficulty falling asleep. Insomnia is a type of sleep-pattern disturbance. The client does not complain of fatigue.
Rest is a ______? (list at least 4)
A basic physiologic need
State where feel mentally relaxed, free from anxiety, and physically calm--Does not mean inactivity
Taking a walk, listening to music, sitting quietly
Allows body to repair cells, enhances removal of waste products
nRestores tissues to max functional ability before new activity
Theories of need need for sleep include
To restore balance among different parts of CNS
To mediate stress, anxiety & tension
To help a person cope with physical and/or psychological stress of daily activities
List the 3 Sleep Cycles
Define Ultradian (sleep cycle)
Frequentshort cycles of sleep throughout 24 hours (normal finding in newborns, elderly)
Define Circadian Rhythm
The Human body is designed to function on 24-hour sleep-wake cycle where individual gets 8 to 9 hours of sleep per night
Characterized by body temperature fluctuations & hormone secretory cycle (i.e. cortisol)
Define Infradian Rhythm
Sleep cycle that lasts longer than 24 hours in length where person needs more than 8 to 9 hours of sleep (often seen with teens)
Sleep Stages are determined by what?
Brain waves – electroencephalogram(EEG)
Eye movements – electooculogram (EOG)
Degree of muscle tension – electromyogram (EMG)
What are the first four Stages of sleep classifications?
First 4 stages are all classified as
Non-Rapid Eye Movement (REM) sleep
What stage of sleep does REM sleep start?
What dose REM sleep Stand for?
Rapid Eye Movement
The nurse is gathering a sleep history from a client who is
being evaluated for obstructive sleep apnea. What common symptom will the
client most likely report?
B) Early wakening
C) Impaired reasoning
D) Excessive daytime sleepiness
D. The client will awake with a headache. The other options may exist, but headache is the most common complaint.
The nurse incorporates what priority nursing intervention into a plan of care to promote sleep for a hospitalized client?
A) Have client follow hospital routines.
B) Avoid awakening client for nonessential tasks.
C) Give prescribed sleeping medications at dinner.
D) Turn television on low to late-night programming.
B.) Hospitals and extended care facilities usually do not adapt care to an individual's sleep-wake cycle preferences. The nurse should attempt to avoid awakening sleeping clients for nonessential tasks to try and preserve their sleep cycles. The other options are incorrect.
Very difficult to awaken a REM-sleeper; may have sense of paralysis at what stage of Sleep?
Stage 5 REM
Older adults are cautioned about the use of nonprescription
sleeping medications because these medications can:
A) Cause headaches and nausea.
B) Be expensive and difficult to obtain.
C) Cause severe depression and anxiety.
D) Lead to further sleep disruption even when they initially seemed to be effective.
D.) Over-the-counter medications for sleep often cause more
problems than benefits. The other answers are incorrect.
The client reports vivid dreaming to the nurse. Through
understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs in which sleep phase?
A) REM sleep
B) Stage 1 NREM sleep
C) Stage 4 NREM sleep
D) Transition period from NREM to REM sleep
A.) The dreams of REM sleep are vivid and elaborate. The other answers are incorrect.
The nurse teaches a client taking phenytoin (Dilantin), an
anticonvulsant, that this group of medications causes which symptom of a sleep problem?
B) Increased daytime sleepiness.
C) Increased awakening from sleep.
D) Increased difficulty falling asleep.
B.) The anticonvulsants can cause increased daytime sleepiness because they decrease REM sleep time. They do not cause nocturia, increased awakenings, or increased difficulty falling asleep.
Which intervention is appropriate to include on a care plan for improving sleep in the older adult?
A) Decrease fluids 2 to 4 hours before sleep.
B) Exercise in the evening to increase fatigue.
C) Allow the client to sleep as late as possible.
D) Take a nap during the day to make up for lost sleep.
A.) By decreasing fluids 2 to 4 hours before sleep, it is less
likely that the client will awaken because of a need to urinate. Limiting naps during the day will help improve nighttime sleep. The client should sleep until the same time each morning. Exercising in the evening can make falling asleep more difficult.
Describe the three defining characteristics of Stage 1 Sleep pattern (Non-REM).
Light sleep: person wakes easily, “floating” feeling
Rolling eye movements & relaxed muscles
Lasts only a few minutes
How long dose Stage 2 of Non-REM Last?
Lasts about 10-20 minutes
Is a person hard to wake at stage 2 of the sleep cycle?
Person in Non-REm still wakes easily
Is the Sleep ijn stage 2 of the Non-REM deep, light or moderate?
Light to moderate sleep
Which stage is considered daydream state ?
Stage 2 Non-REM
During Stage 2 of non-REM the muscles are usually Stiff?
(T or F)
F - muscles are relaxed
Transition to REM sleep begins in this stage
The eyes roll at what stage of sleep?
Stage 1 and may roll in Stage 2 of Non-REM
How long dose deep sleep last during stage 3 & 4 of non-REM?
The pt is easily arroused at this time? T - F
Deep sleep lasting about 15 to 30 minutes
F - Pt is difficult to arouse;
Snoring is common at which stage of sleep?
Stages 3 & 4 Non-REM
Enuresis (bedwetting) common with kids during which stage of sleep?
Stage 3 & 4 Non-REM
Is there eye movement in stage 3 & 4?
No there is no eye movement in stage 3 & 4 Non-REM
In stage 3 & 4 the muscles are very relaxed T or F?
T- the muscles are very relaxed in stage 3&4 Non-REM
There is no dreaming during stage 3 & 4 of no REM sleep? T or F
F there is some realistic dreaming
Describe the five defining characteristics of Stages 3&4 Sleep pattern (Non-REM )
Stages 3 & 4
Deep sleep lasting about 15 to 30 minutes
Difficult to arouse; some realistic dreaming
Enuresis (bedwetting) common with kids
No eye movement, muscles very relaxed
At what stage of sleep do dreams occour?
Stage 5 REM
At what stage of sleep dose the characteristic rapid eye movements give the impression that the sleeper is following something with their gaze?
Stage 5 REM
Very low Muscle tone (except respiratory muscles) is common what stage of sleep?
Stage 5 REM Sleep
sporadic muscle twitching occours in which stage of sleep?
Stage 5 REM Sleep
How long dose Stage 5 REM sleep last?
it lasts about 10-20 minutes
What sleep pattern prevents people from reaching REM sleep often?
Insomniacs rarely make it to REM
stage of sleep.
Insomniacs rarely make it to what stage of sleep?
REMstage of sleep
What type of mechenisim are food, drugs, other substances and exercise considered?
What are common factors that affecting sleep?
Name 4 out of the 7
Usual Sleep Patterns
Exercise & Fatigue
Food and Caloric Intake
What substance shortens sleep onset & ability to arouse easily?
What should be avoided close to bedtime because it may delay sleep becasue it has a half-life of 1 to 2 hrs.
Exercise increases REM and N-REM sleep so why should it be avoided at least 2 hours before bedtime?
It can cause wakefulness
Having to urinate throughout the night is what?
Why does consuming caffeine close to bed disrupts sleep patterns?
Caffeine has a long half-life, and it can delay or disrupt non-REM sleep.
NO caffeine after 3pm (what I've heard FYI) :-)<
How does nutrition effect sleep patterns?
too much or too little food before bedtime; L-Tryptophan foods (tryptophan is an amino acid the body uses to make serotonin, the neurotransmitter that slows down nerve traffic so your brain isn't so busy) induce sleep.
Sleep apnea, Orthopnea, Colds are examples of whcih type of sleep distrubance (system)?
Unstable angina would effect sleep how?
Chest pain, Heart ache (pain) + Cardiac Disease +
What disease process causes decrease in stage 4 sleep?
What are some environmental factors that might effect sleep?
Sleep Pattern Disturbance – change in quantity or quality of rest pattern that causes discomfort or interferes with desired lifestyle
Sleep Deprivation – prolonged periods of time withoutsustained, natural sleep; periodic states of relative unconsciousness
Fatigue – overwhelming, sustained sense ofexhaustion and decreased capacity for physical and mental work