the day, decrease fluids at night, and dispense diuretics
REST AND SLEEP
1.Question:
A nurse assesses a patient's body temperature in
the late afternoon as 37.2°C (99°F). What would be
the nurse's best action related to this slight
elevation in temperature?
a. Assess the patient for infection.
b. Record the temperature as a normal finding.
c. Call the physician for an order for antipyretics.
d. Decrease the room temperature.: Answer:
b. A slight increase in body temperature in the late
afternoon is the result of a normal circadian rhythm and
does not need to be reported unless it becomes higher.
This slight variation from normal does not necessarily
mean an infection is present. A warm environment might
cause an elevation in body temperature, but the most
likely cause is normal circadian rhythm.
2.Question:
A nurse caring for patients in a busy hospital
environment should implement which
recommendation to promote sleep?
a. Keep the room light dimmed during the day.
b. Keep the room cool.
c .Keep the door of the room open.
d. Offer a sleep aid medication to patients on a
regular basis.: Answer:
b. The nurse should keep the room cool and provide
earplugs and eye masks. The nurse should also
maintain a brighter room environment during daylight
hours and dim lights in the evening, and keep the door of
the room closed. Sleep aid medications should only be
offered as prescribed.
3.Question:
A nurse caring for patients in a long-term care
facility is implementing interventions to help
promote sleep in elderly patients. Which action is
recommended for these patients?
a. Increase physical activities during the day.
b. Encourage short periods of napping during the
day.
c. Increase fluids during the evening.
d. Dispense diuretics during the afternoon
hours.: Answer:
a. In order to promote sleep in the elderly patient, the
nurse should encourage daily physical activity such as
walking or water aerobics, discourage napping during
in the morning or early evening.
4.Question:
A nurse formulates the following diagnosis for an
elderly patient who is having trouble getting to sleep
at night: Disturbed Sleep Pattern: Initiation of Sleep.
Which of the following nursing interventions would
the nurse perform related to this diagnosis? Select
all that apply.
a. Arrange for assessment for depression and
treatment.
b. Discourage napping during the day.
c. Decrease fluids during the evening.
d. Administer diuretics in the morning.
e. Encourage patient to engage in some type of
physical activity.
f. Assess medication for side effects of sleep pattern
disturbances.: Answer: 
a, b, e, f. For patients who are having trouble initiating
sleep, the nurse should arrange for assessment for
depression and treatment, discourage napping, promote
activity, and assess medications for sleep disturbance
side effects. Limiting fluids and administering diuretics in
the morning are appropriate interventions for Disturbed
Sleep Pattern: Maintaining Sleep.
5.Question:
A nurse is assessing patients in a skilled nursing
facility for sleep deficits. Which patients would be
considered at a higher risk for having sleep
disturbances? Select all that apply.
a. A patient who has uncontrolled hypothyroidism
b. A patient with coronary artery disease
c. A patient who has gastroesophageal reflux
(GERD)
d. A patient who is HIV positive
e. A patient who is taking corticosteroids for arthritis
f. A patient with a urinary tract infection: Answer:
a, b, c. A patient who has uncontrolled hypothyroidism
tends to have a decreased amount of NREM sleep,
especially stages II and IV. The pain associated with
coronary artery disease and myocardial infarction is
more likely with REM sleep, and a patient who has
gastroesophageal reflux (GERD) may awaken at night
with heartburn pain. Being HIV positive, taking
corticosteroids, and having a urinary tract infection does
not usually change sleep patterns.
6.Question:
A nurse is caring for a patient who states he has had
trouble sleeping ever since his job at a factory
changed from the day shift to the night shift. Which
 diagnosis would be most appropriate for this
patient?
a. Ineffective Coping: Multiple Stressors of New Job
b. Sleep Deprivation: Difficulty Falling Asleep
c. Disturbed Sleep Pattern: Altered Sleep-Wake
Pattern
d. Risk for Injury: Activity Intolerance/Sleep
Deprivation: Answer:
c. When assessment data point to a sleep problem that
is amenable to nursing therapy, it receives the label
Disturbed Sleep Pattern if the problem is time limited
(such as changing shifts) or Sleep Deprivation if the
problem is prolonged. The labels Ineffective Coping and
Risk for Injury have not yet been determined.
7.Question:
A nurse is discussing with an older female patient
the factors that affect sleep. What fact does the
nurse teach her?
a. Drinking a cup of regular tea at night induces
sleep.
b. Using alcohol moderately promotes a deep sleep.
c. Aging decreases the amount of REM sleep a
person experiences.
d. Exercising decreases REM and NREM
sleep.: Answer:
c. The nurse would teach the patient that the amount of
REM sleep decreases with age. Regular tea contains
caffeine and increases alertness. Large quantities of
alcohol limit REM and delta sleep. Physical activity
increases both REM and NREM sleep.
8.Question:
A nurse is performing a sleep assessment on a
patient being treated for a sleep disorder. During the
assessment, the patient falls asleep in the middle of
a conversation. The nurse would suspect which
disorder?
a. REM behavior disorder
b. Narcolepsy
c. Enuresis
d. Sleep apnea: Answer:
b. Narcolepsy is an uncontrollable desire to sleep; the
person may fall asleep in the middle of a conversation.
REM Behavior Disorder (RBD) is characterized by
"acting out" dreams while asleep. Enuresis is urinating
during sleep or bedwetting. Sleep apnea is a condition in
which breathing ceases for a period of time between
snoring.
9.Question:
A nurse is providing discharge teaching for patients
regarding their medications. For which patients
would the nurse recommend actions to promote
sleep? Select all that apply.
a. A patient who is taking iron supplements for
anemia
b. A patient with Parkinson disease who is taking
dopamine
c. An elderly patient taking diuretics for congestive
heart failure
d. A patient who is taking antibiotics for an ear
infection
e. A patient who is prescribed antidepressants
f. A patient who is taking low-dose aspirin
prophylactically: Answer:
b, c, e. Drugs that decrease REM sleep include
barbiturates, amphetamines, and antidepressants.
Diuretics, antiparkinsonian drugs, some antidepressants
and antihypertensives, steroids, decongestants, caffeine,
and asthma medications are seen as additional common
causes of sleep problems.
10.Question:
A nurse is teaching a patient with a sleep disorder
how to keep a sleep diary. Which data would the
nurse have the patient document? Select all that
apply.
a. Daily mental activities
b. Daily physical activities
c. Morning and evening body temperature
d. Daily measurement of fluid intake and output
e. Presence of anxiety or worries affecting sleep
f. Morning and evening blood pressure
readings: Answer:
a, b, e. A sleep diary includes mental and physical
activities performed during the day and the presence of
any anxiety or worries the patient may be experiencing
that affect sleep. A record of fluid intake and output,
body temperature, and blood pressure is not usually kept
in a sleep diary.
11.Question:
A nurse observes a slight increase in a patient's vital
signs while he is sleeping during the night.
According to the patient's stage of sleep, the nurse
expects what conditions to be true? Select all that
apply.
a. He is aware of his surroundings at this point.
b. He is in delta sleep at this time.
c. It would be most difficult to awaken him at this
time.
d. This is most likely an NREM stage.
e. This stage constitutes around 20% to 25% of total
sleep.
 f. The muscles are relaxed in this stage.: Answer:
c, e. This scenario describes REM sleep. During REM
sleep, it is difficult to arouse a person, and the vital signs
increase. REM sleep constitutes about 20% to 25% of
sleep. In stage I NREM sleep, the person is somewhat
aware of surroundings. Delta sleep is NREM stages III
and IV sleep. In stage IV NREM sleep, the muscles are
relaxed, whereas small muscle twitching may occur in
REM sleep.
12.Question:
A nurse observes some involuntary muscle jerking
in a sleeping patient. The nurse determines that the
patient is most likely in which stage of sleep?
a. Stage I NREM sleep
b. Stage II NREM sleep
c. Stage IV NREM sleep
d. REM sleep: Answer:
a. Involuntary muscle jerking occurs in stage I NREM
sleep. In the other stages, the muscles proceed from a
relaxed state to large muscle immobility.
13.Question:
A nurse working the night shift at a hospital
observes the developmental factors that may affect
sleep. Which statements accurately describe these
variations? Select all that apply.
environment and doesn't recall the incident in the
morning. Which sleep disorder would the nurse
expect?
a. Bruxism
b. Cataplexy
c. Restless leg syndrome
d. Somnambulism: Answer:
d. Somnambulism (sleepwalking) may range from sitting
up in bed to walking around the room or the house to
walking outside the house. The sleepwalker is unaware
of the environment. Bruxism is grinding of one's teeth
and frequently is an indicator of stress. Cataplexy is a
sudden loss of motor tone that may cause the person to
fall asleep; it is usually experienced during a period of
strong emotion. People with restless leg syndrome
(RLS) cannot lie still and report unpleasant creeping,
crawling, or tingling sensations in the legs.

a. REM sleep constitutes much of the sleep cycle of

a preschool child.
b. By the age of 8 years, most children no longer
take naps.
c. Sleep needs usually decrease when physical
growth peaks.
d. Many adolescents do not get enough sleep.
e. Total sleep decreases in adults with a decrease in
stage IV sleep.
f. Sleep is less sound in older adults and stage IV
sleep may be absent.: Answer:
d, e, f. Many adolescents do not get enough sleep due to
the stresses of school, activities, and part-time
employment causing restless sleep. Total sleep time
decreases during adult years, with a decrease in stage
IV sleep. Sleep is less sound in older adults, and stage
IV sleep is absent or considerably decreased. REM
sleep constitutes much of the sleep cycle of a young
infant, and by the age of 5 years, most children no
longer nap. Sleep needs usually increase when physical
growth peaks.
14.Question:
A nurse working the night shift in a pediatric unit
observes a 10-year-old male patient walking the
hallway in a sleep state. The child is unaware of his