Test Bank for Medical Surgical Nursing in Canada 4th Edition By Lewis

Test Bank for Medical Surgical Nursing in Canada

4th Edition By Lewis

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Chapter 09: Sleep and Sleep Disorders
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition

MULTIPLE CHOICE

1. The nurse is caring for a client in the ambulatory care setting that has chronic insomnia.
Which of the following interventions should the nurse do initially?
a. Schedule a polysomnography (PSG) study.
b. Arrange for the client to have a sleep study.
c. Ask the client to keep a 2-week sleep diary.
d. Teach the client about the use of an actigraph.

ANS: C
The diagnosis of insomnia is made on the basis of subjective complaints and an evaluation
of a 1- to 2-week sleep diary completed by the client. Actigraphy and PSG studies/sleep
studies may be used for determining specific sleep disorders, but are not necessary to
make an initial insomnia diagnosis.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

2. Which instruction will the nurse include when teaching a client with chronic insomnia
about ways to improve sleep quality?
a. Avoid aerobic exercise during the day.
b. Read in bed for a few minutes each night.
c. Keep the bedroom temperature slightly warm.
d. Try to go to bed at the same time every evening.
ANS: D
A regular evening schedule is recommended to improve sleep time and quality. Aerobic
exercise may improve sleep quality, but should occur several hours before bedtime.
Reading in bed is discouraged for clients with insomnia. The bedroom temperature should
be slightly cool.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

3. After the nurse has taught a client about the use of extended-release zopiclone for
insomnia, which client statement indicates a need for further teaching?
a. “I will take the medication an hour before bedtime.”
b. “I should take the medication on an empty stomach.”
c. “I should not take this medication unless I can sleep for at least 6 hours.”
d. “I will schedule activities that require mental alertness for later in the day.”
ANS: A
Benzodiazepine receptor agonists such as zopiclone work quickly and should be taken
immediately before bedtime, not 1 hour before. The other client statements are correct.

DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation

4. Which action is best for the nurse to include in the plan of care in order to improve sleep
quality for a critically ill client in the intensive care unit (ICU)?
 a. Ask all visitors to leave the ICU for the night.
b. Lower the level of light from 8:00 PM until 7:00 AM.
c. Avoid the use of opioids for pain relief during the evening hours.
d. Schedule assessments to allow at least 4 hours of uninterrupted sleep.
ANS: B
Lowering the level of light will help mimic normal day/night patterns and maximize the
opportunity for sleep. Although frequent assessments and opioid use can disturb sleep
patterns, these actions are necessary for the care of critically ill clients. For some clients,
having a family member or friend at the bedside may decrease anxiety and improve sleep.

DIF: Cognitive Level: Application TOP: Nursing Process: Planning

5. Which information will the nurse plan to include when teaching a client with narcolepsy
about management of the disorder?
a. Stimulant drugs should be used for only a short time because of the risk for abuse.
b. Driving an automobile may be possible with appropriate treatment of narcolepsy.
c. Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.
d. Antidepressant drugs are prescribed to treat the depression caused by the disorder.
ANS: B
The accident rate for clients with narcolepsy who are receiving appropriate treatment is
similar to the general population. Stimulant medications are used on an ongoing basis for
clients with narcolepsy. The purpose of antidepressant drugs in the treatment of narcolepsy
is the management of cataplexy, not to treat depression. Changes in sleep hygiene are
recommended for clients with narcolepsy to improve sleep quality.

DIF: Cognitive Level: Application TOP: Nursing Process: Planning

6. Which action by the nurse manager of an acute care unit will improve the alertness of
nurses who work the night shift?
a. Arrange for older staff members to work most night shifts.
b. Provide a sleeping area for staff to use for napping at night.
c. Post reminders about the relationship of sleep and alertness.
d. Schedule nursing staff to rotate day and night shifts monthly.

ANS: B
Short on-site naps will improve alertness. Rotating shifts causes the most disruption in
sleep habits. Reminding staff members about the impact of lack of sleep on alertness will
not improve sleep or alertness.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

7. The nurse takes the health history for four clients in the clinic. Which information
regarding the clients’ sleep is most important to communicate to the health care provider?
a. A 21-year-old student takes melatonin to assist in sleeping when travelling from
the Canada to Europe.
b. A 32-year-old who is experiencing a stressful week uses diphenhydramine for
several nights.
c. A 41-year-old with a body mass index (BMI) of 42 kg/m2 says that the spouse
complains about the client’s snoring.
 d. A 64-year-old nurse who works the night shift reports drinking hot chocolate
before going to bed in the morning.
ANS: C
The client’s BMI and snoring suggest possible sleep apnea, which can cause complications
such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe
to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a
concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to be affecting this
client’s sleep quality.

DIF: Cognitive Level: Analysis TOP: Nursing Process: Assessment

8. Which of these actions should the nurse take first for a client in the clinic who is
complaining of insomnia and daytime fatigue?
a. Question the client about the use of over-the-counter (OTC) sleep aids.
b. Suggest that the client decrease intake of caffeine-containing beverages.
c. Advise the client to get out of bed if unable to fall asleep in 10–20 minutes.
d. Recommend that the client use any prescribed sleep aids for only 2–3 weeks.
ANS: A
The nurse’s first action should be assessment of the client for factors that may contribute
to poor sleep quality or daytime fatigue such as the use of OTC medications. The other
actions may be appropriate, but assessment is needed first to choose appropriate
interventions to improve the client’s sleep.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

9. A client with sleep apnea who received a new prescription for a continuous positive
airway pressure (CPAP) device a week ago returns to the clinic and says that severe
daytime fatigue is still a problem. Which action should the nurse take first?
a. Teach about radiofrequency ablation.
b. Plan to schedule a nighttime PSG study.
c. Ask the client whether the CPAP is being used every night.
d. Discuss the possible surgical approaches used for sleep apnea.
ANS: C
CPAP is very effective in reducing sleep apnea, but patient adherence is frequently a
problem. Surgery, radiofrequency ablation, or a follow-up PSG study may be indicated,
but the nurse’s first action should be to assess whether the CPAP is being used as
prescribed.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

10. The nurse is providing a health-promotion session to young adults that have difficulty
sleeping at night and has instructed them to limit their caffeine intake. Which of the
following beverages have more than 50 mg of caffeine?
a. Green tea (237 mL)
b. Chocolate cake (5 cm square)
c. Brewed coffee (237 mL)
d. Black tea (237 mL)
ANS: C
Test Bank for Medical Surgical Nursing in Canada 4th Edition By Lewis

Brewed coffee is the only choice that has more than 50 mg of caffeine; it has 135 mg
caffeine. Black tea, either leaf or bag, has 50 mg of caffeine. Green tea has 30 mg of
caffeine.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

11. The nurse is caring for a client that has sleep deprivation and is teaching about the effects
that lack of sleep can have on the body. Which of the following information would be
included in the teaching plan for this client?
a. Decreased insulin resistance
b. Increased growth hormone
c. Decreased risk of type 2 diabetes
d. Increased risk of gastro-esophageal reflux disease (GERD)
ANS: D
Clients with sleep deprivation are at an increased risk of GERD, type 2 diabetes, heart
disease, hypertension and impaired immune function and can also experience cognitive
impairment, and behavioural changes such as irritability and moodiness. Sleep deprivation
causes an increase in insulin resistance and a decrease in growth hormone.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

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