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MSN NCLEX Exam for Sleep Disorder (PM)
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Question 1
Narcolepsy can be best explained as:
A
Stopping breathing for short intervals during sleep
B
Frequent awakenings during the night
C
A sudden muscle weakness during exercise
D
An overwhelming wave of sleepiness and falling asleep
Question 1 Explanation:
Narcolepsy is a dysfunction of mechanisms that regulate the sleep and wake states. Excessive daytime sleepiness is the most common complaint associated with this disorder. During the day a person may suddenly feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur within 15 minutes of falling asleep.
Question 2
The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply):
A
Extended time to fall asleep
B
Difficulty staying asleep
C
Falling asleep at inappropriate times
D
Feeling tired after a night’s sleep
Question 2 Explanation:
These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia.
Question 3
To validate the suspicion that a married male client has sleep apnea the nurse first:
A
Schedules the client for a sleep test
B
asks the client if he experiences apnea in the middle of the night
C
Questions the spouse if she is awakened by her husband’s snoring
D
Places the client on a continuous positive airway pressure (CPAP) device
Question 3 Explanation:
(Although this is a diagnostic tool, the first thing the nurse would do is question the spouse. This may lead to determining whether more tests are needed).
Question 4
Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent?
A
Monitor geriatric patients for the common occurrence of paradoxical reactions.
B
Administer safely with other CNS depressants for insomnia
C
Use IM dosage forms for longer duration
D
Evaluate for physical dependence that occurs within 48 hours of beginning the drug.
Question 5
When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:
A
Opioids
B
Anticonvulsants
C
Adjuvants
D
Nonsteroidal antiinflammatory drugs (NSAIDs)
E
Antidepressants
Question 5 Explanation:
Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.
Question 6
To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.)
A
Drinking a glass of wine just before retiring to bed
B
Eating a large meal 1 hour before bedtime
C
Performing mild exercises 30 minutes before going to bed
D
Consuming a small glass of warm milk at bedtime
Question 6 Explanation:
A small glass of milk relaxes the body and promotes sleep.
Question 7
The patient’s chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced:
A
Respiratory arrest
B
A tonic-clonic seizure
C
Malignant hyperthermia
D
Delirium tremens
Question 7 Explanation:
Dantrolene is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia
Question 8
Which of the following medications are the safest to administer to adults needing assistance in falling asleep?
A
Benzodiazepines
B
Anti-anxiety agents
C
Hypnotics
D
Sedatives
Question 8 Explanation:
The group of drugs that are the safest are the benzodiazepines. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.
Question 9
Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?
A
Alteration in tissue perfusion
B
Risk for injury
C
Fluid volume excess
D
Risk for infection
Question 9 Explanation:
Sedative-hypnotics cause CNS depression, putting the patient at risk for injury.
Question 10
A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?
A
activated charcoal
B
ipecac syrup
C
flumazenil (Romazicon)
D
naloxone HCl (Narcan)
Question 10 Explanation:
There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the GI tract, preventing absorption.
Question 11
Which of the following conditions characterizes rapid eye movement (REM) sleep?
A
Jerky limb movements and position changes
B
Highly active brain and physiological activity levels.
C
Pulse rate slowed by 5 to 10 beats/minute
D
Disorientation and disorganized thinking
Question 11 Explanation:
Highly active brain and physiological activity levels characterize REM stage. Stages 3 and 4 of NREM sleep are characterized by disorientation and disorganization, During REM sleep, the body movement ceases except for the eyes. The pulse rate slows by 5-10 beats/minute during NREM sleep, not REM sleep.
Question 12
The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises.
A
4th
B
2nd
C
1st
D
3rd
Question 12 Explanation:
The client is most sensitive to noise in the hospital setting the first night because everything is new. This represents sensory overload, which interferes with sleep and decreases rapid eye movement (REM) as well as total sleep time.
Question 13
A client taking a beta adrenergic blockers for HTN can experience interference with sleep patterns such as:
A
Increased difficulty falling asleep
B
Increased daytime sleepiness
C
Increased awakening from sleep
D
Nocturia
Question 13 Explanation:
Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.
Question 14
A patient is admitted to the emergency department with an overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart?
A
nalmefene (Revex)
B
naloxone (Narcan)
C
flumazenil (Romazicon)
D
naltrexone (ReVia)
Question 14 Explanation:
Flumazenil is the antidote for benzodiazepine overdoses.
Question 15
Which of the following substances is a natural hormone produced by the pineal gland that induces sleep?
A
Amphetamine
B
Melatonin
C
Methylphenidate
D
Pemoline
Question 15 Explanation:
Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.
Question 16
A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply:
A
Excessive caffeine
B
Severe anxiety
C
Environmental noise
D
Chronic depression
E
Chronic stress
F
Generalized pain
Question 16 Explanation:
Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.
Question 17
Select all that apply to the use of barbiturates in treating insomnia:
A
Barbiturates deprive people of NREM sleep
B
When the barbiturates are discontinued, the REM sleep increases.
C
When the barbiturates are discontinued, the NREM sleep increases.
D
Barbiturates deprive people of REM sleep
E
Nightmares are often an adverse effect when discontinuing barbiturates.
Question 17 Explanation:
Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares.
Question 18
The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply):
A
Prone
B
Side-lying
C
Supine
D
Fowler’s
Question 18 Explanation:
Research demonstrate that the occurrence of SIDS is reduced with these two positions.
Question 19
The nurse finds a client sleep walking down the unit hallway. An appropriate intervention the nurse implements is:
A
Quietly approaching the client and then loudly calling his or her name
B
Blocking the hallway with chairs and seating the client
C
Lightly tapping the client on the shoulder and leading him or her back to bed
D
Asking the client what he or she is doing and call for help
Question 19 Explanation:
The nurse should not startle the client but should gently awaken the client and lead him or her back to bed.
Question 20
A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care?
A
Clear a path to the bathroom at bedtime.
B
Instruct the client to call for ambulation assistance
C
Monitor apical heart rate every 2 hours
D
Monitor blood pressure every 4 hours
Question 20 Explanation:
Chloral hydrate is a sedative. This medication does not affect cardiac function. Blood pressure changes are not significant with the use of this medication. A client should call for assistance to the bathroom at night. Additionally, the client may experience residual daytime sedation; therefore, the nurse should instruct the client to call for ambulation assistance during the daytime hours.
Question 21
During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating:
A
“Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.”
B
“There really is no difference; the terms are used interchangeably.”
C
“Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis.”
D
“Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.”
Question 21 Explanation:
Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.
Question 22
When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is:
A
Headache
B
Early awakening
C
Excessive daytime sleepiness
D
Impaired reasoning
Question 22 Explanation:
Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.
Question 23
The nurse understands that the most vivid dreaming occurs during:
A
Stage 4 NREM
B
Stage 1 NREM
C
REM sleep
D
Transition period from NREM to REM sleep
Question 23 Explanation:
Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate and are believed to be functionally important to learning, memory processing, and adaptation to stress.
Question 24
Older adults who take long-acting sedatives or hypnotics are likely to experience:
A
Ataxia
B
Dyspnea
C
Alertness
D
Hallucinations
Question 24 Explanation:
If longer-acting barbiturates are used in older adults, these clients may experience daytime sedation, ataxia, and memory deficits.
Question 25
A nursing measure to promote sleep in school-age children is to:
A
Encourage quiet activities prior to bed time.
B
Encourage television watching
C
Make sure the room is dark and quiet
D
Encourage evening exercise
Question 25 Explanation:
The amount of sleep needed during the school years is individualized because of varying states of activities and levels of health. A 6-year old averages 11-12 hours of sleep nightly, whereas an 11-year old sleeps about 9-10 hours. The 6- or 7-year old can usually be persuaded to go to bed by encouraging quiet activities.
Question 26
Select all that apply that is appropriate when there is a benzodiazepine overdose:
A
Activated charcoal and a saline cathartic
B
Administration of Flumazenil
C
Hemodialysis
D
Gastric lavage
E
Administration of syrup of ipecac
Question 26 Explanation:
If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation.
Question 27
Pediatric and geriatric patients often react with more sensitivity to CNS depressants. This type of sensitivity manifests itself in the development of which type of reaction?
A
Idiopathic
B
Psychogenic
C
Teratogenic
D
Paradoxical
Question 28
Which of the following sleep disorders is the most prevalent?
A
Parasomnia
B
Insomnia
C
Sleep-awake schedule disturbance.
D
Hypersomnia
Question 28 Explanation:
Approximately 1/3 of American adults have some type of sleep disorder, and insomnia is the most common.
Question 29
Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants?
A
Make sure the patient’s call light is close by in case of the need for assistance with activities.
B
Prevent any activity within the hospital setting while on oral muscle relaxants
C
Cardiovascular stimulation, a common side effect, would lead to hytertension
D
Make sure that the patient knows that sedation should be minimal with these agents.
Question 30
A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply.
A
Eat a heavy snack before bedtime
B
Drink a cup of warm tea with milk at bedtime
C
Count backwards from 100 to 0 when your mind is racing.
D
Exercise in the afternoon rather than the evening
E
Leave the bedroom if you are unable to sleep
F
Read in bed before shutting out the light
Question 30 Explanation:
Lying in bed when one is unable to sleep increases frustration and anxiety which further impede sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backwards requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.
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Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.
MSN NCLEX Exam for Sleep Disorder (EM)
Choose the letter of the correct answer. You have 30 minutes to finish this exam. Good luck!
Start
Congratulations - you have completed MSN NCLEX Exam for Sleep Disorder (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
A patient is admitted to the emergency department with an overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart?
A
naltrexone (ReVia)
B
nalmefene (Revex)
C
flumazenil (Romazicon)
D
naloxone (Narcan)
Question 1 Explanation:
Flumazenil is the antidote for benzodiazepine overdoses.
Question 2
Older adults who take long-acting sedatives or hypnotics are likely to experience:
A
Alertness
B
Dyspnea
C
Ataxia
D
Hallucinations
Question 2 Explanation:
If longer-acting barbiturates are used in older adults, these clients may experience daytime sedation, ataxia, and memory deficits.
Question 3
Which of the following sleep disorders is the most prevalent?
A
Sleep-awake schedule disturbance.
B
Hypersomnia
C
Insomnia
D
Parasomnia
Question 3 Explanation:
Approximately 1/3 of American adults have some type of sleep disorder, and insomnia is the most common.
Question 4
A client taking a beta adrenergic blockers for HTN can experience interference with sleep patterns such as:
A
Increased difficulty falling asleep
B
Increased daytime sleepiness
C
Increased awakening from sleep
D
Nocturia
Question 4 Explanation:
Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.
Question 5
The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply):
A
Fowler’s
B
Side-lying
C
Supine
D
Prone
Question 5 Explanation:
Research demonstrate that the occurrence of SIDS is reduced with these two positions.
Question 6
During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating:
A
“Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.”
B
“Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.”
C
“Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis.”
D
“There really is no difference; the terms are used interchangeably.”
Question 6 Explanation:
Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.
Question 7
Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants?
A
Make sure that the patient knows that sedation should be minimal with these agents.
B
Prevent any activity within the hospital setting while on oral muscle relaxants
C
Make sure the patient’s call light is close by in case of the need for assistance with activities.
D
Cardiovascular stimulation, a common side effect, would lead to hytertension
Question 8
A nursing measure to promote sleep in school-age children is to:
A
Encourage quiet activities prior to bed time.
B
Make sure the room is dark and quiet
C
Encourage evening exercise
D
Encourage television watching
Question 8 Explanation:
The amount of sleep needed during the school years is individualized because of varying states of activities and levels of health. A 6-year old averages 11-12 hours of sleep nightly, whereas an 11-year old sleeps about 9-10 hours. The 6- or 7-year old can usually be persuaded to go to bed by encouraging quiet activities.
Question 9
Narcolepsy can be best explained as:
A
Stopping breathing for short intervals during sleep
B
Frequent awakenings during the night
C
A sudden muscle weakness during exercise
D
An overwhelming wave of sleepiness and falling asleep
Question 9 Explanation:
Narcolepsy is a dysfunction of mechanisms that regulate the sleep and wake states. Excessive daytime sleepiness is the most common complaint associated with this disorder. During the day a person may suddenly feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur within 15 minutes of falling asleep.
Question 10
To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.)
A
Drinking a glass of wine just before retiring to bed
B
Eating a large meal 1 hour before bedtime
C
Consuming a small glass of warm milk at bedtime
D
Performing mild exercises 30 minutes before going to bed
Question 10 Explanation:
A small glass of milk relaxes the body and promotes sleep.
Question 11
Pediatric and geriatric patients often react with more sensitivity to CNS depressants. This type of sensitivity manifests itself in the development of which type of reaction?
A
Paradoxical
B
Teratogenic
C
Psychogenic
D
Idiopathic
Question 12
Which of the following conditions characterizes rapid eye movement (REM) sleep?
A
Highly active brain and physiological activity levels.
B
Jerky limb movements and position changes
C
Pulse rate slowed by 5 to 10 beats/minute
D
Disorientation and disorganized thinking
Question 12 Explanation:
Highly active brain and physiological activity levels characterize REM stage. Stages 3 and 4 of NREM sleep are characterized by disorientation and disorganization, During REM sleep, the body movement ceases except for the eyes. The pulse rate slows by 5-10 beats/minute during NREM sleep, not REM sleep.
Question 13
The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply):
A
Falling asleep at inappropriate times
B
Difficulty staying asleep
C
Feeling tired after a night’s sleep
D
Extended time to fall asleep
Question 13 Explanation:
These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia.
Question 14
A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?
A
naloxone HCl (Narcan)
B
flumazenil (Romazicon)
C
activated charcoal
D
ipecac syrup
Question 14 Explanation:
There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the GI tract, preventing absorption.
Question 15
A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply:
A
Environmental noise
B
Chronic depression
C
Chronic stress
D
Severe anxiety
E
Excessive caffeine
F
Generalized pain
Question 15 Explanation:
Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.
Question 16
Which of the following substances is a natural hormone produced by the pineal gland that induces sleep?
A
Melatonin
B
Pemoline
C
Methylphenidate
D
Amphetamine
Question 16 Explanation:
Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.
Question 17
Select all that apply to the use of barbiturates in treating insomnia:
A
When the barbiturates are discontinued, the NREM sleep increases.
B
When the barbiturates are discontinued, the REM sleep increases.
C
Nightmares are often an adverse effect when discontinuing barbiturates.
D
Barbiturates deprive people of REM sleep
E
Barbiturates deprive people of NREM sleep
Question 17 Explanation:
Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares.
Question 18
The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises.
A
4th
B
2nd
C
3rd
D
1st
Question 18 Explanation:
The client is most sensitive to noise in the hospital setting the first night because everything is new. This represents sensory overload, which interferes with sleep and decreases rapid eye movement (REM) as well as total sleep time.
Question 19
Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent?
A
Monitor geriatric patients for the common occurrence of paradoxical reactions.
B
Use IM dosage forms for longer duration
C
Evaluate for physical dependence that occurs within 48 hours of beginning the drug.
D
Administer safely with other CNS depressants for insomnia
Question 20
A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care?
A
Clear a path to the bathroom at bedtime.
B
Monitor apical heart rate every 2 hours
C
Instruct the client to call for ambulation assistance
D
Monitor blood pressure every 4 hours
Question 20 Explanation:
Chloral hydrate is a sedative. This medication does not affect cardiac function. Blood pressure changes are not significant with the use of this medication. A client should call for assistance to the bathroom at night. Additionally, the client may experience residual daytime sedation; therefore, the nurse should instruct the client to call for ambulation assistance during the daytime hours.
Question 21
The nurse finds a client sleep walking down the unit hallway. An appropriate intervention the nurse implements is:
A
Asking the client what he or she is doing and call for help
B
Quietly approaching the client and then loudly calling his or her name
C
Blocking the hallway with chairs and seating the client
D
Lightly tapping the client on the shoulder and leading him or her back to bed
Question 21 Explanation:
The nurse should not startle the client but should gently awaken the client and lead him or her back to bed.
Question 22
When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is:
A
Impaired reasoning
B
Excessive daytime sleepiness
C
Early awakening
D
Headache
Question 22 Explanation:
Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.
Question 23
To validate the suspicion that a married male client has sleep apnea the nurse first:
A
Questions the spouse if she is awakened by her husband’s snoring
B
asks the client if he experiences apnea in the middle of the night
C
Places the client on a continuous positive airway pressure (CPAP) device
D
Schedules the client for a sleep test
Question 23 Explanation:
(Although this is a diagnostic tool, the first thing the nurse would do is question the spouse. This may lead to determining whether more tests are needed).
Question 24
A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply.
A
Drink a cup of warm tea with milk at bedtime
B
Eat a heavy snack before bedtime
C
Leave the bedroom if you are unable to sleep
D
Read in bed before shutting out the light
E
Count backwards from 100 to 0 when your mind is racing.
F
Exercise in the afternoon rather than the evening
Question 24 Explanation:
Lying in bed when one is unable to sleep increases frustration and anxiety which further impede sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backwards requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.
Question 25
Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?
A
Risk for infection
B
Fluid volume excess
C
Risk for injury
D
Alteration in tissue perfusion
Question 25 Explanation:
Sedative-hypnotics cause CNS depression, putting the patient at risk for injury.
Question 26
Which of the following medications are the safest to administer to adults needing assistance in falling asleep?
A
Benzodiazepines
B
Anti-anxiety agents
C
Hypnotics
D
Sedatives
Question 26 Explanation:
The group of drugs that are the safest are the benzodiazepines. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.
Question 27
The nurse understands that the most vivid dreaming occurs during:
A
Transition period from NREM to REM sleep
B
Stage 4 NREM
C
Stage 1 NREM
D
REM sleep
Question 27 Explanation:
Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate and are believed to be functionally important to learning, memory processing, and adaptation to stress.
Question 28
The patient’s chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced:
A
Respiratory arrest
B
A tonic-clonic seizure
C
Delirium tremens
D
Malignant hyperthermia
Question 28 Explanation:
Dantrolene is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia
Question 29
Select all that apply that is appropriate when there is a benzodiazepine overdose:
A
Administration of syrup of ipecac
B
Gastric lavage
C
Hemodialysis
D
Administration of Flumazenil
E
Activated charcoal and a saline cathartic
Question 29 Explanation:
If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation.
Question 30
When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:
A
Anticonvulsants
B
Opioids
C
Nonsteroidal antiinflammatory drugs (NSAIDs)
D
Adjuvants
E
Antidepressants
Question 30 Explanation:
Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.
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1. To validate the suspicion that a married male client has sleep apnea the nurse first:
asks the client if he experiences apnea in the middle of the night
Questions the spouse if she is awakened by her husband’s snoring
Places the client on a continuous positive airway pressure (CPAP) device
Schedules the client for a sleep test
2. When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:
Nonsteroidal antiinflammatory drugs (NSAIDs)
Opioids
Anticonvulsants
Antidepressants
Adjuvants
3. The nurse finds a client sleep walking down the unit hallway. An appropriate intervention the nurse implements is:
Asking the client what he or she is doing and call for help
Quietly approaching the client and then loudly calling his or her name
Lightly tapping the client on the shoulder and leading him or her back to bed
Blocking the hallway with chairs and seating the client
4. The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises.
1st
2nd
3rd
4th
5. Which of the following medications are the safest to administer to adults needing assistance in falling asleep?
Sedatives
Hypnotics
Benzodiazepines
Anti-anxiety agents
6. To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.)
Drinking a glass of wine just before retiring to bed
Eating a large meal 1 hour before bedtime
Consuming a small glass of warm milk at bedtime
Performing mild exercises 30 minutes before going to bed
7. The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply):
Extended time to fall asleep
Falling asleep at inappropriate times
Difficulty staying asleep
Feeling tired after a night’s sleep
8. The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply):
Prone
Side-lying
Supine
Fowler’s
9. When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is:
Headache
Early awakening
Impaired reasoning
Excessive daytime sleepiness
10. The nurse understands that the most vivid dreaming occurs during:
REM sleep
Stage 1 NREM
Stage 4 NREM
Transition period from NREM to REM sleep
11. A client taking a beta adrenergic blockers for HTN can experience interference with sleep patterns such as:
Nocturia
Increased daytime sleepiness
Increased awakening from sleep
Increased difficulty falling asleep
12. Narcolepsy can be best explained as:
A sudden muscle weakness during exercise
Stopping breathing for short intervals during sleep
Frequent awakenings during the night
An overwhelming wave of sleepiness and falling asleep
13. A nursing measure to promote sleep in school-age children is to:
Make sure the room is dark and quiet
Encourage evening exercise
Encourage television watching
Encourage quiet activities prior to bed time.
14. A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply.
Eat a heavy snack before bedtime
Read in bed before shutting out the light
Leave the bedroom if you are unable to sleep
Drink a cup of warm tea with milk at bedtime
Exercise in the afternoon rather than the evening
Count backwards from 100 to 0 when your mind is racing.
15. A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply:
Chronic stress
Severe anxiety
Generalized pain
Excessive caffeine
Chronic depression
Environmental noise
16. A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care?
Monitor apical heart rate every 2 hours
Monitor blood pressure every 4 hours
Instruct the client to call for ambulation assistance
Clear a path to the bathroom at bedtime.
17. Select all that apply to the use of barbiturates in treating insomnia:
Barbiturates deprive people of NREM sleep
Barbiturates deprive people of REM sleep
When the barbiturates are discontinued, the NREM sleep increases.
When the barbiturates are discontinued, the REM sleep increases.
Nightmares are often an adverse effect when discontinuing barbiturates.
18. Select all that apply that is appropriate when there is a benzodiazepine overdose:
Administration of syrup of ipecac
Gastric lavage
Activated charcoal and a saline cathartic
Hemodialysis
Administration of Flumazenil
19. A patient is admitted to the emergency department with an overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart?
naloxone (Narcan)
naltrexone (ReVia)
nalmefene (Revex)
flumazenil (Romazicon)
20. Older adults who take long-acting sedatives or hypnotics are likely to experience:
Hallucinations
Ataxia
Alertness
Dyspnea
21. Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?
Alteration in tissue perfusion
Fluid volume excess
Risk for injury
Risk for infection
22. A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?
naloxone HCl (Narcan
activated charcoal
flumazenil (Romazicon)
ipecac syrup
23. During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating:
“Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.”
“Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis.”
“Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.”
“There really is no difference; the terms are used interchangeably.”
24. The patient’s chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced:
Delirium tremens
Malignant hyperthermia
A tonic-clonic seizure
Respiratory arrest
25. Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent?
Use IM dosage forms for longer duration
Administer safely with other CNS depressants for insomnia
Monitor geriatric patients for the common occurrence of paradoxical reactions.
Evaluate for physical dependence that occurs within 48 hours of beginning the drug.
26. Pediatric and geriatric patients often react with more sensitivity to CNS depressants. This type of sensitivity manifests itself in the development of which type of reaction?
Idiopathic
Teratogenic
Paradoxical
Psychogenic
27. Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants?
Prevent any activity within the hospital setting while on oral muscle relaxants
Make sure that the patient knows that sedation should be minimal with these agents.
Cardiovascular stimulation, a common side effect, would lead to hytertension
Make sure the patient’s call light is close by in case of the need for assistance with activities.
28. Which of the following conditions characterizes rapid eye movement (REM) sleep?
Disorientation and disorganized thinking
Jerky limb movements and position changes
Pulse rate slowed by 5 to 10 beats/minute
Highly active brain and physiological activity levels.
29. Which of the following sleep disorders is the most prevalent?
Hypersomnia
Insomnia
Parasomnia
Sleep-awake schedule disturbance.
30. Which of the following substances is a natural hormone produced by the pineal gland that induces sleep?
Amphetamine
Melatonin
Methylphenidate
Pemoline
Answers and Rationales
D. (Although this is a diagnostic tool, the first thing the nurse would do is question the spouse. This may lead to determining whether more tests are needed).
B. Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.
C. The nurse should not startle the client but should gently awaken the client and lead him or her back to bed.
A. The client is most sensitive to noise in the hospital setting the first night because everything is new. This represents sensory overload, which interferes with sleep and decreases rapid eye movement (REM) as well as total sleep time.
C. The group of drugs that are the safest are the benzodiazepines. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.
C. A small glass of milk relaxes the body and promotes sleep.
A, C, and D. These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia.
B and C. Research demonstrate that the occurrence of SIDS is reduced with these two positions.
D. Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.
A. Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate and are believed to be functionally important to learning, memory processing, and adaptation to stress.
B. Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.
D. Narcolepsy is a dysfunction of mechanisms that regulate the sleep and wake states. Excessive daytime sleepiness is the most common complaint associated with this disorder. During the day a person may suddenly feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur within 15 minutes of falling asleep.
D. The amount of sleep needed during the school years is individualized because of varying states of activities and levels of health. A 6-year old averages 11-12 hours of sleep nightly, whereas an 11-year old sleeps about 9-10 hours. The 6- or 7-year old can usually be persuaded to go to bed by encouraging quiet activities.
C, E, and F. Lying in bed when one is unable to sleep increases frustration and anxiety which further impede sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backwards requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.
A, D, and F. Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.
C. Chloral hydrate is a sedative. This medication does not affect cardiac function. Blood pressure changes are not significant with the use of this medication. A client should call for assistance to the bathroom at night. Additionally, the client may experience residual daytime sedation; therefore, the nurse should instruct the client to call for ambulation assistance during the daytime hours.
B, D, and E. Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares.
B, C, and E. If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation.
D. Flumazenil is the antidote for benzodiazepine overdoses.
B. If longer-acting barbiturates are used in older adults, these clients may experience daytime sedation, ataxia, and memory deficits.
C. Sedative-hypnotics cause CNS depression, putting the patient at risk for injury.
B. There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the GI tract, preventing absorption.
C. Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.
B. Dantrolene is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia (remember intraoperative nursing???)
C.
C.
D.
D.Highly active brain and physiological activity levels characterize REM stage. Stages 3 and 4 of NREM sleep are characterized by disorientation and disorganization, During REM sleep, the body movement ceases except for the eyes. The pulse rate slows by 5-10 beats/minute during NREM sleep, not REM sleep.
B. Approximately 1/3 of American adults have some type of sleep disorder, and insomnia is the most common.
B. Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.