Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
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Chapter 33: Adult Issues
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
MULTIPLE CHOICE
1) A client who has degenerative arthritis of the knees and hips for which she takes nonsteroidal antiinflammatory drugs tells the nurse “For the past month I have been having a lot of trouble sleeping. I cannot seem to fall asleep, and then when I finally do get to sleep, I find I wake up a number of times during the night.” Which information should the nurse seek initially?
| A. | “Are you snoring a lot?” |
| B. | “Do you have pain at night?” |
| C. | “Do you sleep better with the radio on?” |
| D. | “Can you define ‘good sleep’ for me?” |
ANS: B
Clients with diseases such as arthritis may have sleep disturbance related to nightly pain. Because the pain is chronic the client may fail to realize it is the reason for the inability to sleep. The other options do not follow the client’s lead.
DIF: Cognitive Level: Analysis REF: Text Page: 659, Text Page: 660
TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity
2) A nurse who works the night shift tells the nurse practitioner who is her primary caregiver “I am exhausted most of the time. I sleep through my alarm and have to have a friend phone me to make sure I get up to go to work. Sometimes while I am on duty, my brain does not seem to work right. I am beginning to be concerned that I might make a practice error.” What question will the nurse need to ask before problem solving?
| A. | “How much sleep to you get in a 24-hour period?” |
| B. | “Do you exercise just before going to bed?” |
| C. | “What stress are you experiencing in your life?” |
| D. | “Have you ever used a hypnotic to help you sleep?” |
ANS: A
Total sleep hours need to be ascertained before giving advice to correct a sleep disorder. In this case the client describes sleep deprivation symptoms rather than a sleep disorder. Option A is the only option that addresses total sleep hours.
DIF: Cognitive Level: Application REF: Text Page: 659
TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity
3) A client goes to the clinic to report that the medication prescribed to help her get to sleep worked well when she took it each night for 1 month. However, now that the medication is gone, her insomnia is worse than ever and she has had nightmares the last two nights. The nurse can hypothesize that the physician had prescribed a
| A. | hypnotic. |
| B. | neuroleptic. |
| C. | central nervous system stimulant. |
| D. | tricyclic antidepressant. |
ANS: A
Hypnotics can worsen existing sleep disturbances when they induce drug-dependency insomnia. Once the drug is discontinued the individual may have rebound insomnia and nightmares. Neuroleptics rarely worsen insomnia. CNS stimulants worsen insomnia while they are in use. Tricyclic antidepressants may help insomnia.
DIF: Cognitive Level: Application
REF: Text Page: 662, Text Page: 663, Text Page: 664, Text Page: 665
TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity
4) A client with primary insomnia asks the nurse why day naps do not really compensate for a lost night’s sleep. The best reply for the nurse is
| A. | “Circadian cycles give daytime naps a structure different from nighttime sleep.” |
| B. | “The body clock operates on a 25-hour cycle, making nap effectiveness unpredictable.” |
| C. | “ It is a matter of habit and expectation. We expect to be more refreshed from a night’s sleep.” |
| D. | “Sleep restores homeostasis but works more efficiently when aided by melatonin secreted at night.” |
ANS: A
A regular 90- to 100-minute sleep cycle occurs with nighttime sleep, with progression through two distinct physiological states: four stages of non–rapid eye movement (REM) sleep and a period of REM sleep. Naps often contain different amounts of REM sleep, thus changing the physiology of sleep as well as the psychological and behavioral effects of sleep. Options B and D are not true statements. Option C has little bearing on the reason for lack of refreshment.
DIF: Cognitive Level: Analysis REF: Text Page: 661, Text Page: 662
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
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