Priorities in Critical Care Nursing 7th Edition Urden - Stacy - Lough - Test Bank

Priorities in Critical Care Nursing 7th Edition Urden – Stacy – Lough – Test Bank

 

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Chapter 05: Sleep Alterations

Test Bank

 

MULTIPLE CHOICE

 

1. Which stage of NREM sleep is associated with anabolic processes?

a.	N1
b.	N2
c.	N3
d.	N4

 

 

ANS:  C

In stage N3 sleep, slow waves continue to develop until 50% of the EEG waveforms are slow wave. This stage of sleep is often referred to as slow-wave sleep. The release of other hormones, such as prolactin and testosterone, suggests that anabolism occurs during the slow-wave sleep of stage N3. N1 sleep is a transitional, lighter sleep state from which the patient can be easily aroused by light touch or by softly calling his or her name. Stage N2 sleep occupies about 45% to 55% of the night, with sleep deepening and a higher arousal threshold being required to awaken the patient. N4 sleep does not exist.

 

2. What occurs physiologically during REM sleep?

a.	Growth hormone is secreted.
b.	Metabolic needs are decreased.
c.	Sympathetic nervous system predominates.
d.	Heart rate and blood pressure decrease.

 

 

ANS:  C

The sympathetic nervous system predominates during REM sleep. Oxygen consumption increases, and cardiac output, blood pressure, heart rate, and respiratory rate may become erratic. NREM sleep is dominated by parasympathetic nervous system. Blood pressure, heart and respiratory rates, and the metabolic rate return to basal levels. About 80% of total daily growth stimulating hormone is released in NREM sleep.

 

3. Interventions to help with circadian synchronization include

a.	opening the window blinds.
b.	encouraging the patient to take frequent naps during the day.
c.	administering sedatives at bedtime.
d.	keeping the patient awake during the early morning hours.

 

 

ANS:  A

Nursing interventions that maintain normal rhythm of the day–night cycle, such as opening window blinds, should be encouraged.

 

4. The patient has been in the critical care unit for 3 weeks and has been on an intra-aortic balloon pump for the past 3 days. The patient’s condition has been serious, and hourly assessments and vital signs have been necessary. The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time. The patient has been given diazepam (Valium) prn. The anticipated effect of diazepam on the patient’s sleep is

a.	a decrease in NREM stage 1.
b.	an increase in NREM stage 3.
c.	total NREM suppression.
d.	REM suppression in larger doses.

 

 

ANS:  D

Diazepam increases NREM stage 1 and reduces NREM stages 3 and REM. REM suppression is dose related.

 

5. The patient has been in the critical care unit for 3 weeks and has been on the intra-aortic balloon pump for the past 3 days. The patient’s condition has been serious, and hourly assessments and vital signs have been necessary. The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time. The patient has been given diazepam (Valium) prn. Which techniques may assist in assessing the patient’s sleep pattern?

a.	Correlating sleep time with vital signs
b.	Documenting sleep periods of more than 90 minutes
c.	Assessing degree of arousal on hourly checks
d.	Observing the length of NREM sleep periods

 

 

ANS:  B

Keeping a sleep chart for 48 to 72 hours and documenting sleep periods greater than 90 minutes, the number and length of awakenings, and the total possible sleep time can help assess sleep patterns in the critical care unit.

 

6. Where are EMG leads placed to detect muscle atonia?

a.	Scalp
b.	Intercostal
c.	Anterior tibialis
d.	Chin

 

 

ANS:  D

Electromyography involves leads placed over various muscle groups. When placed over the chin, the leads can help detect muscle atonia associated with REM sleep. Intercostal leads detect respiratory effort, and leads over the anterior tibialis detect leg movements that may be causing the patient to arouse. Electroencephalographic electrodes are attached to the patient’s scalp to measure brain waves.

 

7. Hypnotic benzodiazepines

a.	promote deeper sleep stages.
b.	can produce prolonged effects in older adults.
c.	are metabolized more rapidly in the presence of steroids.
d.	enhance short-term recall.

 

 

ANS:  B

Hypnotic benzodiazepines have a high lipophilicity, resulting in increased half-life in older adults. They also promote lighter sleep stages, are potentiated by steroids, and cause memory failure.

 

8. Which of the following patients would the nurse most strongly suspect of having obstructive sleep apnea?

a.	A severely obese woman with diabetes
b.	A moderately obese man who snores
c.	A nonobese woman with hypertension
d.	A severely obese man with renal dysfunction

 

 

ANS:  B

Obesity associated with snoring is a hallmark of obstructive sleep apnea.

 

9. Which of the following older patients demonstrates changes in sleep patterns attributable to central sleep apnea?

a.	A patient who wakes up two to three times per night and is tired during the day
b.	A patient who reports sleeping less soundly and not feeling rested
c.	A patient who consistently awakens at 4 AM and goes to bed at 7 PM
d.	A patient who has irregular respiration during sleep and whose inspiratory muscles intermittently fail

 

 

ANS:  D

Inspiratory muscle paralysis is a symptom of central sleep apnea. The other answers are associated with lifestyle habits that should be modified or changed to enhance sleep hygiene.

 

10. Sleep deprivation can result from which of the following?

a.	CPAP machine use
b.	Mechanical ventilation
c.	Use of nonbenzodiazepine short-acting hypnotics
d.	Use of analgesic medications to control pain

 

 

ANS:  B

Not surprisingly, mechanical ventilation and the required care associated with it contribute to sleep disturbances. CPAP treats the obstruction and the snoring, choking, and gasping that accompany it, and it provides cardiovascular benefits. Hypnotics and analgesic medications may aid sleep. Nurses have a responsibility to administer these medications in the most efficient manner to promote sleep and to monitor effectiveness.

 

11. During a sleep study, which of the following groups of information are gathered?

a.	Airflow, snoring, and tonsil size
b.	Electroencephalogram, electrocardiogram, and end-tidal carbon dioxide
c.	Oxygen saturation, number of arousals, and airflow
d.	Frequency of awakenings, REM speed, and apnea–hypopnea index

 

 

ANS:  C

Polysomnography is used to determine the number and length of apnea episodes and sleep stages, number of arousals, airflow, respiratory effort, and oxygen desaturation.

 

12. A patient with mild obstructive sleep apnea (OSA) can expect treatment to consist of

a.	medical management with protriptyline.
b.	weight loss, elimination of alcohol before bedtime, and side sleeping.
c.	immediate use of continuous positive airway pressure (CPAP).
d.	surgical intervention with uvulopalatopharyngoplasty (UPPP).

 

 

ANS:  B

For patients with mild OSA (apnea–hypopnea index of 5 to 10), weight loss, sleeping on the side (if apnea is associated with sleeping on the back), avoidance of sedative medications and alcohol before bedtime, and avoidance of sleep deprivation may be all that is necessary. CPAP would be the next treatment choice.

 

13. The primary determinant in the efficacy of CPAP in patients with OSA is

a.	compliance.
b.	weight.
c.	tonsil size.
d.	respiratory effort.

 

 

ANS:  A

CPAP, although the treatment of choice, is effective only if the patient is compliant with therapy. Regular attendance at CPAP clinics can improve patient compliance.

 

14. A patient was given the diagnosis of congestive heart failure (CHF) 2 years ago. The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring. Central sleep apnea is suspected. Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea. Which of the following indicates a diagnosis of nonhypercapnic central sleep apnea (CSA)?

a.	Polysomnography with absence of airflow for at least 5 seconds
b.	Apnea–hypopnea index of 10
c.	Peripheral edema, polycythemia, and obesity
d.	Insomnia, awakenings accompanied by choking, and normal body mass index

 

 

ANS:  D

Nonhypercapnic central sleep apnea characteristics include daytime sleepiness, insomnia or poor sleep, mild or intermittent snoring, and awakenings accompanied by choking or feeling short of breath; frequently, patients are of normal body weight. CSA can be seen on polysomnography as an absence of airflow and respiratory effort for at least 10 seconds.

 

15. A patient was given the diagnosis of congestive heart failure (CHF) 2 years ago. The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring. Central sleep apnea is suspected. Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea. The patient’s primary treatment plan should include

a.	CPAP.
b.	bilevel positive airway pressure (BiPAP).
c.	acetazolamide and medroxyprogesterone.
d.	modafinil and zolpidem.

 

 

ANS:  A

One treatment for the nonhypercapnic or heart failure patients is nasal CPAP, which also may provide a beneficial cardiovascular effect. Nocturnal oxygen supplementation may be effective as well. If CPAP is not tolerated, pharmacologic management may be tried.

 

16. _____ is a diagnostic test used to determine sleep disturbances.

a.	Electrooculography
b.	Electromyography
c.	Electroencephalography
d.	Polysomnography

 

 

ANS:  D

Polysomnography uses electroencephalography, electrooculography, myography, and electrocardiography to assess the quality of sleep.

 

17. _____ is used during polysomnography to determine when the patient enters REM sleep.

a.	Electrooculography
b.	Electromyography
c.	Electroencephalography
d.	Polysomnography

 

 

ANS:  A

Electrooculography is used during polysomnography to determine when the patient enters REM sleep.

 

18. _____ is the external element that has the most significant effect on circadian rhythms.

a.	Lower body temperature
b.	Light
c.	Melatonin cycle
d.	Background noise

 

 

ANS:  B

Light is the external element that has the most significant effect on circadian rhythms. Lower body temperature and melatonin cycles are internal elements that help with the sleep–wake cycle. Background noise can influence the circadian rhythms but not as significantly as light.

 

19. Sleep disturbance in critically ill patients is defined as insufficient duration or stages of sleep that results in

a.	less sleep that promotes recovery.
b.	discomfort and interferes with quality of life.
c.	adaptation of the environment to promote sleep.
d.	more sleep that promotes recovery.

 

 

ANS:  B

Sleep disturbance in critically ill patients is defined as insufficient duration or stages of sleep that result in discomfort and interferes with quality of life. When ill, most people need more sleep than usual, and sleep seems to promote recovery.

 

20. Identify the usual cycle of sleep onset.

a.	NR1, NR2, NR3, NR2, REM
b.	NR1, NR2, NR3, REM
c.	NR1, NR2, NR3, NR1, REM
d.	NR1, NR2, NR3, REM, NR3

 

 

ANS:  A

Sleep onset usually occurs in stage 1 sleep, progressing through stages 2 and 3 and then going back to stage 2, at which time the person usually enters REM.

 

21. REM sleep comprises what percent of the sleep cycle?

a.	70% to 75%
b.	45% to 65%
c.	15% to 20%
d.	20% to 25%

 

 

ANS:  D

NREM sleep usually occupies 70% to 75% of the sleep cycle, with REM sleep comprising 20% to 25%.

 

22. A sufficient amount of sleep has been achieved when a person awakens

a.	after 8 to 10 hours of uninterrupted sleep.
b.	with external stimuli and gets through the day without feeling sleepy.
c.	without external stimuli and gets through the day without feeling sleepy.
d.	feeling rested in the morning and takes a nap in the afternoon.

 

 

ANS:  C

A sufficient amount of sleep has been achieved when one awakens without external stimuli and gets through the day without feeling sleepy. The amount of sleep required is uncertain. No set number of hours has been established.

 

MULTIPLE RESPONSE

 

1. Which of the following occur during REM sleep stages? (Select all that apply.)

a.	Vital signs remain at basal levels.
b.	Dreams occur.
c.	Myocardial infarction often occurs.
d.	Sweating or shivering is common.
e.	Growth hormone is released.

 

 

ANS:  B, C

The sympathetic nervous system predominates during REM sleep. Vital signs remain at basal levels, sweating or shivering commonly occurs with extreme temperature changes, and releases of growth hormone are parasympathetic nervous system responses.