Urden: Thelan’s Critical Care Nursing, 5th Edition

Test Bank

Chapter 6: Sleep Alterations And Management

MULTIPLE CHOICE

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

a. 1
b. 2
c. 3
d. 4

ANS: D
Elevated growth hormone and other anabolic hormones are released during NREM stage
4 sleep.

DIF: Cognitive Level: Knowledge REF: 81-82

OBJ: Nursing Process Step: Diagnosis TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

2. Physiologically, what occurs 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.

DIF: Cognitive Level: Knowledge REF: 82

OBJ: Nursing Process Step: Assessment TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

3. Interventions to help with circadian desynchronization include

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

ANS: A

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Test Bank 2

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

DIF: Cognitive Level: Application REF: 83-84

OBJ: Nursing Process Step: Intervention TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

Ms. C has been in the critical care unit for 3 weeks and has been on the intraaortic
balloon pump for the last 3 days. Her condition has been serious, and hourly assessments
and vital signs have been necessary. The nursing staff has noted that she has been unable
to achieve sleep for more than 30 minutes at a time. She has been given diazepam
(Valium) prn.

4. The anticipated effect of diazepam on Ms. C’s sleep is

a. a decrease in NREM stage 1.
b. an increase in NREM stages 3 and 4.
c. total NREM suppression.
d. REM suppression in larger doses.

ANS: D
Diazepam increases NREM stage 1 and reduces NREM stages 3 and 4 and REM. REM
suppression is dose related.

DIF: Cognitive Level: Application REF: 86

OBJ: Nursing Process Step: Evaluation TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

5. Which techniques may assist in assessing Ms. C’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, number and length of awakenings, and total possible sleep time can help assess
sleep patterns in the critical care unit.

DIF: Cognitive Level: Application REF: 88

OBJ: Nursing Process Step: Intervention TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

6. Which stage of sleep is associated with muscle atonia?

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Test Bank 3

a. NREM sleep
b. REM sleep
c. Stage 1
d. Stage 2

ANS: D
REM sleep is associated with paralysis of the skeletal muscles.

DIF: Cognitive Level: Knowledge REF: 82

OBJ: Nursing Process Step: Diagnosis TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

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

ANS: B
Sedative-hypnotics have a higher lipophilicity, resulting in increased half-life in elders.
They also promote lighter sleep stages, are potentiated by steroids, and cause memory
failure.

DIF: Cognitive Level: Knowledge REF: 84

OBJ: Nursing Process Step: Intervention TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

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.

DIF: Cognitive Level: Comprehension REF: 90

OBJ: Nursing Process Step: Assessment TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

9. Which of the following factors is the most important regulator of circadian rhythm?
a. Social activity

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 Test Bank 4

b. Exercise
c. Meals
d. Light

ANS: D
Light is the most important regulator of circadian rhythms.

DIF: Cognitive Level: Knowledge REF: 83-84

OBJ: Nursing Process Step: Intervention TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

10. Which of the following elderly patients demonstrates changes in sleep patterns NOT
attributable to normal aging?
a. J, who wakes up two to three times per night and is tired during the day
b. K, who reports sleeping less soundly and not feeling rested
c. L, who consistently awakens at 4 AM and goes to bed at 7 PM
d. M, who has irregular respiration during sleep and whose inspiratory muscles
intermittently fail

ANS: D
Inspiratory muscle paralysis is a symptom of central sleep apnea. This is not a normal
consequence of aging.

DIF: Cognitive Level: Comprehension REF: 83

OBJ: Nursing Process Step: Assessment TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

11. Sleep deprivation can result in which of the following?

a. Decreased cortisol production
b. Decreased glucose tolerance
c. Hyperactivity
d. Somnolence

ANS: B
Sleep debt was found to produce glucose intolerance, decreased thyrotropin
concentrations, increased cortisol production, and increased nervous system activity.

DIF: Cognitive Level: Application REF: 85-86

OBJ: Nursing Process Step: Diagnosis TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

12. During a sleep study, which of the following groups of information are gathered?
a. Airflow, snoring, tonsil size

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Test Bank 5

b. Electroencephalogram, electrocardiogram, end-tidal carbon dioxide

c. Oxygen saturation, leg movement, chest excursion
d. Frequency of awakenings, REM speed, apnea-hypopnea index

ANS: C
Parameters not measured are tonsil size, end-tidal carbon dioxide, and REM speed. All
the other parameters are documented.

DIF: Cognitive Level: Comprehension REF: 90

OBJ: Nursing Process Step: Diagnosis TOP: Sleep
MSC: NCLEX: Psychosocial Integrity

COMPLETION

1. __________ is a diagnostic test used to determine sleep disturbances.

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

DIF: Cognitive Level: Comprehension REF: 80

OBJ: Nursing Process Step: Assessment TOP: Sleep Alterations
MSC: NCLEX: Physiologic Integrity

2. ___________ is used during polysomnography to determine when the patient enters

REM sleep.

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

DIF: Cognitive Level: Comprehension REF: 80

OBJ: Nursing Process Step: Diagnosis TOP: Sleep Alterations
MSC: NCLEX: Physiologic Integrity

3. __________ is the external element that has the most significant effect on circadian
rhythms.

ANS:
Light

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Test Bank 6

Rationale: Light is the external element that has the most significant effect on circadian
rhythms.

DIF: Cognitive Level: Comprehension REF: 84

OBJ: Nursing Process Step: N/A TOP: Sleep Alterations
MSC: NCLEX: Physiologic Integrity

OTHER

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
Rationale: The sympathetic nervous system predominates during REM sleep.

DIF: Cognitive Level: Analysis REF: 82

OBJ: Nursing Process Step: Assessment TOP: Sleep Alterations
MSC: NCLEX: Physiologic Integrity

2. Which of the following are characteristic of sleep in the elderly? Select all that apply.
a. Insomnia
b. Less sleep required
c. Altered circadian rhythms
d. Higher incidence of sleep apnea
e. Longer periods of non-REM sleep

ANS:
a, c
Rationale: Insomnia and altered circadian rhythms are characteristic of the aged adult;
however, it is a misconception that the elderly require less sleep than their younger
counterparts.

DIF: Cognitive Level: Comprehension REF: 83

OBJ: Nursing Process Step: Diagnosis TOP: Sleep Alterations
MSC: NCLEX: Physiologic Integrity

Copyright © 2006 Mosby, Inc.