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Basic Geriatric Nursing 4th Edition Wold Test Bank

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Basic Geriatric Nursing 4th Edition Wold Test Bank

ISBN-13: 978-0323052436

ISBN-10: 0323052436

 

Description

Basic Geriatric Nursing 4th Edition Wold Test Bank

ISBN-13: 978-0323052436

ISBN-10: 0323052436

 

 

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Wold: Basic Geriatric Nursing, 4th Edition

 

Test Bank

 

Chapter 21: Sleep and Rest

 

MULTIPLE CHOICE

 

  1. The nurse is aware that the initial entry to deep sleep is:
a. stage 1 NREM.
b. stage 3 NREM.
c. stage 5 NREM.
d. REM sleep.

 

 

ANS:  B

Stage 3 NREM is the initial phase of deep sleep in which there is complete muscular relaxation and vital signs begin to decline.

 

DIF:    Comprehension                               REF:   328, Box 21-1, Stages of Sleep

OBJ:   1                    TOP:   Deep Sleep     KEY:  Assessment

MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The phenomenon of sleep walking is most likely to occur in the sleep stage of:
a. stage 1 NREM.
b. stage 2 NREM.
c. stage 4 NREM.
d. REM sleep.

 

 

ANS:  C

Stage 4 NREM is the deepest stage of sleep in which sleep walking is most likely to occur.

 

DIF:    Comprehension                               REF:   328, Box 21-1, Stages of Sleep

OBJ:   1                    TOP:   Sleep Walking                                 KEY:  Assessment

MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse explains that older adults often experience a disturbed sleep-wake cycle because of hormonal changes, which include:
a. increase in angiotensin level.
b. decrease in insulin level.
c. increase in growth hormone level.
d. decrease in melatonin level.

 

 

ANS:  D

A decrease in the melatonin level causes age-related sleep disturbances.

 

DIF:    Application    REF:   328                OBJ:   1                    TOP:   Hormonal Changes

KEY:  Implementation                               MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The older man in a long-term care facility consistently wakes at 3 AM and does not return to sleep. The nurse records this behavior as:
a. sleep initiation insomnia.
b. sleep maintenance insomnia.
c. terminal insomnia.
d. undifferentiated insomnia.

 

 

ANS:  C

Terminal insomnia is a sleep disturbance in which the patient consistently wakes at an early hour and cannot return to sleep.

 

DIF:    Application    REF:   329                OBJ:   2                    TOP:   Terminal Insomnia

KEY:  Assessment    MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The newly admitted older adult who cannot fall asleep and asks for a sedative every night is most probably experiencing a difficulty with:
a. sleep initiation related to anxiety of relocation.
b. sleep maintenance related to unfamiliar environment.
c. sleep initiation related to depression associated with relocation.
d. sleep maintenance related to episodes of nocturnal movement disorders.

 

 

ANS:  A

Sleep initiation issues are usually associated with anxiety.

 

DIF:    Application    REF:   329                OBJ:   2                    TOP:   Insomnia

KEY:  Assessment    MSC:  Psychosocial Integrity: Coping and Adaptation

 

  1. The home health nurse assesses that the patient probably is experiencing myoclonus when his wife says:
a. “His loud snoring and jerking awake wakes me up too.”
b. “I am black and blue from his kicking me every night.”
c. “He wakes up a 2 AM every morning and walks around the house.”
d. “His constant leg movements tear up the covers and keep me awake.”

 

 

ANS:  B

Myoclonus is a periodic kicking movement of the lower extremities, which can be severe.

 

DIF:    Application    REF:   329                OBJ:   2                    TOP:   Myoclonus

KEY:  Assessment    MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse would question the order for lorazepam (Ativan), 5 mg at bedtime, for a patient with:
a. chronic obstructive pulmonary disease (COPD).
b. any form of dementia.
c. hypertension.
d. sleep apnea.

 

 

ANS:  D

Sedation may prevent the patient with sleep apnea to awaken to restore respiration.

 

DIF:    Application    REF:   329, Table 21-1, Medications Used to Promote Sleep

OBJ:   3                    TOP:   Lorazepam     KEY:  Implementation

MSC:  Physiological Integrity: Pharmacological Therapies

 

  1. In order to assist a 75-year-old male resident in a long-term care facility to decrease his problems with sleep initiation, the nurse would:
a. provide a heavy snack at bedtime.
b. reschedule the 8 PM albuterol inhalation treatment to 4 PM.
c. coach the resident in 10 minutes of exercise prior to bedtime.
d. provide a cola drink, strong tea, or cocoa at bedtime.

 

 

ANS:  B

Albuterol is a drug that may interfere with sleep schedules.

 

DIF:    Analysis         REF:   330, Table 21-2, Drugs That Contribute to Sleep Disorders

OBJ:   7                    TOP:   Insomnia        KEY:  Implementation

MSC:  Physiological Integrity: Pharmacological Therapies

 

  1. The nurse cautions the patient who has just started on the antidepressant trazodone hydrochloride to help relieve insomnia to:
a. increase fluids.
b. avoid aged cheese and red wine.
c. decrease sodium intake.
d. avoid excessive exposure to the sun.

 

 

ANS:  D

Trazodone makes persons photosensitive.

 

DIF:    Application    REF:   329, Table 21-1, Medications Used to Promote Sleep

OBJ:   7                    TOP:   Trazodone      KEY:  Implementation

MSC:  Physiological Integrity: Pharmacological Therapies

 

  1. The 80-year-old man complains that when he goes to bed and cannot fall asleep, he tosses and turns and gets so frustrated that he gets up and drinks coffee all night. The nurse suggests that when he hasn’t fallen asleep after 30 minutes, he should:
a. take two tablets of a sedative medication.
b. get up and do a mild stretching exercise for 15 minutes.
c. remain in bed with his eyes closed.
d. get up and read until he feels sleepy and then return to bed.

 

 

ANS:  D

Getting up and reading or watching TV is more restful than experiencing the frustration of inability to fall asleep. Sleep-inducing drugs frequently have a negative effect on older adults; exercising is stimulating and lying in bed may increase tension.

 

DIF:    Application    REF:   330                OBJ:   7                    TOP:   Insomnia

KEY:  Implementation                               MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse clarifies that the continuous positive airway pressure (CPAP) machine decreases the incidence of episodes of sleep apnea by:
a. stimulating inspiration to be deeper.
b. taking over respiratory activity when the patient ceases to breathe.
c. sounding an alarm if respirations have ceased.
d. keeping alveoli from collapsing.

 

 

ANS:  D

The use of CPAP keeps alveoli from collapsing and causing periodic apnea.

 

DIF:    Comprehension                               REF:   331                OBJ:   7

TOP:   Continuous Positive Airway Pressure (CPAP) Machine      KEY:  Implementation

MSC:  Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. When the patient tells the home health nurse that he has flung himself out of bed three times in the course of a violent nightmare, the nurse recognizes the cardinal indicator of:
a. myoclonus.
b. restless leg syndrome.
c. REM sleep disorder.
d. epilepsy.

 

 

ANS:  C

REM sleep disorders excite excessive muscle activity during a nightmare, which causes the patient to thrash about to the point that he or she falls out of bed.

 

DIF:    Application    REF:   331                OBJ:   5                    TOP:   REM Sleep Disorder

KEY:  Assessment    MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse cautions that although activity and exercise during the day are an effective sleep aid, activity and exercise should be avoided within ____________ prior to bedtime.
a. 30 minutes
b. 1 hour
c. 2 hours
d. 3 hours

 

 

ANS:  C

Exercise should be avoided within 2 hours of bedtime because activity increases the metabolic rate and may interfere with sleep.

 

DIF:    Knowledge     REF:   334                OBJ:   7                    TOP:   Exercise

KEY:  Implementation                               MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The patient is encouraged to decrease fluid intake in the late evening to prevent interruption of sleep from:
a. increased digestive processes in the bowel.
b. episodes of nocturia.
c. gastroesophageal reflux.
d. changes in body temperature.

 

 

ANS:  B

Reduced fluid intake in the evening will prevent nocturia, which interrupts sleep.

 

DIF:    Knowledge     REF:   334                OBJ:   7                    TOP:   Nocturia

KEY:  Implementation                               MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse makes arrangements to promote normal circadian rhythm in a long-term care facility by ensuring that all rooms have:
a. bright lights during the daytime.
b. dim lights to promote relaxation.
c. appropriate environmental temperature.
d. curtains for privacy.

 

 

ANS:  A

Bright lights during the day support normal circadian rhythm. Environmental temperature control and privacy are important, but do not affect circadian rhythm.

 

DIF:    Application    REF:   333                OBJ:   7                    TOP:   Circadian Rhythm

KEY:  Implementation                               MSC:  Physiological Integrity: Basic Care and Comfort

 

           MULTIPLE RESPONSE

 

  1. The nurse is aware that an older adult’s diurnal patterns can be altered by __________________________________________. (Select all that apply.)
a. shift work.
b. time zone changes.
c. stress.
d. illness.
e. medications.

 

 

ANS:  A, B, C, D, E

All options have the potential to alter the diurnal patterns of the older adult.

 

DIF:    Knowledge     REF:   327                OBJ:   1

TOP:   Factors That Disrupt Diurnal Patterns                                KEY:  Assessment

MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The long-term care facility nurse takes into consideration that most residents go to sleep early and awaken early because of ________________________________. (Select all that apply.)
a. increased blood pressure.
b. drop in core temperature.
c. diminished food intake.
d. diminished hormone production.
e. decreased exposure to light.

 

 

ANS:  B, E

Decrease in body temperature and diminished light exposure cause circadian changes, which result in going to bed early and rising early.

 

DIF:    Analysis         REF:   329                OBJ:   2

TOP:   Age-Related Changes in Circadian Rhythm                       KEY:  Assessment

MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse gives the antihistamine diphenhydramine (Benadryl) as a sleep aid with caution because the older adult may experience side effects, such as ___________________________________. (Select all that apply.)
a. confusion.
b. urinary retention.
c. hypotension.
d. depression of respiration.
e. diarrhea.

 

 

ANS:  A, B, C

Benadryl can cause confusion, urinary retention, and hypotension in the older adult.

 

DIF:    Application    REF:   329, Table 21-1, Medications Used to Promote Sleep

OBJ:   4                    TOP:   Antihistamines as Sedatives             KEY:  N/A

MSC:  Physiological Integrity: Pharmacological Therapies

 

  1. When mild sedation has failed to solve the problem of insomnia in the older adult, the nurse suggests ______________________________. (Select all that apply.)
a. relaxation therapy.
b. taking a warm bath or shower prior to bedtime.
c. listening to relaxing music.
d. arranging the sleep environment to promote sleep.
e. going to bed at a regular time after observing routine “sleep rituals.”

 

 

ANS:  A, B, C, D, E

All options listed would encourage sleep.

 

DIF:    Comprehension                               REF:   330                OBJ:   7

TOP:   Insomnia        KEY:  Implementations

MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse explains that factors that contribute to sleep apnea include ____________________________________. (Select all that apply.)
a. obesity.
b. diabetes.
c. hypertension.
d. African-American heritage.
e. use of alcohol.

 

 

ANS:  A, B, C, D, E

All options are considered to be factors that contribute to sleep apnea.

 

DIF:    Comprehension                               REF:   331                OBJ:   5

TOP:   Sleep Apnea   KEY:  Implementation

MSC:  Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The wife of a patient tells the home health nurse that she suspects her husband has sleep apnea because he _________________________________. (Select all that apply.)
a. snores loudly.
b. interrupts snoring with several seconds of silence.
c. complains of daytime drowsiness.
d. frequently is incontinent of urine.
e. has episodes of myoclonus.

 

 

ANS:  A, B, C

Incontinence and myoclonus are not associated with sleep apnea.

 

DIF:    Application    REF:   331                OBJ:   5                    TOP:   Sleep Apnea

KEY:  Assessment    MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nursing staff helps encourage sleep in long-term care facility residents by _____________________________________. (Select all that apply)
a. using the minimum light necessary when making rounds.
b. making necessary sleep interruptions at the same time every night.
c. keep conversational noise at the nursing station to a minimum.
d. answering call lights promptly.
e. providing light blankets for warmth.

 

 

ANS:  A, B, C, D, E

All options listed will help diminish sleep interruptions.

 

DIF:    Comprehension                               REF:   332                OBJ:   7

TOP:   Sleep Support                                 KEY:  Implementation

MSC:  Physiological Integrity: Basic Care and Comfort

 

           SHORT ANSWER

 

  1. The nurse reminds the CNAs that most older adults require a minimum of _____ hours of sleep per day.

 

ANS:

7.5 hours

 

DIF:    Knowledge     REF:   327                OBJ:   2                    TOP:   Sleep Requirements

KEY:  Implementation                               MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse encourages the long-term facility resident experiencing insomnia to drink a glass of milk with supper and again prior to bedtime because milk contains the sleep-inducing agent _______________________.

 

ANS:

Tryptophan

 

DIF:    Comprehension                               REF:   333                OBJ:   7

TOP:   Tryptophan     KEY:  Implementation

MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse clarifies that the individual’s pattern of wakefulness and sleeping is referred to as the ___________________ rhythm.

 

ANS:

Circadian or diurnal

 

DIF:    Knowledge     REF:   327                OBJ:   1                    TOP:   Circadian Rhythm

KEY:  Implementation                               MSC:  Physiological Integrity: Physiological Adaptation

 

  1. The nurse clarifies that the individual’s pattern of wakefulness and sleeping is referred to as the ___________________ rhythm.

 

ANS:

Circadian or diurnal

 

DIF:    Knowledge     REF:   327                OBJ:   1                    TOP:   Circadian Rhythm

KEY:  Implementation                               MSC:  Physiological Integrity: Physiological Adaptation