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Fundamentals of Nursing 3rd Edition Harkreader Hogan Thobaben Test Bank

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Fundamentals of Nursing 3rd Edition Harkreader Hogan Thobaben Test Bank

ISBN-13: 978-1416034360

ISBN-10: 1416034366

 

Description

Fundamentals of Nursing 3rd Edition Harkreader Hogan Thobaben Test Bank

ISBN-13: 978-1416034360

ISBN-10: 1416034366

 

 

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Below you will find some free nursing test bank questions from this test bank:

Harkreader: Fundamentals of Nursing, 3rd Edition

 

Test Bank

 

Chapter 36: Managing Sleep and Rest

 

MULTIPLE CHOICE

 

  1. The concept of mental rest can best be explained as:
1. a feeling of serenity and freedom from worries.
2. the experience of having no active thoughts.
3. an event that occurs during sleep.
4. an event that occurs upon awakening.

 

 

ANS:   1

Mental rest, sometimes called “peace of mind,” implies serenity and freedom from worries. It does not necessarily imply the absence of mental or physical activity.

 

DIF:    Cognitive Level: Knowledge             REF:    Page: 36-976

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Psychosocial Integrity

 

  1. You awaken a client during the night to measure blood pressure and heart rate. You observe that these vital signs are elevated. On the basis of your knowledge of normal sleep cycles, you can expect that the client was experiencing which of the following?
1. delta or slow-wave sleep
2. stage 1 non–rapid eye movement (NREM) sleep
3. rapid eye movement (REM) sleep
4. stage 2 NREM sleep

 

 

ANS:   3

REM sleep is characterized by high brain activity, loss of muscle tone, dreaming, variable arousability, and potential physiological instability. Blood pressure, heart rate, and cardiac output all rise during REM sleep and may begin to fluctuate.

 

DIF:    Cognitive Level: Comprehension      REF:    Page: 36-977

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. A mother brings her adolescent to the clinic, complaining that the child “must be on drugs” because he “sleeps all the time” and “sometimes gets floppy like a rag doll.” You refer the child to the physician because you recognize that these behaviors may be manifestations of:
1. depression.
2. sleep deprivation.
3. a parasomnia.
4. narcolepsy.

 

 

ANS:   4

Narcolepsy is classified as a hypersomnia, which is a sleep disorder characterized by excessive sleepiness. By an unknown mechanism, the central nervous system loses control of REM sleep. This loss of control is manifested as daytime sleep attacks, cataplexy, hypnagogic hallucinations, and sleep paralysis.

 

DIF:    Cognitive Level: Analysis                  REF:    Page: 36-982

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. Which of the following steps should you take to optimize sleep and address elimination needs for a client diagnosed with nocturnal enuresis?
1. Restrict fluids in the evening hours.
2. Put a diaper on the client.
3. Prepare a “floor bed” as close to the bathroom as possible.
4. Keep a light on to illuminate the path to the bathroom.

 

 

ANS:   1

Treatment for nocturnal enuresis may involve low doses of tricyclic antidepressants, behavioral techniques (such as bladder training or the use of a pad and buzzer), and fluid restriction in the evening.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-989

KEY:   Nursing Process Step: Intervention   MSC:   NCLEX: Physiological Integrity

 

  1. Sleep assessment reveals that a client who has difficulty staying asleep at night always drinks a glass of sherry before going to bed. To improve sleep quality, you should counsel the client to do which of the following?
1. Eliminate the alcohol because it may be causing rebound arousal.
2. Substitute a sleeping pill for the alcohol.
3. Switch from sherry to a beverage that contains less alcohol, such as beer or wine.
4. Increase the amount of sherry at bedtime to increase central nervous system sedation.

 

 

ANS:   1

Alcohol, a brain sedative, shortens sleep onset. However, it disturbs sleep patterns late at night because its rapid metabolism causes a rebound arousal. It may also cause early morning awakenings secondary to a full bladder.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-989

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. Which of the following sleep-related changes is seen in the older adult?
1. decreased sleep efficiency
2. increased slow-wave sleep
3. reduced stage 2 sleep
4. fewer nocturnal awakenings

 

 

ANS:   1

Studies have shown that the healthy elderly generally spend more time in bed, spend less time asleep, awaken more often and for longer periods, and have less efficient sleep time. That is, they are spending more time in bed but less time asleep. They spend less time in REM and slow-wave sleep and often take naps. In addition, aging raises the risk of development of a primary sleep disorder or a sleep disorder secondary to chronic medical or psychiatric illness.

 

DIF:    Cognitive Level: Knowledge             REF:    Page: 36-979

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. A client is admitted to the intensive care unit with a myocardial infarction. When taking a sleep history, you learn that the client’s loud snoring often awakens the partner and that the client frequently experiences unrefreshing sleep. These findings suggest that the client has which of the following?
1. narcolepsy
2. obstructive sleep apnea
3. a normal sleep pattern
4. REM sleep

 

 

ANS:   2

If obstructive sleep apnea is causing interrupted sleep, the partner may mention that the client has loud snoring, gasping, or choking.

 

DIF:    Cognitive Level: Analysis                  REF:    Page: 36-982

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. The nurse would select which of the following nursing diagnoses as having the highest priority for a client with narcolepsy?
1. Self-care deficit
2. Risk for injury
3. Disturbed thought processes
4. Compromised family coping

 

 

ANS:   2

A client with a primary sleep disorder is at high risk for injury. Two thirds of narcoleptic people have fallen asleep while driving and 80% have fallen asleep while at work.

 

DIF:    Cognitive Level: Analysis                  REF:    Page: 36-988

KEY:   Nursing Process Step: Diagnosis       MSC:   NCLEX: Physiological Integrity

 

  1. You have instructed a client with insomnia how to promote sleep onset using the Bootzin technique. Which client statement suggests a need for further teaching?
1. “I will try to take my sleeping pill before going to bed.”
2. “I will engage in relaxing activities like watching TV or reading while in bed.”
3. “After my physical, I will enroll in an afternoon exercise program at the YMCA.”
4. “I will take a hot bath every evening before going to bed.”

 

 

ANS:   2

According to the Bootzin technique for improving sleep hygiene through behavioral modification techniques, the client should use the bed only for sleeping and sex. The client should not read, eat, or watch television in bed.

 

DIF:    Cognitive Level: Analysis                  REF:    Page: 36-992

KEY:   Nursing Process Step: Evaluation      MSC:   NCLEX: Physiological Integrity

 

  1. You are providing instruction to a client with a sleep disorder about use of a bedtime hypnotic medication. You would remind the client to take the medication:
1. 4 hours after bedtime if the client has not fallen asleep.
2. 2 hours after bedtime if the client has not fallen asleep.
3. at least 1 to 2 hours before bedtime.
4. shortly before going to bed.

 

 

ANS:   4

Instruct the client to take sleep medication shortly before going to bed. Remember that many clients take their medication hours after retiring, when they have finally become frustrated by the inability to sleep. Consequently, their sleep will be out of phase with their normal sleep-wake circadian pattern.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-992

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. The nurse would encourage which of the following bedtime snacks for a client with a sleep pattern disturbance?
1. a large serving of nachos with cheese
2. a cup of tea and a chocolate bar
3. a 12-ounce glass of beer
4. an 8-ounce glass of milk

 

 

ANS:   4

Instruct clients to avoid alcohol, nicotine, and caffeine, all of which have been associated with higher frequency of arousals. A light bedtime snack may be helpful. Some clients respond well to foods high in tryptophan, such as bananas and milk.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-994

KEY:   Nursing Process Step: Intervention   MSC:   NCLEX: Physiological Integrity

 

  1. You have been teaching the parents of a child with a history of sleep terrors. Which parent activity demonstrates understanding of your instructions?
1. locking all doors and windows
2. waking the child up when sleep terrors occur
3. ensuring that the child follows bedtime routines
4. giving the child a high-protein, high-fat snack just before bedtime

 

 

ANS:   3

The child with sleep terrors may need to be restrained during an episode, and breakable objects must be placed out of reach. Parents should not attempt to awaken the child. Teach parents the importance of maintaining the child’s routines and ensuring that the child gets enough sleep to prevent an exacerbation of the symptoms. Locking doors and windows is helpful for sleepwalking, not night terrors.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-995

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. You have taught a client about the use of a continuous positive airway pressure (CPAP) mask for obstructive sleep apnea. Which client statement shows that the client understands your teaching?
1. “I will need to use CPAP every night for the rest of my life unless I elect to have surgery.”
2. “The CPAP will prepare me for the surgery.”
3. “I will use the CPAP when my symptoms are bad.”
4. “I will take a tranquilizer because it will help me relax during the treatment.”

 

 

ANS:   1

The client using a CPAP mask to manage sleep apnea needs to understand that the underlying disease will recur if the apparatus is not used, even for short periods.

 

DIF:    Cognitive Level: Analysis                  REF:    Page: 36-994

KEY:   Nursing Process Step: Evaluation      MSC:   NCLEX: Physiological Integrity

 

  1. You would consider implementing a “floor bed” program by placing the client’s mattress on the floor for a client with which of the following sleep-related problems?
1. sundowning
2. narcolepsy
3. night terrors
4. sleepwalking

 

 

ANS:   1

Sundowning is a sleep disruption involving the nocturnal exacerbation of disruptive behaviors and agitation. The condition is associated with clients who have dementia. You may want to institute a “floor bed” program by placing the client’s mattress on the floor to avoid restraints and eliminate the client’s risk of falling out of bed.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-995

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. The nurse would assess for which of the following classic sleep disturbances in a client diagnosed with depression?
1. narcolepsy
2. sleepwalking
3. early morning awakenings
4. delayed onset of sleep

 

 

ANS:   3

Early morning awakenings are a classic sign of depression.

 

DIF:    Cognitive Level: Knowledge             REF:    Page: 36-995

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. What is the best method to evaluate the effectiveness of a sleep promotion program?
1. Observe the client for sleep-associated behaviors when the client goes to bed.
2. Ask the client whether the client feels well rested after a night’s sleep.
3. Observe the client for irritability, tremors, and other symptoms of sleep deprivation.
4. Ask whether the client’s bed partner slept through the night.

 

 

ANS:   2

Until researchers can identify and quantify events that must occur during sleep for people to feel well rested, evaluation must be made primarily on the basis of client reports.

 

DIF:    Cognitive Level: Knowledge             REF:    Page: 36-996

KEY:   Nursing Process Step: Evaluation      MSC:   NCLEX: Physiological Integrity

 

  1. Your client is a 14-year-old female who comes in for assessment related to an inability to wake up in the morning. Which of the following statements is an appropriate consideration?
1. Teens experience delayed sleep syndrome.
2. Teens have longer sleep-wake cycles.
3. Teens have shorter sleep-wake cycles.
4. Most teens need 8 to 10 hours of sleep a night.

 

 

ANS:   2

Teenagers have a longer sleep-wake cycle, causing sleep onset insomnia and difficulty with early morning rising.

 

DIF:    Cognitive Level: Application

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. A client complains of excessive daytime sleepiness with sudden daytime sleep attacks, cataplexy, and sleep paralysis. You suspect:
1. obstructive sleep apnea.
2. insomnia.
3. primary hypersomnia.
4. narcolepsy.

 

 

ANS:   4

Narcolepsy is characterized by abnormal sleep tendencies as well as pathological REM sleep, manifested as excessive daytime sleepiness, disturbed nighttime sleep, cataplexy, and sleep paralysis.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-982

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. The hormone that regulates the circadian rhythms of sleep is:
1. melatonin.
2. melanin.
3. ultradian.
4. Zeitgeber’s.

 

 

ANS:   1

Melatonin is the hormone made in the pineal glad that is released into the blood when darkness occurs.

 

DIF:    Cognitive Level: Knowledge             REF:    Page: 36-976

KEY:   Nursing Process Step: N/A                MSC:   NCLEX: Physiological Integrity

 

  1. Your client is sleeping and you can see rapid movement of the eyes beneath the closed lids. You know that the client is in which stage of sleep?
1. stage 2
2. stage 3
3. stage 4
4. REM

 

 

ANS:   4

REM sleep is characterized by rapid saccadic movement of the eyes.

 

DIF:    Cognitive Level: Application             REF:    Page: 36-977

KEY:   Nursing Process Step: Assessment    MSC:   NCLEX: Physiological Integrity

 

  1. The three processes that regulate sleep are all of the following EXCEPT:
1. homeostatic mechanisms.
2. circadian rhythms.
3. ultradian rhythms.
4. NREM.

 

 

ANS:   4

Sleep is regulated by homeostatic mechanisms as well as by the circadian and ultradian rhythms. NREM is the non–rapid eye movement stage of sleep.

 

DIF:    Cognitive Level: Knowledge             REF:    Page: 36-977

KEY:   Nursing Process Step: N/A                MSC:   NCLEX: Physiological Integrity