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Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

Test Generator Questions, Chapter 28, Sleep–Wake Disorders: Nursing Care of Persons with Insomnia and Sleep Problems Multiple Choice 1. The nurse is assessing the sleep patterns of a female client age 70 years with a mental disorder. Based on the knowledge of circadian rhythms and the influence of age, which of the following would the nurse anticipate that the client would report about her sleep pattern? A) “When I was younger, I didn’t notice any differences in how I felt in the morning or evening.” B) “Now it seems like I have difficulty falling asleep or maintaining sleep even when circumstances are adequate for sleep.” C) “When I worked days, I’d always have trouble feeling sleepy in the morning.” D) “When I was younger, the amount of sleep I got didn’t seem to matter.” Ans: B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: e-14 Feedback: Insomnia has a greater prevalence among older people and among divorced, separated, and widowed adults. Increasing age, female sex, and comorbid disorders (e.g., medical, mental disorders, and substance use) are all risks for developing insomnia disorder. 2. A student nurse is preparing a nursing care plan for a client who has insomnia and is experiencing sleep deprivation. Which nursing diagnosis would the nurse most likely identify as reflecting a priority care issue? A) Risk for Injury B) Ineffective Coping C) Deficient Knowledge D) Anxiety Ans: A Chapter: 28 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 4 Page Number: e-14 Feedback: Safety is a priority for people with insomnia. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Sedating medication could

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

potentially increase falls. 3. A client who is receiving counseling at a community health center has complained during the last three weekly sessions about being unable to sleep. The nurse interviews the family members to determine the effect of the client ’s problem on them. Which response would the nurse most likely expect to hear? A) “It really hasn’t seemed to be a problem for us.” B) “There’s been little change in how they get along with other family members.” C) “The not sleeping has really had a positive effect on us all.” D) “It’s been exhausting living with them these past few weeks.” Ans: D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: e-14 Feedback: Living with a family member with insomnia is challenging. Irritability, complaints of sleeplessness, and chronic fatigue interfere with quality interpersonal relationships. It would be highly unlikely that things are not problematic or that the effects of the insomnia would be positive. 4. The nurse is discussing strategies to enhance sleep with a client who is experiencing insomnia. Which of the following would be most appropriate for the nurse to suggest? A) “Eat right before you go to bed, as long as it is something rich that will make you sleepy.” B) “Try exercising a bit right before your bedtime so you will feel tired and sleepy. ” C) “Drinking a warm cup of tea right before bedtime will help to relax you. ” D) “Establish a regular time for going to bed and getting up in the morning.” Ans: D Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 6 Page Number: e-17 Feedback: Routines are important, especially when preparing the body to sleep. Therefore, establishing and maintaining a regular time for bedtime and awakening is appropriate. Clients with insomnia should be counseled not to eat anything heavy for several hours before retiring. Spicy foods, alcohol, and caffeine should be avoided. Additionally, exercise promotes sleep, but regular exercise should be planned for 3 hours before bedtime. 5. A nurse is working with a psychiatric client who was admitted to the inpatient facility and is being discharged. The client asks the nurse what he should do when he

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

goes home to promote getting adequate sleep. Which response by the nurse would be most appropriate? A) “Go to bed at the same time every night and watch a television show that relaxes you.” B) “Save your bedroom for sleeping; that means no work and no TV in the bedroom.” C) “Why don’t you ask your psychiatrist for a prescription for a sleeping pill?” D) “Make sure to keep the bedroom warm and toasty. ” Ans: B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: e-17 Feedback: The nurse can help the client develop bedtime rituals and good sleep hygiene. Bedtime should be at a regular hour, and the bedroom should be conducive to sleep. Preferably, the bedroom should not be a place where the individual watches television or does work-related activities. The bedroom should be viewed as a room for sleeping and sex, and the environment should be cool, with minimal lighting. 6. A client with a mental disorder is being discharged from the inpatient unit. During the hospital stay, the client eventually was able to get an adequate night ’s sleep even though the client had experienced chronic insomnia over the years. The client’s spouse asks the nurse what the family can do in the home environment to promote healthy sleep. Which response by the nurse would be most appropriate? A) “It is basically up to your spouse to focus on promoting their own sleep.” B) “You might consider a glass of wine about 30 minutes before they are ready to go to bed.” C) “Remember to keep stimulating activities at a minimum before he goes to bed. ” D) “Give them a spicy snack with a warm cup of tea at night before bedtime. ” Ans: C Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: e-19 Feedback: Family and friends should be encouraged to support the new habits that the client is trying to establish. Avoiding stimulating activities and engaging in relaxing activities before bedtime are crucial, and family and friends can help create an environment conducive to sleep. Alcohol, spicy foods, and caffeine should be avoided. 7. A client has been admitted to the psychiatric unit with a diagnosis of narcolepsy. Which client statement would the nurse interpret as reflecting this condition?

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

A) “Sometimes I fall asleep when I’m driving my car home from work.” B) “I often have brief periods of intense excitement when going to sleep, and my legs won’t hold still.” C) “I lie there and worry all night, and it keeps me awake. I just can’t relax.” D) “I think my sleep pattern is messed up because I took sleeping pills when I was younger.” Ans: A Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: e-20 Feedback: The overwhelming urge to sleep is the primary symptom of narcolepsy. This irresistible urge to sleep occurs at any time of the day, regardless of the amount of sleep the client has had. Falling asleep often occurs in inappropriate situations, such as while driving a car or reading a newspaper. These sleep episodes are usually short, lasting 5 to 20 minutes, but may last up to an hour if sleep is not interrupted. Individuals with narcolepsy may experience sleep attacks and report frequent dreaming. They usually feel alert after a sleep attack, only to fall asleep unintentionally again several hours later. Excitement with leg restlessness, worrying, an inability to relax, and the use of sleeping pills are not associated with narcolepsy. 8. A nurse is working with a client diagnosed with insomnia. When developing an education plan for the client, which sleep promotion intervention would the nurse implement first? A) Encouraging the client to stop smoking B) Instructing the client to keep regular bedtimes and rising times C) Encouraging the client to take frequent naps D) Administering prescribed sleep medications Ans: B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: e-16 Feedback: Nonpharmacologic, health-promoting interventions are the first choice before administering pharmacologic agents. Sleep hygiene strategies, such as keeping regular times for going to bed and rising, are effective and should be encouraged. The goal is to normalize sleep patterns to improve well-being. 9. The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. When reviewing the effect of caffeine on sleep with the client, which of the following would the nurse incorporate into the discussion as a caffeine effect?

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

A) B) C) D)

Decreased sleep latency Increased total sleep time Decreased REM sleep Increased slow-wave sleep

Ans: C Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: e-16 Feedback: Caffeine causes increased sleep latency, decreased total sleep time, and decreased REM sleep. It does not affect slow-wave sleep. 10. A client with insomnia is taught to avoid watching television, eating, and doing work in the bedroom. Which technique is being used? A) Sleep restriction B) Relaxation training C) Cognitive behavior therapy D) Stimulus control Ans: D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 4 Page Number: e-19 Feedback: Stimulus control is a technique used when the bedroom environment no longer provides cues for sleep, but has become the cue for wakefulness. Clients are instructed to avoid behaviors in the bedroom that are incompatible with sleep, including watching television, doing homework, and eating. This allows the bedroom to be reestablished as a stimulus for sleep. Clients often increase their time in bed to provide more opportunity for sleep, resulting in fragmented sleep and irregular sleep schedules. With sleep restriction, clients are instructed to spend less time in bed and to avoid napping. Relaxation training involves the use of progressive relaxation, autogenic training, and biofeedback to relieve physical or emotional distress impacting sleep. Cognitive behavior therapy identifies the maladaptive behavior, bringing the distortions to the client’s attention and extinguishing the association between effort to sleep and increased arousals. 11. A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the medication’s effect on which of the following? A) GABA B) Serotonin C) Dopamine

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

D) Norepinephrine Ans: A Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: e-17 Feedback: Zolpidem is a benzodiazepine receptor agonist that exerts its effects by facilitating GABA effects. Serotonin, dopamine, and norepinephrine are not involved. 12. A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent as a melatonin receptor agonist? A) Trazodone B) Estazolam C) Mirtazapine D) Ramelteon Ans: D Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 4 Page Number: e-17, e-18 Feedback: Ramelteon is a melatonin receptor agonist. Trazodone and mirtazapine are sedating antidepressants. Estazolam is a benzodiazepine classified as a benzodiazepine receptor agonist. Multiple Select 13. A nursing instructor is describing the prevalence of sleep--wake disorders as being greater in individuals with mental health disorders. Which disorders would the instructor include as being associated with sleep--wake disorders? (Select all that apply.) A) Depression B) Borderline personality disorder C) Schizophrenia D) Posttraumatic stress disorder E) Anxiety Ans: A, D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

Objective: 1 Page Number: e-9 Feedback: Sleep--wake disorders occur independently of the diagnosis of other mental disorders, but they are also seen in people with mental disorders. For example, a core feature of posttraumatic stress disorder (PTSD) is sleep disturbance. Insomnia often increases the risk for relapse of the mental disorder. Documented comorbid conditions include cardiovascular disorders, diabetes, musculoskeletal disorders, respiratory disorders, digestive disorders, pain conditions, and mental disorders including depression, PTSD, and other sleep disorders such as sleep apnea, and restless legs syndrome (RLS). OSA is not associated with borderline personality disorder or schizophrenia. 14. After teaching a class about circadian rhythm disorders, a nursing instructor determines that the education was successful when the class identifies which of the following as a subtype identified in the DSM-5? (Select all that apply.) A) Delayed sleep phase B) Nightmare C) Sleep terror D) Shift work type E) Jet lag type Ans: A, D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 2 Page Number: e-23 Feedback: According to the DSM-5, subtypes of circadian rhythm disorders include a delayed sleep phase and shift work type. Although jet lag type is a circadian rhythm sleep--wake disorder, it is not included in the DSM-5. Nightmare and sleep terror are separate disorders. Multiple Choice 15. A nurse is interviewing a client about their sleep patterns. The client tells the nurse that they go to bed about 11 PM and usually falls asleep by 11:15 PM. The nurse identifies this time period as which of the following? A) Sleep latency B) Sleep architecture C) Sleep efficiency D) Slow-wave sleep Ans: A Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

Objective: 3 Page Number: e-10 Feedback: Sleep latency is the time period measured from lights out, or bedtime, to initiation of sleep. Sleep architecture is the pattern of non–rapid eye movement (NREM) and rapid eye movement (REM) that are in approximately a 90- to 110-minute cycle. Sleep occurs in stages, and the timing of sleep is regulated by circadian rhythms. Sleep efficiency is the ratio of total sleep time to time in bed. Slow-wave sleep is the deepest state of sleep occurring during stages 3 and 4 of non--rapid eye movement (NREM) sleep. 16. What characteristic will the nurse note regarding a client who is experiencing dysfunctional slow-wave sleep? A) Easy arousal B) Generally feeling “unrested” C) Electroencephalogram shows K complexes D) Alpha rhythm is gradually being replaced by theta rhythm

Ans: B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Understand Integrated Process: Nursing Process Objective: 1 Page Number: e-12 Feedback: Slow-wave sleep, or the deepest state of sleep, characterizes stages 3 and 4. Slow-wave sleep is believed to have a restorative function. Light sleep is characteristic of stages 1 and 2, in which the person is easily aroused. During stages 1 and 2, an electroencephalogram (EEG) shows an alpha rhythm gradually being replaced by a theta rhythm. Sleep spindles or “k complexes” occur in stage 2.

17. A client with a history of both managed posttraumatic stress disorder (PTSD) and type 2 diabetes now presents with new reports of insomnia. Considering the most urgent, immediate risk for a client, what will the nurse assess for regularly? A) The relapse of PTSD symptoms B) The conversion of type 2 to type 1 diabetes

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

C) The symptoms associated with early onset dementia D) The development of obessive--compulsive disorder (OCD)

Ans: A Chapter: 28 Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Objective: 3 Page Number: e-14 Feedback: Sleep–wake disorders occur independently of the diagnosis of other mental disorders, but they are also seen in people with mental disorders such as PTSD and depression. Insomnia often increases the risk for relapse of the mental disorder but there is no research to support that it will trigger the onset of a new mental health disorder. Type 2 diabetes will not convert to the type 1 form of the disorder.

18. The nurse is assessing a client reporting the symptoms associated with insomnia. What assessment question demonstrates the nurse’s understanding of mental health issues often related to the development of insomnia? A) “Are you afraid for your personal safety?” B) “Would you consider yourself as being depressed?” C) “Can you hear or see things others canno t hear or see?” D) “Do you engage in compulsive hand washing or other ritualistic behaviors?”

Ans: B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Nursing Process Objective: 3

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd (Test Bank PDF Files)

Page Number: e-14 Feedback: Many factors affect sleep, but one of the major reasons for insomnia is depression, which accounts for most cases. Asking if the client considers oneself as being depressed will assess for this condition. There is no currently accepted correlation between paranoid (Are you afraid for your personal safety?), hallucinations (Can you hear or see things others cannot hear or see?) or compulsive (Do you engage in compulsive hand washing or other ritualistic behaviors?) behaviors with the development of insomnia.

Multiple Select 19. The nurse is conducting an assessment of a client reporting difficulty falling asleep. Which statement(s) made by the client would be most relevant to supporting a mental health-related diagnosis of a sleep disorder? (Select all that apply.) A) “I am awake at least 4 to 5 times a night.” B) “Both my parents where fitful sleepers as well.” C) “I work shifts and so my sleep routine varies.” D) “An afternoon nap is not a luxury but rather a necessity.” E) “It is like I never feel rested regardless of when I go to bed.”

Ans: A, C, D, E Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: e-15 Feedback: Insomnia is affected by sleep schedule (bedtime and rise time), difficulty falling asleep or maintaining sleep, quality of sleep, and existence of daytime sleepiness. A family history is not a common factor in the presence of insomnia.

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