Download full PDF test bank for gerontological nursing 3rd edition by tabloski

Reference: Page 194 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process

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Test Bank for Gerontological Nursing 3rd Edition by Tabloski

Tabloski Gerontological Nursing, 3/e

Chapter 08 View Sample

Fatigue occurring at night

Development of Alzheimer’s disease

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Rationale 4: Sleep deprivation is not known to be a causative factor for Alzheimer’s disease but is known to exacerbate behavioral problems in persons with Alzheimer’s disease

Reference: Page 194

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Discuss the importance of obtaining adequate sleep and the sleep cycle

Question 2

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Type: MCSA

An older patient is telling the nurse about problems with sleeping What does the nurse realize about sleep and the older adult?

The need for sleep decreases with age

Disrupted sleep is not associated with depression

A person should not awaken more than once during the night

An older person does not have as much deep sleep as a younger person

Correct Answer: 4

Rationale 1: Generally, the amount of sleep needed is about the same for the

youth, middle-aged, and older adult

Reference: Page 194

Rationale 2: Many persons with depression report sleep problems, including

difficulty getting to sleep, early morning awakenings, and daytime napping

Reference: Page 194

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Global Rationale:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 2 Describe normal changes in sleep occurring with aging

Question 3

Type: MCMA

The nurse is concerned that an older patient is experiencing sleep apnea What did the nurse assess in this patient?

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Standard Text: Select all that apply

Jumpy legs

Sleeping with three pillows

Excessive daytime sleepiness

Excessive snoring upon inspiration

Complaints of choking when waking from sleep

Correct Answer: 3,4,5

Rationale 1: Sudden muscle contractions in the legs occur with restless leg syndrome Reference: Page 199

Rationale 2: Persons with congestive heart failure often must sleep with several pillows

to allow the lungs to clear fluid while breathing

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Global Rationale:

Learning Outcome: 3 Identify potential causes of sleep disruption in older people

Question 4

Type: MCMA

An older patient is having difficulty sleeping What can the nurse instruct the patient

to help improve the patient’s sleep?

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Do not nap during the day

Take a walk an hour before going to sleep

Have a glass of wine before going to sleep

Avoid reading or watching television in bed

If unable to sleep, get up and go to another room

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Global Rationale:

Cognitive Level: Applying

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Formulate appropriate nursing interventions to improve or restore sleep

Question 5

Type: MCSA

The nurse is assessing an older patient who wakes up during the night Which finding does the nurse identify as a risk factor for disturbed sleep?

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Patient has osteoarthritis of both hips

Patient ingests one cup of coffee every morning

Patient takes antidepressant medication in the morning

Patient walks for half an hour before lunch each day

Correct Answer: 1

Rationale 1: A common source of pain in older adults is the chronic pain resulting from osteoarthritis Because osteoarthritis is so common in aging, it can result in chronic sleep disruption for large numbers of older people

Reference: Page 198

Rationale 2: Limiting caffeine intake to one morning cup of coffee should have

little interference with sleeping during the night

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Question 6

Type: MCMA

The nurse is concerned that an older patient with dementia receiving psychotropic medications for sleep is experiencing side effects What did the nurse assess in this patient?

Dizziness

Constipation

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Rationale 5: Typical side effects of hypnotic drugs include problems with swallowing Reference: Pages 198-199

Global Rationale:

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Excessive deep sleep

Increased risk for sudden death and stroke

Excessive tension in the muscles of the throat and soft palate

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Correct Answer: 3

Rationale 1: Being underweight is not associated with sleep apnea Obesity is

associated with sleep apnea

Reference: Page 199

Rationale 2: Persons with sleep apnea seldom achieve deep sleep because of

frequent brief awakenings to end the apneic episodes

Reference: Page 199

Rationale 3: The person with sleep apnea is subject to episodes of hypoxemia,

which increases the risk for sudden death and stroke

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Client Need Sub: Reduction of Risk Potential

Question 8

Type: MCMA

The nurse is teaching an older patient about an overnight sleep study to diagnose sleep apnea What will the nurse include when teaching this patient?

Oxygen saturation level will be measured

An electrocardiogram will be used to measure heart activity

Pins will be inserted into leg muscles to measure tone and tension An

electromyogram will be done to measure face and leg movements An

electroencephalogram will be done to measure brain wave activity

Correct Answer: 1,2,4,5

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Rationale 1: During an overnight sleep study, the patient’s oxygen saturation level will

be measured

Reference: Pages 199-200

Rationale 2: During an overnight sleep study, an electrocardiogram will be used

to measure heart activity

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Question 9

Type: MCMA

An older patient is diagnosed with sleep apnea Which interventions can the nurse add to the patient’s care plan to address this health problem?

Discussing smoking cessation techniques

Encouraging the patient to sleep on the side

Instructing to avoid alcohol before going to sleep

Suggesting sleeping in an upright position in a chair

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Consulting with a dietitian to discuss meal planning for weight

reduction Correct Answer: 1,2,3,5

Rationale 1: Treatment for sleep apnea may include teaching the patient to avoid

smoking since this has been known to aggravate sleep apnea

Rationale 5: Treatment for sleep apnea may include weight reduction for obesity

since this has been known to aggravate sleep apnea

Reference: Page 200

Global Rationale:

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Question 10

Type: MCMA

An older patient with sleep apnea is prescribed continuous positive airway

pressure (CPAP) What will the nurse explain to the patient about this treatment?

Pressure keeps the airway open

An oral airway is inserted each night

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The machine is noisy and will keep the patient awake

Noninvasive treatment is administered through a nasal mask The

face mask is uncomfortable but the patient will get used to it

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Question 11

Type: MCSA

An older patient who is hospitalized has been having difficulty sleeping since admission and is prescribed a low dose of zolpidem (Ambien) What does the nurse realize about this medication?

Contains the hormone melatonin

Is associated with daytime hangover

Does not adversely alter the sleep architecture

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Is safe to use along with diphenhydramine (Benadryl)

Correct Answer: 3

Rationale 1: The medication does not contain melatonin Melatonin is a hormone that is naturally produced by the pineal gland in the human Melatonin is sold in pharmacies and health food stores and has been effective in improving sleep in some people

Rationale 4: Zolpidem should not be used with diphenhydramine (Benadryl)

Diphenhydramine is an antihistamine and is not recommended as a medication for sleep because of anticholinergic side effects and the potential to adversely affect respiratory function

Reference: Page 205

Global Rationale:

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Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 List the risks and benefits of pharmacological

and nonpharmacological interventions for sleep disturbance

Question 12

Type: MCSA

An older patient is being prescribed medication to help with sleep What should the nurse include in this patient’s plan of care?

Diazepam is the best benzodiazepine to use for sleep

A benzodiazepine should only be used for 2 weeks

Lorazepam should be avoided for sleep in the older patient

A higher dose of an antidepressant medication is needed for sleep

Correct Answer: 2

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Rationale 1: It is important to avoid using the benzodiazepines with longer half-lives such

as diazepam since this drug is associated with a high abuse potential, daytime sedation and falls, and memory impairment

Rationale 2: Benzodiazepine therapy is recommended for short-term use not to exceed

2 weeks

Rationale 3: Shorter-acting benzodiazepines such as lorazepam are suggested to be the better choice for older adults because these drugs have the best effects and fewer safety concerns

Rationale 4: Lower doses of tricyclic antidepressants are needed for sleep disorders

than are needed to treat depression

Global Rationale:

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

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Learning Outcome: 4 List the risks and benefits of pharmacological

and nonpharmacological interventions for sleep disturbance

Question 13

Type: MCMA

Which actions should the nurse take to ensure effective sleep for older patients in a long-term care facility?

Use nightlights during the night

Establish consistent nighttime routines

Schedule routine care in the early evening hours

Put patients to bed immediately after the evening meal

Reduce noise and light disruption throughout the night

Correct Answer: 1,2,3,5

Rationale 1: Interventions to ensure effective sleep for older patients in a long-term care facility include using nightlights during the night

Reference: Page 204

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Rationale 2: Interventions to ensure effective sleep for older patients in a long-term care facility include establishing consistent nighttime routines

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Question 14

Type: MCSA

How should the nurse explain rapid eye movement (REM) sleep to an older patient?

Is when dreaming occurs

Is necessary for physical restoration

Involves sudden sustained muscle contractions in the extremities

Is accompanied by slowing of the heart rate and a fall in blood

pressure Correct Answer: 1

Rationale 1: Dreaming occurs during REM sleep

Reference: Page 195

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Rationale 2: Hormones that aid in physiological restoration are released during NREM (nonrapid eye movement) sleep

Learning Outcome: 1 Discuss the importance of obtaining adequate sleep and the sleep cycle

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Question 15

Type: MCSA

The nurse is implementing sleep restriction therapy with an older patient

What intervention will be performed to support this plan of treatment?

Structuring patient naps to occur midmorning and midafternoon

Putting on the television in the room after getting the patient ready for sleep

Teaching the patient to watch the second hand move on the clock while waiting to fall asleep

Planning to wake the patient up at the same time each morning regardless of the sleep obtained

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Rationale 3: In sleep restriction therapy, patients are instructed to not watch the clock Reference: Page 203

Rationale 4: In sleep restriction therapy, the patient is to be woken up from sleep at the same time every morning, regardless of the amount of sleep obtained the previous night

Reference: Page 203

Global Rationale:

Question 16

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Type: MCSA

An older patient with insomnia lives in an assisted living facility and is seen reading in the lounge area most nights Which issue causes the greatest concern for the nurse caring for this patient?

The patient has significant underlying problems

Insomnia is linked to cardiac dysfunction if it is not managed

Liability is created by a patient who is unsupervised in the lounge areas

The patient’s ability to function during the day may be hindered by these episodes Correct Answer: 4

Rationale 1: Insomnia is not a diagnostic test to determine underlying problems

Reference: Page 194

Rationale 2: Insomnia is not specifically linked to cardiac dysfunction

Reference: Page 194

Rationale 3: The patient lives in an assisted living facility and has access to

common lounge areas whenever desired

Reference: Page 194

Rationale 4: Insomnia is defined as an inability to fall asleep or stay asleep on most nights and lasting for over a month The individual experiencing insomnia is at risk for

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