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Test Bank for Gerontological Nursing 3rd Edition by Tabloski Tabloski Gerontological Nursing, 3/e Chapter 08 View Sample Question Type: MCSA The nurse is caring for an older patient who is experiencing sleep deprivation Which manifestation might the nurse assess in this patient? Improved healing Visual hallucinations Fatigue occurring at night Development of Alzheimer’s disease Correct Answer: Rationale 1: Delayed healing is associated with sleep deprivation Reference: Page 194 Rationale 2: The patient who is deprived of sleep may experience visual or auditory hallucinations Reference: Page 194 Rationale 3: Fatigue may occur, but this is during the daytime Reference: Page 194 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: Discuss the importance of obtaining adequate sleep and the sleep cycle Question 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: 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 Rationale 3: Waking up three or more times during the night is considered abnormal Reference: Page 194 Rationale 4: With aging, the amount of time spent in deep sleep decreases as the night progresses The older person may have more difficulty obtaining the quality and quantity of sleep Reference: Page 194 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: Describe normal changes in sleep occurring with aging Question Type: MCMA The nurse is concerned that an older patient is experiencing sleep apnea What did the nurse assess in this patient? 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 Reference: Page 199 Rationale 3: Excessive daytime sleepiness is a manifestation of sleep apnea Reference: Page 199 Rationale 4: Excessive snoring upon inspiration is a manifestation of sleep apnea Reference: Page 199 Rationale 5: Complaints of choking when waking from sleep is a manifestation of sleep apnea Reference: Page 199 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Identify potential causes of sleep disruption in older people Question Type: MCMA An older patient is having difficulty sleeping What can the nurse instruct the patient to help improve the patient’s sleep? Standard Text: Select all that apply 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 Correct Answer: 1,4,5 Rationale 1: One action to improve sleep is to avoid napping during the day Reference: Page 203 Rationale 2: Activity should be restricted to hours before going to sleep Reference: Page 203 Rationale 3: Alcohol has been found to disrupt sleep and should be avoided Reference: Page 203 Rationale 4: The bed should be used for sex or sleep and not for reading or watching television Reference: Page 203 Rationale 5: One action to improve sleep is to get up and go to another room if unable to sleep Reference: Page 203 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate appropriate nursing interventions to improve or restore sleep Question 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? 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: 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 Reference: Page 198 Rationale 3: Some antidepressants have stimulating effects and should be taken in the morning This would not disrupt the patient’s sleep Reference: Page 198 Rationale 4: A short walk in the morning is an appropriate type and time of exercise and should help with sleep Reference: Page 198 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Identify potential causes of sleep disruption in older people Question 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? Standard Text: Select all that apply Dizziness Constipation “Older adults may have reduced levels of melatonin.” “I will need to have a prescription from my physician to obtain it.” Correct Answer: Rationale 1: Melatonin is a natural hormone produced in the pineal gland Reference: Page 205 Rationale 2: Nausea is a side effect of melatonin Reference: Page 205 Rationale 3: Older people have reduced levels of melatonin Reference: Page 205 Rationale 4: Melatonin is available over-the-counter A prescription from a physician is not needed Reference: Page 205 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: List the risks and benefits of pharmacological and nonpharmacological interventions for sleep disturbance Question 19 Type: MCSA An older patient with difficulty sleeping wants to use an herbal remedy to help getting to sleep since problems with hay fever and nasal congestion are interfering with “drifting off” at night Which herbal remedy should the nurse caution the patient to avoid? Lemon balm A glass of warm milk A cup of chamomile tea A small turkey sandwich Correct Answer: Rationale 1: Lemon balm is a natural remedy to induce sleep and could be used by this patient Reference: Page 205 Rationale 2: Warm milk is a natural remedy to induce sleep and could be used by this patient Reference: Page 205 Rationale 3: The use of chamomile products is contraindicated with allergies to ragweed The patient has hay fever and seasonal allergies, which may be associated with ragweed Reference: Page 205 Rationale 4: A turkey sandwich is a natural remedy to induce sleep and could be used by this patient Reference: Page 205 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: List the risks and benefits of pharmacological and nonpharmacological interventions for sleep disturbance Question 20 Type: MCSA During an assessment, the nurse learns that an older patient does not feel refreshed in the morning after sleeping and reports that family members complain about the loud snoring at night Which assessment finding supports sleep apnea as a potential problem for this patient? Short stature Hypertension Female gender Thin body build Correct Answer: Rationale 1: Stature does not play a role in sleep apnea Reference: Page 199 Rationale 2: Risk factors for sleep apnea include hypertension Reference: Page 199 Rationale 3: Males have a higher incidence of sleep apnea than females Reference: Page 199 Rationale 4: Risk factors for sleep apnea include obesity and not a thin body build Reference: Page 199 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: Identify potential causes of sleep disruption in older people Question 21 Type: MCMA The nurse is planning care for an older patient who reports interrupted sleep because of needing to void during the night Which common age-related changes is this symptom most likely associated with? Standard Text: Select all that apply Nocturia Kidney stones Urinary frequency Urinary tract infection Benign prostatic hypertrophy Correct Answer: 1,3,5 Rationale 1: Older people may be awakened from sleep because of the need to urinate Common age-related alterations in urinary tract function include nocturia Reference: Page 200 Rationale 2: Older people may be awakened from sleep because of the need to urinate Kidney stones are not a common age-related alteration in urinary tract function Reference: Page 200 Rationale 3: Older people may be awakened from sleep because of the need to urinate Common age-related alterations in urinary tract function include urinary frequency Reference: Page 200 Rationale 4: Older people may be awakened from sleep because of the need to urinate Urinary tract infections are not a common age-related alteration in urinary tract function Reference: Page 200 Rationale 5: Older people may be awakened from sleep because of the need to urinate Common age-related alterations in urinary tract function include benign prostatic hypertrophy Reference: Page 200 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: Identify potential causes of sleep disruption in older people Question 22 Type: MCSA An older patient does not understand why an alcoholic drink cannot be provided before going to sleep in the evening What should the nurse explain to the patient? Alcohol has an initially depressant effect Alcohol can increase the time needed to fall asleep Alcohol is disruptive of the second half of the sleep cycle Alcohol can enable an individual to sleep through the entire night Correct Answer: Rationale 1: Alcohol has an initial stimulating effect Reference: Page 201 Rationale 2: Alcohol reduces the amount of time needed to fall asleep Reference: Page 201 Rationale 3: Alcohol use at bedtime is associated with disruption during the second portion of the sleep cycle Reference: Page 201 Rationale 4: Since alcohol disrupts the second portion of the sleep cycle, it does not enable an individual to sleep through the entire night Reference: Page 201 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Identify potential causes of sleep disruption in older people Question 23 Type: MCSA During a routine physical examination, an older patient reports having problems falling asleep at night despite engaging in vigorous activities to become tired in the evening How should the nurse respond to the patient? “You should vary your routine each day.” “You should time activities to end within an hour of bedtime.” “Exercise is recommended, but it should not be done closer than hours to bedtime.” “Lighten your exercise routine in the afternoon; concentrate exercise toward the morning hours.” Correct Answer: Rationale 1: Varying the routine is a positive idea but does not meet the problems presented by the patient Reference: Page 203 Rationale 2: Exercise close to bedtime can cause difficulty falling asleep Reference: Page 203 Rationale 3: Exercise should not be done closer than hours to bedtime Reference: Page 203 Rationale 4: Varying the routine is a positive idea but does not meet the problems presented by the patient Reference: Page 203 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Identify potential causes of sleep disruption in older people Question 24 Type: MCMA An older patient is prescribed paroxetine hydrochloride (Paxil) for depression When discussing the medication, which patient statements indicate the need for additional instruction? Standard Text: Select all that apply “I may feel tired after taking this medication.” “I can drive my car while taking this medication.” “I should take this medication with my breakfast.” “I should take this medication before eating my evening meal.” “I cannot take this medication with any of my other medications.” Correct Answer: 1,4,5 Rationale 1: Paroxetine hydrochloride (Paxil) is a stimulating antidepressant and will not make the patient feel tired after taking it Reference: Page 202 Rationale 2: This medication is stimulating so it should not affect the patient’s ability to drive Reference: Page 202 Rationale 3: This medication should be taken with breakfast so it does not interfere with sleep Reference: Page 202 Rationale 4: This medication should be taken with breakfast If taken with dinner, it can interfere with sleep since it is a stimulating antidepressant Reference: Page 202 Rationale 5: There is no evidence to suggest that paroxetine hydrochloride (Paxil) cannot be taken with other prescribed medications Reference: Page 202 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: List the risks and benefits of pharmacological and nonpharmacological interventions for sleep disturbance Question 25 Type: MCSA After completing an assessment, the nurse reviews the older patient’s medications Which medication may cause problems with sleep? Benadryl Ibuprofen Vitamin B Ferrous sulfate Correct Answer: Rationale 1: Antihistamines such as diphenhydramine (Benadryl) should not be used for sleep because of their anticholinergic side effects and the potential to decrease respiratory drive Reference: Page 204 Rationale 2: Ibuprofen is a nonsteroidal anti-inflammatory medication and is not associated with sleep disorders Reference: Page 204 Rationale 3: Vitamins are not associated with sleep problems Reference: Page 204 Rationale 4: Supplements are not associated with sleep problems Reference: Page 204 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: List the risks and benefits of pharmacological and nonpharmacological interventions for sleep disturbance