CHAPTER 33: Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford

Fundamentals of Nursing, 2nd Edition – Active Learning for Collaborative Practice by Yoost & Crawford Chapter 33: Sleep Multiple Choice Questions 1. The nurse identifies what physiological response occurs with the onset of darkness and in preparation for sleep? A. Cortisol levels peak B. Cortisol levels increase C. Core body temperature increases D. Melatonin levels increase Answer: D Explanation: Melatonin production increases in response to darkness, promoting sleep readiness, while cortisol levels and core body temperature decrease. Why Other Options Are Wrong: A and B are incorrect because cortisol peaks in the morning. C is incorrect as core temperature drops during sleep preparation. 2. The nurse recognizes what function of the reticular activating system (RAS)? A. Records brain waves and other variables. B. Relays motor impulses to the hypothalamus. C. Influences patterns of biological functioning. D. Is affected by the light-dark cycle. Answer: B Explanation: The RAS relays motor impulses to the thalamus and cerebral cortex, coordinating wakefulness. Polysomnography records brain waves (A), while circadian rhythms (C/D) regulate biological cycles. Why Other Options Are Wrong: A describes polysomnography. C and D refer to circadian rhythms, not RAS function. 3. The nurse is educating a patient about avoiding circadian rhythm disruption. Which statement by the patient indicates a need for further education? A. "I know the circadian rhythm influences biological functions." B. "I know the circadian rhythm exists only in humans." C. "I know the sleep-wake cycle is impacted by light-dark cycles." D. "The most familiar circadian rhythm is the 24-hour day-night cycle." Answer: B Explanation: Circadian rhythms exist in plants, animals, and humans, regulating biological processes universally. Why Other Options Are Wrong: A, C, and D are accurate statements about circadian rhythms. 4. The nurse teaches the patient what information about polysomnography? A. This is the recording of brain waves and other variables. B. This is the relay of motor impulses to the hypothalamus. C. This is the pattern of biological functioning. D. This is the recording of seizure activity in the brain. Answer: A Explanation: Polysomnography records brain waves, muscle activity, and eye movements during sleep to diagnose sleep disorders. Why Other Options Are Wrong: B describes RAS function. C refers to circadian rhythms. D describes an EEG. 5. The nurse identifies which sequence to be the usual progression of sleep? A. NREM 1-3 then REM, then back through NREM 1 and 2. B. REM then NREM 1-4, then back through NREM 2 and 3. C. NREM 1-3 then back through NREM 3 and 2 then REM. D. REM then NREM 1-4 then back through NREM 3. Answer: C Explanation: Sleep typically progresses through NREM stages 1-3, reverts to NREM 2, then enters REM. NREM stage 4 does not exist. Why Other Options Are Wrong: A and B incorrectly include NREM 4. D reverses the sequence. 6. The nurse is providing discharge instructions to parents of a toddler about sleeping habits. Which statement indicates further education is needed? A. "Sleep needs may change during growth spurts." B. "Children sleep 12 hours a day." C. "Toddlers will often resist going to bed." D. "The bedtime routine can vary." Answer: D Explanation: Consistent bedtime routines are crucial for toddlers; variability can disrupt sleep. Why Other Options Are Wrong: A, B, and C are accurate statements about toddler sleep. 7. When explaining cataplexy to a patient, which description should the nurse include? A. It is an uncontrolled desire to sleep. B. It is falling asleep for several minutes. C. It is loss of voluntary muscle tone. D. It is a sleep cycle that begins with NREM. Answer: C Explanation: Cataplexy involves sudden muscle tone loss, often triggered by strong emotions, and is associated with narcolepsy. Why Other Options Are Wrong: A and B describe narcolepsy symptoms. D misrepresents sleep cycle initiation. 8. The nurse is providing discharge instructions to a patient with sleep alterations. Which statement indicates further education is needed? A. "I should avoid caffeine close to bedtime." B. "I should not eat anything too close to bedtime." C. "I should exercise regularly to help with sleeping." D. "I can gain weight if I don't sleep enough." Answer: B Explanation: Light bedtime snacks (e.g., complex carbs) can promote sleep; complete avoidance is unnecessary. Why Other Options Are Wrong: A, C, and D are evidence-based sleep hygiene practices. 9. The nurse is assessing a patient's sleep patterns. Which question will elicit the best response? A. "Do you feel rested when you awaken?" B. "What is your normal eating pattern?" C. "Do you awaken during the night?" D. "Do you drink beverages with caffeine?" Answer: C Explanation: Frequent nighttime awakenings directly indicate sleep disruption, aiding in diagnosis. Why Other Options Are Wrong: A assesses sleep quality, while B and D identify potential sleep disruptors but are less specific. 10. A patient has sleep deprivation. What finding best indicates goal achievement? A. Remains asleep for 6–7 hours consistently for 1 week. B. Falls asleep within 15 minutes of going to bed. C. Reports improved concentration on tasks. D. Verbalizes understanding of medication instructions. Answer: A Explanation: Sustained uninterrupted sleep is the primary indicator of resolving sleep deprivation. Why Other Options Are Wrong: B relates to insomnia. C and D are secondary outcomes. Multiple Response Questions 1. The nurse knows that during REM sleep, which activities occur? A. Memories are stored. B. Increase in cerebral blood flow. C. Slow rhythmic scanning eye movements. D. Release of epinephrine. E. Repair of brain cells. Answer: A, B, D Explanation: REM sleep involves memory consolidation, heightened brain activity, and epinephrine release, linked to dreaming. Why Other Options Are Wrong: C occurs in wakefulness. E happens during NREM sleep. 2. The student nurse learns that during NREM sleep, which activities occur? A. Brain waves slow. B. Slow rhythmic scanning eye movements. C. Dreaming. D. Drop in blood pressure. E. Conservation of energy. Answer: A, D, E Explanation: NREM sleep features slowed brain waves, reduced blood pressure, and energy restoration. Why Other Options Are Wrong: B is absent in NREM. C occurs in REM. 3. The nurse recognizes which changes in sleep patterns occur in older adults? A. Sleep increases to 8–10 hours nightly. B. REM sleep is shorter. C. Stage 4 NREM is decreased. D. Medications may interfere with sleep. E. Older adults awaken more at night. Answer: C, D, E Explanation: Older adults experience reduced deep sleep (stage 4 NREM), medication-related disruptions, and frequent nighttime awakenings. Why Other Options Are Wrong: A is incorrect as sleep duration remains 7–8 hours. B is false— initial REM may lengthen. 4. The nurse is educating about sudden infant death syndrome (SIDS). What information is included? A. SIDS is the leading cause of infant death (1–12 months). B. The etiology remains largely unknown. C. The most modifiable risk factor is prone sleeping. D. Risk factors include cigarette smoke exposure. E. It is defined as sudden unexpected death. Answer: B, D, E Explanation: SIDS is unexplained infant death, linked to smoke exposure and unknown causes, with prone sleeping as a key modifiable risk. Why Other Options Are Wrong: A understates SIDS prevalence. C is correct but not listed in the original answer key. 5. The nurse recognizes which conditions are dyssomnias? A. Difficulty falling asleep. B. Nocturnal enuresis. C. Inability staying asleep. D. Excessive sleepiness. E. Falling asleep during the day. Answer: A, C, D, E Explanation: Dyssomnias involve sleep initiation/maintenance issues or excessive sleepiness, unlike parasomnias (e.g., enuresis). Why Other Options Are Wrong: B is a parasomnia, not a dyssomnia. 6. The nurse manager suggests interventions for night-shift nurses with sleep disturbances. Which are appropriate? A. Power nap before the first night shift. B. Get a minimum of 4 hours of sleep. C. Wear dark glasses when driving home. D. Seek bright light upon waking. E. Maintain a regular sleep schedule. Answer: A, C, D, E Explanation: Power naps, light management, and consistent schedules mitigate shift-work sleep disruption. Why Other Options Are Wrong: B is insufficient—6+ hours are recommended. 7. The nurse identifies which patients are at risk for obstructive sleep apnea (OSA)? A. Deviated septum. B. Recessed chin. C. Alcohol use. D. Large neck. E. Recent tonsillectomy. Answer: A, B, C, D Explanation: OSA risk factors include anatomical abnormalities (deviated septum, recessed chin), alcohol use, and obesity (large neck). Why Other Options Are Wrong: E reduces OSA risk by removing airway obstruction. 8. The nurse assesses what components during a routine sleep evaluation? A. Usual sleep/wake times. B. Bedtime routines. C. Sleeping environment preferences. D. Sleep medications. E. Current life events. Answer: A, B, C, D, E Explanation: Comprehensive sleep assessments include habits, environment, medications, and stressors. Why Other Options Are Wrong: All options are relevant to sleep assessment. 9. The nurse includes which interventions to improve hospitalized patients' sleep? A. Maintain sleep routines. B. Minimize disruptions. C. Provide light snacks. D. Use sleep medications. E. Use relaxation measures. Answer: A, B, C, E Explanation: Non-pharmacological strategies (routine, quiet environment, snacks, relaxation) promote natural sleep. Why Other Options Are Wrong: D is a last resort due to dependency risks.