Chapter 9: Sleep and Sleep Disorders:
Lewis’s Medical-Surgical Nursing, 5th Edition
1. Which instruction will the nurse include when teaching a patient with chronic
insomnia about ways to improve sleep quality?
A. Avoid aerobic exercise during the day.
B. Read in bed for a few minutes each night.
C. Keep the bedroom temperature slightly warm.
D. Try to go to bed at the same time every evening.
Answer: D
Explanation: A regular evening schedule is recommended to improve sleep time and quality.
Aerobic exercise may improve sleep quality but should occur several hours before bedtime.
Reading in bed is discouraged for patients with insomnia as it can be stimulating. The
bedroom temperature should be slightly cool to promote sleep.
2. The nurse is providing a health-promotion session to young adults who have difficulty
sleeping at night and has instructed them to limit their caffeine intake. Which of the
following beverages have 50 mg or more of caffeine? (Select all that apply.)
A. Green tea (237 mL)
B. Dr. Pepper soda (237 mL)
C. Chocolate cake (5 cm square)
D. Brewed coffee (237 mL)
E. Black tea (237 mL)
Answer: D, E
Explanation: Brewed coffee contains approximately 135 mg of caffeine per 237 mL, and
black tea contains about 50 mg per 237 mL. Green tea has about 30 mg, Dr. Pepper soda has
41 mg, and a 5 cm square of chocolate cake contains about 36 mg of caffeine.
3. After the nurse has taught a patient about the use of extended-release zopiclone for
insomnia, which patient statement indicates a need for further teaching?
A. "I will take the medication an hour before bedtime."
B. "I should take the medication on an empty stomach."
C. "I should not take this medication unless I can sleep for at least 6 hours."
D. "I will schedule activities that require mental alertness for later in the day."
Answer: A
,Explanation: Benzodiazepine receptor agonists such as zopiclone work quickly and should
be taken immediately before bedtime, not one hour before, to reduce the risk of injury. The
other patient statements are correct regarding taking the medication on an empty stomach,
ensuring adequate time for sleep, and avoiding activities requiring alertness after taking the
medication.
4. Which action by the nurse manager of an acute care unit will improve the alertness of
nurses who work the night shift?
A. Arrange for older staff members to work most night shifts.
B. Provide a sleeping area for staff to use for napping at night.
C. Post reminders about the relationship of sleep and alertness.
D. Schedule nursing staff to rotate day and night shifts monthly.
Answer: B
Explanation: Short on-site naps have been shown to improve alertness and performance for
night-shift workers. Rotating shifts frequently causes significant disruption to sleep patterns
and circadian rhythms. Simply posting reminders does not actively improve sleep or
alertness.
5. The nurse is caring for a patient in the ambulatory care setting who has chronic
insomnia. Which of the following interventions should the nurse do initially?
A. Schedule a polysomnography (PSG) study.
B. Arrange for the patient to have a sleep study.
C. Ask the patient to keep a 2-week sleep diary.
D. Teach the patient about the use of an actigraph.
Answer: C
Explanation: The diagnosis of insomnia is made primarily on the basis of subjective
complaints and an evaluation of a 1- to 2-week sleep diary completed by the patient.
Actigraphy and PSG studies/sleep studies may be used for determining specific sleep
disorders, but are not necessary to make an initial insomnia diagnosis.
6. The nurse takes the health history for four patients in the clinic. Which information
regarding the patients' sleep is most important to communicate to the health care
provider?
A. A 21-year-old student takes melatonin to assist in sleeping when travelling from Canada to
Europe.
B. A 32-year-old who is experiencing a stressful week uses diphenhydramine for several
nights.
, C. A 41-year-old with a body mass index (BMI) of 42 kg/m2 says that the spouse complains
about the patient's snoring.
D. A 64-year-old nurse who works the night shift reports drinking hot chocolate before going
to bed in the morning.
Answer: C
Explanation: The patient's high BMI and reported snoring are significant risk factors for
obstructive sleep apnea, which can lead to serious complications such as hypertension,
cardiac dysrhythmias, and heart failure. Melatonin is safe for jet lag, short-term
diphenhydramine use is common, and the caffeine content in hot chocolate is minimal and
unlikely to be a primary concern.
7. Which action is best for the nurse to include in the plan of care in order to improve
sleep quality for a critically ill patient in the intensive care unit (ICU)?
A. Ask all visitors to leave the ICU for the night.
B. Lower the level of light from 8:00 P.M. until 7:00 A.M.
C. Avoid the use of opioids for pain relief during the evening hours.
D. Schedule assessments to allow at least 4 hours of uninterrupted sleep.
Answer: B
Explanation: Lowering the level of light helps mimic normal day/night patterns and
maximizes the opportunity for sleep. While frequent assessments and opioid use can disturb
sleep, they are often necessary for the care of critically ill patients. The presence of visitors
may sometimes decrease anxiety and improve sleep for some patients.
8. The nurse is caring for a patient who has sleep deprivation and teaching about the
effects that lack of sleep can have on the body. Which of the following information
would be included in the teaching plan for this patient? (Select all that apply.)
A. Decreased insulin resistance
B. Increased growth hormone
C. Increased risk of type 2 diabetes
D. Irritability, moodiness
E. Increased risk of gastro-esophageal reflux disease (GERD)
Answer: C, D, E
Explanation: Sleep deprivation is associated with an increased risk of type 2 diabetes due to
increased insulin resistance, not decreased. It also increases the risk of GERD, heart disease,
hypertension, and impaired immune function. Behavioral changes such as irritability and
moodiness are common. Sleep deprivation causes a decrease, not an increase, in growth
hormone secretion.
Lewis’s Medical-Surgical Nursing, 5th Edition
1. Which instruction will the nurse include when teaching a patient with chronic
insomnia about ways to improve sleep quality?
A. Avoid aerobic exercise during the day.
B. Read in bed for a few minutes each night.
C. Keep the bedroom temperature slightly warm.
D. Try to go to bed at the same time every evening.
Answer: D
Explanation: A regular evening schedule is recommended to improve sleep time and quality.
Aerobic exercise may improve sleep quality but should occur several hours before bedtime.
Reading in bed is discouraged for patients with insomnia as it can be stimulating. The
bedroom temperature should be slightly cool to promote sleep.
2. The nurse is providing a health-promotion session to young adults who have difficulty
sleeping at night and has instructed them to limit their caffeine intake. Which of the
following beverages have 50 mg or more of caffeine? (Select all that apply.)
A. Green tea (237 mL)
B. Dr. Pepper soda (237 mL)
C. Chocolate cake (5 cm square)
D. Brewed coffee (237 mL)
E. Black tea (237 mL)
Answer: D, E
Explanation: Brewed coffee contains approximately 135 mg of caffeine per 237 mL, and
black tea contains about 50 mg per 237 mL. Green tea has about 30 mg, Dr. Pepper soda has
41 mg, and a 5 cm square of chocolate cake contains about 36 mg of caffeine.
3. After the nurse has taught a patient about the use of extended-release zopiclone for
insomnia, which patient statement indicates a need for further teaching?
A. "I will take the medication an hour before bedtime."
B. "I should take the medication on an empty stomach."
C. "I should not take this medication unless I can sleep for at least 6 hours."
D. "I will schedule activities that require mental alertness for later in the day."
Answer: A
,Explanation: Benzodiazepine receptor agonists such as zopiclone work quickly and should
be taken immediately before bedtime, not one hour before, to reduce the risk of injury. The
other patient statements are correct regarding taking the medication on an empty stomach,
ensuring adequate time for sleep, and avoiding activities requiring alertness after taking the
medication.
4. Which action by the nurse manager of an acute care unit will improve the alertness of
nurses who work the night shift?
A. Arrange for older staff members to work most night shifts.
B. Provide a sleeping area for staff to use for napping at night.
C. Post reminders about the relationship of sleep and alertness.
D. Schedule nursing staff to rotate day and night shifts monthly.
Answer: B
Explanation: Short on-site naps have been shown to improve alertness and performance for
night-shift workers. Rotating shifts frequently causes significant disruption to sleep patterns
and circadian rhythms. Simply posting reminders does not actively improve sleep or
alertness.
5. The nurse is caring for a patient in the ambulatory care setting who has chronic
insomnia. Which of the following interventions should the nurse do initially?
A. Schedule a polysomnography (PSG) study.
B. Arrange for the patient to have a sleep study.
C. Ask the patient to keep a 2-week sleep diary.
D. Teach the patient about the use of an actigraph.
Answer: C
Explanation: The diagnosis of insomnia is made primarily on the basis of subjective
complaints and an evaluation of a 1- to 2-week sleep diary completed by the patient.
Actigraphy and PSG studies/sleep studies may be used for determining specific sleep
disorders, but are not necessary to make an initial insomnia diagnosis.
6. The nurse takes the health history for four patients in the clinic. Which information
regarding the patients' sleep is most important to communicate to the health care
provider?
A. A 21-year-old student takes melatonin to assist in sleeping when travelling from Canada to
Europe.
B. A 32-year-old who is experiencing a stressful week uses diphenhydramine for several
nights.
, C. A 41-year-old with a body mass index (BMI) of 42 kg/m2 says that the spouse complains
about the patient's snoring.
D. A 64-year-old nurse who works the night shift reports drinking hot chocolate before going
to bed in the morning.
Answer: C
Explanation: The patient's high BMI and reported snoring are significant risk factors for
obstructive sleep apnea, which can lead to serious complications such as hypertension,
cardiac dysrhythmias, and heart failure. Melatonin is safe for jet lag, short-term
diphenhydramine use is common, and the caffeine content in hot chocolate is minimal and
unlikely to be a primary concern.
7. Which action is best for the nurse to include in the plan of care in order to improve
sleep quality for a critically ill patient in the intensive care unit (ICU)?
A. Ask all visitors to leave the ICU for the night.
B. Lower the level of light from 8:00 P.M. until 7:00 A.M.
C. Avoid the use of opioids for pain relief during the evening hours.
D. Schedule assessments to allow at least 4 hours of uninterrupted sleep.
Answer: B
Explanation: Lowering the level of light helps mimic normal day/night patterns and
maximizes the opportunity for sleep. While frequent assessments and opioid use can disturb
sleep, they are often necessary for the care of critically ill patients. The presence of visitors
may sometimes decrease anxiety and improve sleep for some patients.
8. The nurse is caring for a patient who has sleep deprivation and teaching about the
effects that lack of sleep can have on the body. Which of the following information
would be included in the teaching plan for this patient? (Select all that apply.)
A. Decreased insulin resistance
B. Increased growth hormone
C. Increased risk of type 2 diabetes
D. Irritability, moodiness
E. Increased risk of gastro-esophageal reflux disease (GERD)
Answer: C, D, E
Explanation: Sleep deprivation is associated with an increased risk of type 2 diabetes due to
increased insulin resistance, not decreased. It also increases the risk of GERD, heart disease,
hypertension, and impaired immune function. Behavioral changes such as irritability and
moodiness are common. Sleep deprivation causes a decrease, not an increase, in growth
hormone secretion.
