TEST BANK FOR GERONTOLOGICAL NURSING 3RD EDITION BY TABLOSKI Chapter 08

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1 Link full download: TEST BANK FOR GERONTOLOGICAL NURSING 3RD EDITION BY TABLOSKI Chapter 08 View Sample Question 1 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: 2 Rationale 1: Delayed healing is associated with sleep deprivation. Reference: Page 194

2 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

3 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

4 Learning Outcome: 1. Discuss the importance of obtaining adequate sleep and the sleep cycle. Question 2 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

5 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

6 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 2. Describe normal changes in sleep occurring with aging.

7 Question 3 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.

8 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

9 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3. Identify potential causes of sleep disruption in older people. Question 4

10 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 3 hours before going to sleep. Reference: Page 203 Rationale 3: Alcohol has been found to disrupt sleep and should be avoided. Reference: Page 203

11 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

12 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? 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

13 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

14 Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3. Identify potential causes of sleep disruption in older people. 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? Standard Text: Select all that apply. Dizziness

15 Constipation Hallucinations Daytime lethargy Problems swallowing Correct Answer: 1,2,4,5 Rationale 1: Typical side effects of hypnotic drugs include dizziness. Reference: Pages Rationale 2: Typical side effects of hypnotic drugs include constipation. Reference: Pages Rationale 3: Typical side effects of hypnotic drugs do not include hallucinations. Reference: Pages Rationale 4: The older person who routinely takes hypnotic drugs for sleep will have a change in the architecture of the sleep cycle and may experience daytime lethargy. Reference: Pages Rationale 5: Typical side effects of hypnotic drugs include problems with swallowing.

16 Reference: Pages Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3. Identify potential causes of sleep disruption in older people. Question 7 Type: MCSA

17 The nurse is concerned that an older patient has undiagnosed sleep apnea and is at risk for which additional health problem? Underweight Excessive deep sleep Increased risk for sudden death and stroke Excessive tension in the muscles of the throat and soft palate 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. Reference: Page 199

18 Rationale 4: In sleep apnea, the muscles in the throat, soft palate, and tongue relax during the night and cause airway obstruction. Reference: Page 199 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity

19 Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3. Identify potential causes of sleep disruption in older people. 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? Standard Text: Select all that apply. Oxygen saturation level will be measured. An electrocardiogram will be used to measure heart activity.

20 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 Rationale 1: During an overnight sleep study, the patient s oxygen saturation level will be measured. Reference: Pages Rationale 2: During an overnight sleep study, an electrocardiogram will be used to measure heart activity. Reference: Pages Rationale 3: During an overnight sleep study, pins are not inserted into leg muscles to measure tone and tension. Reference: Pages Rationale 4: During an overnight sleep study, an electromyogram will be done to measure face and leg movements. Reference: Pages

21 Rationale 5: During an overnight sleep study, an electroencephalogram will be done to measure brain wave activity. Reference: Pages Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3. Identify potential causes of sleep disruption in older people.

22 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? Standard Text: Select all that apply. 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 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. Reference: Page 200

23 Rationale 2: Treatment for sleep apnea may include encouraging the patient to sleep on the side to keep the airway open. Reference: Page 200 Rationale 3: Treatment for sleep apnea may include teaching the patient to avoid alcohol before going to sleep since this has been known to aggravate sleep apnea. Reference: Page 200 Rationale 4: Sleeping upright in a chair is not a recommended treatment for sleep ap nea. This might be appropriate for the patient with severe heart failure. Reference: Page 200 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: Cognitive Level: Applying Client Need: Physiological Integrity

24 Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Formulate appropriate nursing interventions to improve or restore sleep. 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? Standard Text: Select all that apply.

25 Pressure keeps the airway open. An oral airway is inserted each night.

26 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. Correct Answer: 1,4 Rationale 1: Continuous positive airway pressure works by applying pressure to the airway in order to keep the airway open during sleep. Reference: Page 200 Rationale 2: CPAP does not involve the insertion of any airways. Reference: Page 200 Rationale 3: There is no information to support that the CPAP machine is noisy. Reference: Page 200 Rationale 4: CPAP is a noninvasive treatment that is administered through a nasal mask. Reference: Page 200 Rationale 5: The face mask has been known to be uncomfortable but the mask can be fitted to the patient to increase comfort. Reference: Page 200

27 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Formulate appropriate nursing interventions to improve or restore sleep. Question 11 Type: MCSA

28 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 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. Reference: Page 205 Rationale 2: Zolpidem (Ambien) has not been associated with harmful side effects, such as daytime drowsiness. Reference: Page 205

29 Rationale 3: Zolpidem (Ambien) is a new drug that does not adversely alter sleep architecture. Reference: Page 205 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: Cognitive Level: Analyzing Client Need: Physiological Integrity 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.

30 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

31 Rationale 1: It is important to avoid using the benzodiazepines with longer halflives 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: Cognitive Level: Analyzing

32 Client Need: Physiological Integrity 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 13 Type: MCMA Which actions should the nurse take to ensure effective sleep for older patients in a long-term care facility? Standard Text: Select all that apply.

33 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 longterm care facility include using nightlights during the night. Reference: Page 204

34 Rationale 2: Interventions to ensure effective sleep for older patients in a longterm care facility include establishing consistent nighttime routines. Reference: Page 204 Rationale 3: Interventions to ensure effective sleep for older patients in a longterm care facility include scheduling routine care in the early evening hours. Reference: Page 204 Rationale 4: Interventions to ensure effective sleep for older patients in a longterm care facility include not putting patients to bed immediately after supper. Try to provide restful evening activities like music or group readings so that gastrointestinal problems such as gastroesophageal reflux disease are avoided. Reference: Page 204 Rationale 5: Interventions to ensure effective sleep for older patients in a longterm care facility include reducing noise and light disruption throughout the night. Reference: Page 204 Global Rationale:

35 Cognitive Level: Applying Client Need: Physiological Integrity

36 Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Formulate appropriate nursing interventions to improve or restore sleep. 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

37 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

38 Rationale 2: Hormones that aid in physiological restoration are released during NREM (nonrapid eye movement) sleep. Reference: Page 195 Rationale 3: In REM sleep, the limbs are temporarily paralyzed. Reference: Page 195 Rationale 4: Heart rate and blood pressure both increase during REM sleep. Reference: Page 195 Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort

39 Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1. Discuss the importance of obtaining adequate sleep and the sleep cycle. 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

40 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 Correct Answer: 4 Rationale 1: In sleep restriction therapy, naps are to be avoided. Reference: Page 203 Rationale 2: In sleep restriction therapy, the bed is for sex or sleep and not for watching television. Reference: Page 203 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:

41 Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Formulate appropriate nursing interventions to improve or restore sleep. Question 16

42 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.

43 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

44 daytime drowsiness and may experience problems with concentration and function. Reference: Page 194 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1. Discuss the importance of obtaining adequate sleep and the sleep cycle.

45 Question 17 Type: MCSA An older patient in a long-term care facility does not sleep much at night and prefers to stay up late reading. The patient takes power naps during the day. How should the nurse respond to this patient s plan to acquire adequate sleep? Naps are sufficient to restore the missed sleep time. Older people do not need as much sleep as younger adults. Napping may simply contribute to the problem getting to sleep at night. There is no problem as long as the total number of hours slept per 24-hour period is at least 8. Correct Answer: 3 Rationale 1: Naps do not replace the needed rest lost at night. Reference: Page 197 Rationale 2: Older people do need similar amounts of sleep as younger adults. Reference: Page 197

46 Rationale 3: Napping during the day may make it more difficult to get to sleep at night. Reference: Page 197 Rationale 4: Napping does not allow the body to reach the deeper sleep stages needed for physical and psychological restoration. Reference: Page 197 Global Rationale:

47 Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1. Discuss the importance of obtaining adequate sleep and the sleep cycle. Question 18

48 Type: MCSA An older patient has been reading about the use of melatonin for sleep. Which statement indicates that the patient needs more instruction about this pharmacological agent? Melatonin is a hormone my body makes. Nausea is a side effect associated with melatonin.

49 Older adults may have reduced levels of melatonin. I will need to have a prescription from my physician to obtain it. Correct Answer: 4 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 do 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:

50 Cognitive Level: Analyzing Client Need: Physiological Integrity

51 Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4. 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

52 A glass of warm milk A cup of chamomile tea A small turkey sandwich Correct Answer: 3 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:

53 Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies

54 Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4. 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

55 Thin body build Correct Answer: 2 Rationale 1: Stature does not play a role in sleep apnea. Reference: Page 199

56 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

57 Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 3. 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

58 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.

59 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:

60 Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential

61 Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 3. 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: 3 Rationale 1: Alcohol has an initial stimulating effect.

62 Reference: Page 201 Rationale 2: Alcohol reduces the amount of time needed to fall asleep. Reference: Page 201

63 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

64 Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3. 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 3 hours to bedtime. Lighten your exercise routine in the afternoon; concentrate exercise toward the morning hours. Correct Answer: 2 Rationale 1: Varying the routine is a positive idea but does not meet the problems presented by the patient. Reference: Page 203

65 Rationale 2: Exercise close to bedtime can cause difficulty falling asleep. Reference: Page 203 Rationale 3: Exercise should not be done closer than 3 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

66 Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3. 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

67 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:

68 Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4. 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?

69 Benadryl Ibuprofen Vitamin B Ferrous sulfate Correct Answer: 1 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

70 Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4. List the risks and benefits of pharmacological and nonpharmacological interventions for sleep disturbance.