Nokea
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.
Correct Answer: C
Rationale: The diagnosis of insomnia is made 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.
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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?
- 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)
Correct Answer: C, D, E
Rationale: Patients with sleep deprivation are at an increased risk of GERD, type 2 diabetes, heart disease, hypertension, and impaired immune function and can also experience cognitive impairment, and behavioural changes such as irritability and moodiness. Sleep deprivation causes an increase in insulin resistance and a decrease in growth hormone.
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.
Correct Answer: A
Rationale: Benzodiazepine receptor agonists such as zopiclone work quickly and should be taken immediately before bedtime, not one hour before. The other patient statements are correct.
Which information will the nurse plan to include when teaching a patient with narcolepsy about management of the disorder?
- A. Stimulant drugs should be used for only a short time because of the risk for abuse.
- B. Driving an automobile may be possible with appropriate treatment of narcolepsy.
- C. Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.
- D. Antidepressant drugs are prescribed to treat the depression caused by the disorder.
Correct Answer: B
Rationale: The accident rate for patients with narcolepsy who are receiving appropriate treatment is similar to the general population. Stimulant medications are used on an ongoing basis for patients with narcolepsy. The purpose of antidepressant drugs in the treatment of narcolepsy is the management of cataplexy, not to treat depression. Changes in sleep hygiene are recommended for patients with narcolepsy to improve sleep quality.
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.
Correct Answer: D
Rationale: 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. The bedroom temperature should be slightly cool.
Which of these actions should the nurse take first for a patient in the clinic who is complaining of insomnia and daytime fatigue?
- A. Question the patient about the use of over-the-counter (OTC) sleep aids.
- B. Suggest that the patient decrease intake of caffeine-containing beverages.
- C. Advise the patient to get out of bed if unable to fall asleep in 10-20 minutes.
- D. Recommend that the patient use any prescribed sleep aids for only 2-3 weeks.
Correct Answer: A
Rationale: The nurse's first action should be assessment of the patient for factors that may contribute to poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions may be appropriate, but assessment is needed first to choose appropriate interventions to improve the patient's sleep.