Nokea
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?
- 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)
Correct Answer: D,E
Rationale: Brewed coffee has 135 mg caffeine and black tea, either leaf or bag, has 50 mg of caffeine. Green tea has 30 mg, chocolate cake has 36 mg, and Dr. Pepper soda has 41 mg.
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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.
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 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.
Correct Answer: B
Rationale: Short on-site naps will improve alertness. Rotating shifts causes the most disruption in sleep habits. Reminding staff members about the impact of lack of sleep on alertness will not improve sleep or alertness.
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.
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/m?² 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.
Correct Answer: C
Rationale: The patient's BMI and snoring suggest possible sleep apnea, which can cause complications such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to be affecting this patient's sleep quality.