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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.
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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.
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 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.
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.