Question 1

Sleep disturbance in critically ill patients is defined as insufficient duration or stages of sleep that results in

Accepted Answer

A)  less sleep that promotes recovery. 
B)  discomfort and interferes with quality of life. 
C)  adaptation of the environment to promote sleep. 
D)  more sleep that promotes recovery. 
A)  less sleep that promotes recovery. 
B)  discomfort and interferes with quality of life. 
C)  adaptation of the environment to promote sleep. 
D)  more sleep that promotes recovery. B

Question 2

Which of the following are characteristic of sleep in elderly adults?

Accepted Answer

A)  Insomnia 
B)  Less sleep required 
C)  Altered circadian rhythms 
D)  Higher incidence of sleep apnea 
E)  Longer periods of non-REM sleep 
A)  Insomnia 
B)  Less sleep required 
C)  Altered circadian rhythms 
D)  Higher incidence of sleep apnea 
E)  Longer periods of non-REM sleep A,C

Question 3

A patient was given the diagnosis of congestive heart failure (CHF)2 years ago.The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring.Central sleep apnea is suspected.Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea.The patient's primary treatment plan should include

Accepted Answer

A)  CPAP. 
B)  bilevel positive airway pressure (BiPAP). 
C)  acetazolamide and medroxyprogesterone. 
D)  modafinil and zolpidem. 
A)  CPAP. 
B)  bilevel positive airway pressure (BiPAP). 
C)  acetazolamide and medroxyprogesterone. 
D)  modafinil and zolpidem. A

Question 4

The patient has been in the critical care unit for 3 weeks and has been on an intra-aortic balloon pump for the past 3 days.The patient's condition has been serious,and hourly assessments and vital signs have been necessary.The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time.The patient has been given diazepam (Valium)prn.The anticipated effect of diazepam on the patient's sleep is

Accepted Answer

A)  a decrease in NREM stage 1. 
B)  an increase in NREM stage 3. 
C)  total NREM suppression. 
D)  REM suppression in larger doses. 
A)  a decrease in NREM stage 1. 
B)  an increase in NREM stage 3. 
C)  total NREM suppression. 
D)  REM suppression in larger doses.

Question 5

A patient with mild obstructive sleep apnea (OSA)can expect treatment to consist of

Accepted Answer

A)  medical management with protriptyline. 
B)  weight loss, elimination of alcohol before bedtime, and side sleeping. 
C)  immediate use of continuous positive airway pressure (CPAP). 
D)  surgical intervention with uvulopalatopharyngoplasty (UPPP). 
A)  medical management with protriptyline. 
B)  weight loss, elimination of alcohol before bedtime, and side sleeping. 
C)  immediate use of continuous positive airway pressure (CPAP). 
D)  surgical intervention with uvulopalatopharyngoplasty (UPPP).

Question 6

_____ is the external element that has the most significant effect on circadian rhythms.

Accepted Answer

A)  Lower body temperature 
B)  Light 
C)  Melatonin cycle 
D)  Background noise 
A)  Lower body temperature 
B)  Light 
C)  Melatonin cycle 
D)  Background noise

Question 7

A patient was given the diagnosis of congestive heart failure (CHF)2 years ago.The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring.Central sleep apnea is suspected.Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea.Which of the following indicates a diagnosis of nonhypercapnic central sleep apnea (CSA)?

Accepted Answer

A)  Polysomnography with absence of airflow for at least 5 seconds 
B)  Apnea-hypopnea index of 10 
C)  Peripheral edema, polycythemia, and obesity 
D)  Insomnia, awakenings accompanied by choking, and normal body mass index 
A)  Polysomnography with absence of airflow for at least 5 seconds 
B)  Apnea-hypopnea index of 10 
C)  Peripheral edema, polycythemia, and obesity 
D)  Insomnia, awakenings accompanied by choking, and normal body mass index

Question 8

Interventions to help with circadian synchronization include

Accepted Answer

A)  opening the window blinds. 
B)  encouraging the patient to take frequent naps during the day. 
C)  administering sedatives at bedtime. 
D)  keeping the patient awake during the early morning hours. 
A)  opening the window blinds. 
B)  encouraging the patient to take frequent naps during the day. 
C)  administering sedatives at bedtime. 
D)  keeping the patient awake during the early morning hours.

Question 9

Where are EMG leads placed to detect muscle atonia?

Accepted Answer

A)  Scalp 
B)  Intercostal 
C)  Anterior tibialis 
D)  Chin 
A)  Scalp 
B)  Intercostal 
C)  Anterior tibialis 
D)  Chin

Question 10

Which stage of NREM sleep is associated with anabolic processes?

Accepted Answer

A)  N1 
B)  N2 
C)  N3 
D)  N4 
A)  N1 
B)  N2 
C)  N3 
D)  N4

Question 11

The primary determinant in the efficacy of CPAP in patients with OSA is

Accepted Answer

A)  compliance. 
B)  weight. 
C)  tonsil size. 
D)  respiratory effort. 
A)  compliance. 
B)  weight. 
C)  tonsil size. 
D)  respiratory effort.

Question 12

What occurs physiologically during REM sleep?

Accepted Answer

A)  Growth hormone is secreted. 
B)  Metabolic needs are decreased. 
C)  Sympathetic nervous system predominates. 
D)  Heart rate and blood pressure decrease. 
A)  Growth hormone is secreted. 
B)  Metabolic needs are decreased. 
C)  Sympathetic nervous system predominates. 
D)  Heart rate and blood pressure decrease.

Question 13

_____ is a diagnostic test used to determine sleep disturbances.

Accepted Answer

A)  Electrooculography 
B)  Electromyography 
C)  Electroencephalography 
D)  Polysomnography 
A)  Electrooculography 
B)  Electromyography 
C)  Electroencephalography 
D)  Polysomnography

Question 14

_____ is used during polysomnography to determine when the patient enters REM sleep.

Accepted Answer

A)  Electrooculography 
B)  Electromyography 
C)  Electroencephalography 
D)  Polysomnography 
A)  Electrooculography 
B)  Electromyography 
C)  Electroencephalography 
D)  Polysomnography

Question 15

Which of the following patients would the nurse most strongly suspect of having obstructive sleep apnea?

Accepted Answer

A)  A severely obese woman with diabetes 
B)  A moderately obese man who snores 
C)  A nonobese woman with hypertension 
D)  A severely obese man with renal dysfunction 
A)  A severely obese woman with diabetes 
B)  A moderately obese man who snores 
C)  A nonobese woman with hypertension 
D)  A severely obese man with renal dysfunction

Question 16

Identify the usual cycle of sleep onset.

Accepted Answer

A)  NR1, NR2, NR3, NR2, REM 
B)  NR1, NR2, NR3, REM 
C)  NR1, NR2, NR3, NR1, REM 
D)  NR1, NR2, NR3, REM, NR3 
A)  NR1, NR2, NR3, NR2, REM 
B)  NR1, NR2, NR3, REM 
C)  NR1, NR2, NR3, NR1, REM 
D)  NR1, NR2, NR3, REM, NR3

Question 17

The patient has been in the critical care unit for 3 weeks and has been on the intraaortic balloon pump for the past 3 days.The patient's condition has been serious,and hourly assessments and vital signs have been necessary.The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time.The patient has been given diazepam (Valium)prn.Which techniques may assist in assessing the patient's sleep pattern?

Accepted Answer

A)  Correlating sleep time with vital signs 
B)  Documenting sleep periods of more than 90 minutes 
C)  Assessing degree of arousal on hourly checks 
D)  Observing the length of NREM sleep periods 
A)  Correlating sleep time with vital signs 
B)  Documenting sleep periods of more than 90 minutes 
C)  Assessing degree of arousal on hourly checks 
D)  Observing the length of NREM sleep periods

Question 18

Which of the following older patients demonstrates changes in sleep patterns attributable to central sleep apnea?

Accepted Answer

A)  A patient who wakes up two to three times per night and is tired during the day 
B)  A patient who reports sleeping less soundly and not feeling rested 
C)  A patient who consistently awakens at 4 AM and goes to bed at 7 PM 
D)  A patient who has irregular respiration during sleep and whose inspiratory muscles intermittently fail 
A)  A patient who wakes up two to three times per night and is tired during the day 
B)  A patient who reports sleeping less soundly and not feeling rested 
C)  A patient who consistently awakens at 4 AM and goes to bed at 7 PM 
D)  A patient who has irregular respiration during sleep and whose inspiratory muscles intermittently fail

Question 19

Which of the following occur during REM sleep stages?

Accepted Answer

A)  Vital signs remain at basal levels. 
B)  Dreams occur. 
C)  Myocardial infarction often occurs. 
D)  Sweating or shivering is common. 
E)  Growth hormone is released. 
A)  Vital signs remain at basal levels. 
B)  Dreams occur. 
C)  Myocardial infarction often occurs. 
D)  Sweating or shivering is common. 
E)  Growth hormone is released.

Question 20

During a sleep study,which of the following groups of information are gathered?

Accepted Answer

A)  Airflow, snoring, and tonsil size 
B)  Electroencephalogram, electrocardiogram, and end-tidal carbon dioxide 
C)  Oxygen saturation, number of arousals, and airflow 
D)  Frequency of awakenings, REM speed, and apnea-hypopnea index 
A)  Airflow, snoring, and tonsil size 
B)  Electroencephalogram, electrocardiogram, and end-tidal carbon dioxide 
C)  Oxygen saturation, number of arousals, and airflow 
D)  Frequency of awakenings, REM speed, and apnea-hypopnea index

Exam 7: Sleep Alterations and Management

Sleep disturbance in critically ill patients is defined as insufficient duration or stages of sleep that results in

Which of the following are characteristic of sleep in elderly adults?

A patient with mild obstructive sleep apnea (OSA)can expect treatment to consist of

_____ is the external element that has the most significant effect on circadian rhythms.

Interventions to help with circadian synchronization include

Where are EMG leads placed to detect muscle atonia?

Which stage of NREM sleep is associated with anabolic processes?

The primary determinant in the efficacy of CPAP in patients with OSA is

What occurs physiologically during REM sleep?

_____ is a diagnostic test used to determine sleep disturbances.

_____ is used during polysomnography to determine when the patient enters REM sleep.

Which of the following patients would the nurse most strongly suspect of having obstructive sleep apnea?

Identify the usual cycle of sleep onset.

Which of the following older patients demonstrates changes in sleep patterns attributable to central sleep apnea?

Which of the following occur during REM sleep stages?

During a sleep study,which of the following groups of information are gathered?

Critical Care Nursing Practice

Ethical Issues

Legal Issues

Genetics and Genomics in Critical Care

Patient and Family Education

Psychosocial and Spiritual Alterations and Management

Nutrition Alterations and Management

Pain and Pain Management

Sedation,Agitation,Delirium: Assessment and Management

End-Of-Life Issues

Cardiovascular Anatomy and Physiology

Cardiovascular Clinical Assessment

Cardiovascular Diagnostic Procedures

Cardiovascular Disorders

Cardiovascular Therapeutic Management

Pulmonary Anatomy and Physiology

Pulmonary Clinical Assessment

Pulmonary Diagnostic Procedures

Pulmonary Disorders

Pulmonary Therapeutic Management

Neurologic Anatomy and Physiology

Neurologic Clinical Assessment and Diagnostic Procedures

Neurologic Disorders and Therapeutic Management

Kidney Anatomy and Physiology

Kidney Clinical Assessment and Diagnostic Procedures

Kidney Disorders and Therapeutic Management

Gastrointestinal Anatomy and Physiology

Gastrointestinal Clinical Assessment and Diagnostic Procedures

Gastrointestinal Disorders and Therapeutic Management

Endocrine Anatomy and Physiology

Endocrine Clinical Assessment and Diagnostic Procedures

Endocrine Disorders and Therapeutic Management

Trauma

Shock,sepsis,and Multiple Organ Dysfunction Syndrome

Burns

Organ Donation and Transplantation

Hematologic Disorders and Oncologic Emergencies

The Obstetric Patient

The Pediatric Patient

The Older Adult Patient

The Perianesthesia Patient

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