Ch 40 Rest And Sleep

Front 1

________connotes a condition in which the body is in a decreased state of activity, with the consequent feeling of being refreshed.

Back 1

rest

Front 2

________ is a state of rest accompanied by altered consciousness and relative inactivity. It is a complex rhythmic state involving a progression of repeated cycles, each representing different phases of body and brain activity. Although sensitivity to external stimuli is diminished during sleep, this sensitivity can be readily reversed.

Back 2

Sleep

Front 3

Two systems in the brainstem the _______________ and the _______________, are believed to work together to control the cyclic nature of sleep.

Back 3

reticular activating system (RAS)

bulbar synchronizing region

Front 4

The ________ extends upward through the medulla, the pons, the midbrain, and into the hypothalamus.

Back 4

reticular activating system (RAS)

Front 5

Injury to the __________ may cause a person to sleep for abnormally long periods.

Back 5

hypothalamus

Front 6

_______________complete a full cycle every 24 hours.

Back 6

Circadian rhythms

Front 7

What are the two major stages of sleep?

Back 7

non–rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep

Front 8

______ sleep (comprising about 75% of total sleep) consists of four stages

Back 8

NREM

Front 9

NREM sleep has 4 stages during states ______ and _______ which consuming about 5% and 50% of a person's sleep time, respectively, are light sleep the person can be aroused with relative ease.

Back 9

I and II

Front 10

Stages _____ and _____, each representing about 10% of total sleep time, are deep-sleep states, termed delta sleep or slow-wave sleep.

Back 10

III IV

Front 11

The person is in a transitional stage between wakefulness and sleep.
The person is in a relaxed state but still somewhat aware of the surroundings.
Involuntary muscle jerking may occur and waken the person.
The stage normally lasts only minutes.
The person can be aroused easily.
This stage constitutes only about 5% of total sleep.

Back 11

Stage I

Front 12

The person falls into a stage of sleep.
The person can be aroused with relative ease.
This stage constitutes 50% to 55% of sleep.

Back 12

Stage II

Front 13

The depth of sleep increases, and arousal becomes increasingly difficult.
This stage composes about 10% of sleep.

Back 13

Stage III

Front 14

The person reaches the greatest depth of sleep, which is called delta sleep.
Arousal from sleep is difficult.
Physiologic changes in the body include the following:
Slow brain waves are recorded on an EEG.
Pulse and respiratory rates decrease.
Blood pressure decreases.
Muscles are relaxed.
Metabolism slows and the body temperature is low.
This constitutes about 10% of sleep.

Back 14

Stage IV

Front 15

Eyes dart back and forth quickly.
Small muscle twitching, such as on the face
Large muscle immobility, resembling paralysis
Respirations irregular; sometimes interspersed with apnea
Rapid or irregular pulse
Blood pressure increases or fluctuates
Increase in gastric secretions
Metabolism increases; body temperature increases
Encephalogram tracings active
REM sleep enters from stage II of NREM sleep and reenters NREM sleep at stage II: arousal from sleep difficult
Constitutes about 20% to 25% of sleep

Back 15

REM

Front 16

_______ sleep is believed to be essential to mental and emotional equilibrium and to play a role in learning, memory, and adaptation.

Back 16

REM

Front 17

You notice that a patient admitted to your unit sleeps for an abnormally long time. This patient may have suffered damage to which of the following areas of the brain?

a. Cerebral cortex

b. Hypothalamus

c. Medulla

d. Midbrain

Back 17

b

Front 18

Wakefulness occurs when which of the following is activated with stimuli from the cerebral cortex and peripheral sensory organs?

a. Reticular activation system

b. Bulbar synchronizing region

c. Circadian rhythm

d. Medulla

Back 18

a

Front 19

Which of the following is a characteristic of REM sleep?

a. Small muscles are immobile as in paralysis

b. pulse is slow and regular

c. Body temperature decreases

d. Eyes dart back and forth quickly.

Back 19

d

Front 20

When an individuals sleep wake patterns follow the inner biologic clock which of the following conditions exists?

a. Circadian rhythm

b. Circadian synchronization

c. Bulbar synchronization

d. Sleep cycle

Back 20

d

Front 21

Which of the following instruments receives and records electrical currents from the brain?

a. electroencephalograph

b. electroculogram

c. electromyograph

d. electrocardiogram

Back 21

a

Front 22

The arousal threshold is usually greatest in which of the following stages of NREM sleep?

a. Stage I

b. Stage II

c. Stage III

d. Stage IV

Back 22

d

Front 23

In normal adults the REM state consumes what percentage of nightly sleep?

a. 5% to 10%

b. 10% to 20%

c. 20% to 25%

d. 25% to 35%

Back 23

c

Front 24

On which of the following patients should a sleep history be obtained?

a. Only patients who have been suffering from a sleep disorder

b. Patients who suffer from a sleep disorder or have been uncousious.

c. Patients who suffer from a sleep disorder or who are spending time in the CCU

d. All patients admitted to a healthcare agency.

Back 24

d

Front 25

A patient who has been diagnosed with hypothyroidism is admitted to a nursing home. On performing a sleep history on this patient, you find out that the patient is suffering from fatigue, lethargy, depression, and difficulty executing the tasks of everyday living. This patient is probably experiencing which of the following types of sleep deprivation?

a. REM depivation

b. NREM deprivation

c. Total sleep deprivation

d. insomnia

Back 25

b

Front 26

Most authorities agree that an individuals sleep wake cycle is fully developed by what age?

a. 9 months to 1 year

b. 1 year to 18 months

c. 2 to 3 years

d. 4 to 6 years

Back 26

c

Front 27

Which of the following interventions would be recommended for a patient with insomnia?

a. Nap frequently during the day to make up for the lost of sleep at night.

b. Eliminate caffeine and alcohol in the evening because both are associated with disturbances in the normal sleep cycle.

c. Exercise vigorously before bedtime to promote drowsiness.

d. Avoid food high in carbohydrates before bedtime.

Back 27

b.

Front 28

Mrs. Leister a new patient in the medical surgical unit complains of difficulty sleeping. She is scheduled for an exploratory laparotomy in the morning. Your diagnosis is Sleep Pattern Disturbance: Insomnia related to fear of impending surgery. Which one of the following steps is the most appropriate in planning care for this diagnosis?

a. Help her maintain her normal bedtime routine and time for sleep.

b. Provide an opportunity for her to talk about her concerns.

c. Use tactile relaxation techniques, such as a back massage.

d. Bring her a warm glass of milk at bedtime.

Back 28

b

Front 29

True or false

The reticular activating system (RAS) extends upward through the medulla the pons and the midbrain and into the hypothalamus.

Back 29

True

Front 30

True or false

During sleep the RAS experiences few stimuli from the cerebral cortex and periphery of the body.

Back 30

True

Front 31

True or false

GABA appears to be necessary for inhibition.

Back 31

True

Front 32

Which of the following are characterisitics of REM sleep? ( select all that apply)

a. The person is in a transitional stage between wakefulness and sleep.

b. The person can be aroused with relative ease.

c. The person reaches the greatest depth of sleep called delta sleep.

d. Respiration are irregular and sometimes interspersed with apnea.

e. Metabolism and body temperature increase.

f. It constitutes about 20% to 25% of sleep.

Back 32

d, e, f

Front 33

Which of the following statements accurately describe developmental patterns of sleep? ( select all that apply)

a. Newborns sleep an average of 16hrs per day.

b. NREM sleep constitutes much of the sleep cycle of a young infant.

c. The need for sleep in toddlers increases with age due to the more active state they are in.

d. 12hrs is the average amount of sleep needed by preschoolers.

e. Sleep needs generally decrease when physical growth peaks.

f. An average of 5 to 7 hours of sleep is generally adequate for older adults.

Back 33

a, d, f

Front 34

Which of the following statements accurately describe factors that affect sleep patterns? (select all that apply)

a. Excessive exercise promotes fatigue and improves the quality of sleep.

b. Sleep disorders are the major problem associated with shift work.

c. Sleep is not affected by watching TV or participating in stimulation outside activities.

d. A small protein and carbohydrate snake is recommended to promote sleep.

e. Large quantities of alcoholic beverages have been found to limit REM and delta sleep

f. Nicotine has a relaxing effect and smokers usually have an easier time falling asleep.

Back 34

b, d, e

Front 35

Which of the following describe the influences of illness on sleep patterns? (select all that apply)

a. Gastric secretions decrease during REM sleep.

b. The pain associated with disease of the coronary artieries and myocardial infarction is more likely during NREM sleep.

c. Epilepsy seizures are more likely to occur during NREM sleep.

d. Liver failure and encephalitis tend to cause a reversal in day night sleeping habits.

e. Hypothyroidism tends to increase the amount of NREM sleep.

f. The administration of a larger mid afternoon dose of asthma medication may prevent attacks that occur at night during sleep.

Back 35

c, d, f

Front 36

Which of the following are recommended intervention for patients experiencing insomnia who are undergoing stimulus control? (Select all that apply)

a. Recommend that the patient use the bedroom for sex and sleep only.

b. Instruct the patient to leave the bedroom if he or she cannot get to sleep within 15 to 20 mins. and return when they are feeling sleepy.

c. Instruct the patient to get up at the same time every day no matter what time he or she feel asleep.

d. Allow the patient to nap during the day if he or she could not sleep during the night.

e. Instruct the patient to exercise moderately 1hr before going to bed.

f. Encourage the patient to consume one or two alcoholic drinks to help him or her relax before bedtime.

Back 36

a, b, c

Front 37

Which of the following are types of sleep therapies to treat insomnia? ( Select all that apply)

a. Sleep modification

b. Sleep hygiene

c. Congnitive therapy

d. Multifaceted therapy

e. Stimulation therapy

f. Multicomponent therapy

Back 37

b, c, e

Front 38

Which of the following statements accurately describe common sleep disorders? (select all that apply)

a. Sleep apnea refers to period of absent breathing between snoring intervals.

b. Patients with restless arm syndrome cannot lie still and experience unpleasant crawling or tingling sensation in the arms.

c. Sleep deprivation results from increased NREM sleep and generally progresses to total sleep deprivation if untreated.

d. Bruxism or sleepwalking is a common type of somnambulism.

e. Enuresis involves bedwetting during sleep and is a form of somnambulism.

f. Sleep related eating disorder is a type of parasomnia in which the patient eats food but does not remember eating in the morning.

Back 38

a, e, f

Front 39

Stages III and IV representing about 10% of total sleep time and deep sleep states termed _______ or slow wave sleep

Back 39

Delta

Front 40

_____ are patterns of waking behavior that appear during sleep

Back 40

Parasomnia

Front 41

____________ is characterized by difficulty falling asleep intermittent sleep or sleep or early awakening from sleep.

Back 41

Insomnia

Front 42

______________ is a condition characterized by excessive sleep particularly during the day.

Back 42

Hypersomnia

Front 43

_________ is a condition characterized by an uncontrollable desire to sleep

Back 43

Narcolepsy

Front 44

Bedwetting during sleep

Back 44

Enuresis

Front 45

Difficulty in falling asleep intermittent sleep or early awakening from sleep

Back 45

Insomnia

Front 46

A condition characterized by an uncontrollable desire to sleep

Back 46

Narcolepsy

Front 47

Grinding teeth during sleep

Back 47

Bruxism

Front 48

A condition characterized by excessive sleep particularly during the day

Back 48

Hypersomnia

Front 49

Periods of no breathing between snoring intervals.

Back 49

Sleep apnea

Front 50

sleepwalking

Back 50

Somnambulism

Front 51

Decreased in the amount of consistency and quality of sleep

Back 51

Sleep Deprivation (what we are all suffering from in nursing school)

Front 52

Marked muscle contraction that results in the jerking of one or both legs during sleep.

Back 52

Hypersomnia

Front 53

The depth of sleep increases and arousal becomes increasingly difficult.

Back 53

Stage III

Front 54

Involuntary muscle jerking may occur and waken the person

Back 54

Stage I

Front 55

It is a transitional stage between wakefulness and sleep

Back 55

Stage I

Front 56

The person reaches the greatest depth of sleep called delta sleep

Back 56

Stage IV

Front 57

Constitutes about 10% of sleep

Back 57

Stage III and Stage IV

Front 58

Constitutes about 50 to 55% of sleep

Back 58

Stage II

Front 59

Metabolism slows and the body temperature is low

Back 59

Stage IV

Front 60

Constitutes about 5% of sleep

Back 60

Stage I

Front 61

How many hours do infants sleep a day?

Back 61

14 to 20hrs per day

Front 62

How may hours do growing children sleep per day

Back 62

10 to 14

Front 63

How many hours do adults sleep per day

Back 63

7 to 9

Front 64

A central nervous system stimulant _________ causes wakefulness may be used to control narcolepsy.

Back 64

Methylphenidate (ritalin)