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101 Cards in this Set
- Front
- Back
Sleep requirements
--most adults require how many hours of sleep for optimal functioning |
7-8 hrs
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Sleep requirements
--long sleepers: require __ or more hours per night -short sleepers: requiring less than __hrs per night |
-long sleepers: require 10 or more hours per night
-short sleepers: requiring less than 5 hrs per night |
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Sleep requirements
-the amount of sleep required is the amount |
necessary to feel full awake and able to sustain normal levels of performance during the periods of wakefulness
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what is the most accurate way to determine ones sleep requirements?
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is to establish a routine bedtime and allow oneself to sleep undisturbed without an alarm for several days. this is best accomplished during an extended period of leisure time, such as during a vacation.
the average of several nights sleep undisturbed is probably a good estimate of total sleep requirement |
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Parasomnias
--characterized by |
unusual or undesirable behaviors or events that occur during sleep/wake transitions, certain stages of sleep, or during arousal from sleep
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Parasomnias
--pts do not complain of: |
-pts do not have specific sleep related complaints such as insomnia or daytime sleepiness
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Parasomnias
-if the pts don't report sleep problems, how does this get known about |
-it is the partner that reports the behavioral disturbance
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Parasomnias
-treatment: |
reduce stress, stress management, and any measures that would protect the pt
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-somnambulism is also called
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sleep walking:
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sleep walking
-consists of a sequence of complex behaviors that begin when |
in the first third of the night during NREM sleep (stages 3 & 4) and usually progress (without full consciousness or later memory) to leaving bed and walking about (may include dressing, going to the bathroom, screaming, or driving)
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sleep walking
-treatment consists of: |
-instructing the patient and family regarding safety measures such as alarm or locks on windows and doors and gating stairways
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sleep walking
-treatment... what are some things you can tell them to do to be helpful |
attention to sleep hygiene, limiting alcohol prior to bed, obtaining adequate amounts of sleep, and stress reduction is helpful
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REM sleep behavior disorder (RSBD)
-what is this disorder about? -most often seen in what population? |
-excessive motor activity, someone acting out their dreams,
most often seen in elderly men |
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REM sleep behavior disorder (RSBD)
-characterized by: |
-characterized by absence of muscle atonia during sleep
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REM sleep behavior disorder (RSBD)
--can be seen in symptoms of neurological pathology such as |
Parkinson’s disease
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REM sleep behavior disorder (RSBD)
-what 2 meds can induce or exacerbate episodes? |
-SNRI and SSRIs
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REM sleep behavior disorder (RSBD)
--treatment focuses on |
patient and sleep partner safety
ex:-placing the mattress on the floor is sometimes necessary to prevent injury as a result of falling out of bed |
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Primary Insomnia-
-how long does this condition persist for? -key for diagnosis? -give examples |
-this condition must persist for 1 month and must not be related to any known physical or medical condition
-key to the diagnosis is a report of some type of daytime consequence associated with the sleep disturbance (ex: impaired social or vocational functioning, decreased concentration or memory impairment, somatic complaints, mood disturbance |
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Primary Insomnia: -individuals complain that they have difficulty with sleep
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initiation, sleep maintenance, early awakening, or non-refreshing non-restorative sleep
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insomnia is best understood as a state of
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constant hyperarousal
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sleep disorders
-treatment? |
sleep hygiene is the treatment, along with behavior therapies, and in some cases the use of hypnotic medication
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sleep hygiene
-maintain: -develop: -reserve the bedroom for: |
-maintain a regular sleep/wake schedule
-develop a pre sleep routine that signals the end of the day -reserve the bedroom for sleep and a place for intimacy |
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sleep hygiene
-creat an envt that is: -avoid: -limit: -avoid: |
-create an envt that is conducive to sleep (taking into consideration light, temperature, and clothing)
-avoid clock watching -limit caffeinated beverages to 1 or 2 a day and non in the evening -avoid heavy meals before bedtime |
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sleep hygiene
-alcohol? -naps? -exercise? |
-use alcohol cautiously, avoid use for several hours before bed
-avoid daytime napping -exercise daily but not right before bed |
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sleep hygiene
-alcohol use -avoid -exercise? |
-use alcohol cautiously, avoid use for several hours before bed
-avoid daytime napping -exercise daily but not right before bed |
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-Treatment for insomnia:
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hypnotics (Benzodiazepines, melatonin receptor agoinst, antidepressant, antihistamines)
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Treatment for insomnia:
-teach what to give a sense of control? -what is the key factor? |
-teaching relaxation techniques gives control (deep breathing effectively)
key factor: anxiety and worry will capture attention |
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treatment
-sleep restriction therapy: what is it? |
spending less time in bed when you are awake (get up and fold laundry)
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-stimulus control: 5 principles (p. 470)
what is the most important part |
-getting up at the same time everyday – most important part
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-the sleep medications (benzos, hypnotics) produce dependence and withdrawal so ideally, they are suppose to be prescribed for __weeks. once the drug (hypnotics) is discontinued , the person can have rebound insomnia and nightmares.
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2
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Cognitive-Behavioral strategies
-includes educational, behavioral, and cognitive components -what does it target? |
-it targets factors that perpetuate insomnia over time
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Cognitive-Behavioral strategies
-the first objectives are to provide what? -what should you ask the patients? |
education regarding sleep and sleep needs and help the patient to set realistic expectations regarding sleep
patients should be asked what they believe constitutes healthy sleep and have any misconceptions clarified |
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Cognitive-Behavioral strategies
eliciting information about the total number of hours spent sleeping typically has value true or false |
it has little value
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focusing in the # of hours slept rather than the quality of sleep and daytime functioning (increases or decrease) the insomnia experience
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increases
-many patients are stuck on a set number of sleep hours rather than on the quality of sleep obtained |
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the first objectives are to provide education regarding sleep and sleep needs and help the patient to set realistic expectations regarding sleep
the next approach involves |
modifying poor sleep habits and establishing a regular sleep/wake schedule
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what is helpful in establishing overall sleep patterns and determine over all sleep efficiency (total sleep time divided by total time in bed x 100)
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sleep diaries for a period of 2 weeks
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what is sleep restriction
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limiting the total sleep time creates a temporary, mild state of sleep deprivation and strengthens the sleep homeostatic drive (this decreases sleep latency and improves sleep continuity and quality
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stimulus control, involves adherence to 5 basic principles that decrease the negative associations between the bed and bedroom and strengthen the stimulus for sleep. patients should be instructed to:
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go to bed only when sleepy
2. use the bed/bedroom only for sleep and intimacy (no tv, reading, or other activities) 3. get out of bed if unable to sleep and engage in quiet time activity like reading or crossword puzzles, no TV, work, or computer 4. maintain a regular sleep/wake schedule, getting up at the time same time each day – most important factor 5. avoid daytime napping (If napping is necessary it should be limited to 20-30 min max) -other objectives are aimed at identifying and correcting maladaptive attitudes and beliefs about sleep that perpetuate insomnia |
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Sleep diaries are helpful to:
-what do they help guide? |
helpful in identifying sleep patterns and behaviors that may be contributing to the sleep complaint
will help guide the assessment and direct the plan of care |
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Sleep diaries are used for evaluation how so?
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used for evaluation (which is based on whether ot not the pt experience improved sleep quality as evidence by decreased sleep latency, fewer nighttime awakenings, short time to get back to sleep after awakened) the pt may perceive that he or she is no longer controlled by sleep (or lack of it) but exerting control over sleep through lifestyle changes and better sleep routine
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Spielman’s 3P assessment model for insomnia is used for what 3 reasons?
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causes of insomnia,
suggest appropriate interventions, provide rationales for treatment |
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Spielman’s 3P assessment model for insomnia suggests that there are 3 factos that contribute to the insomnia which are:
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predisposing, precipitating, perpetuating factors
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
individual factors that create a vulnerability to insomnia |
Predisposing factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
may include a prior history of poor quality sleep, history of depression and anxiety, state of hyperarousal |
Predisposing factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
pts at risk to develop insomnia may describe themselves as light sleepers and night owls |
Predisposing factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
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Predisposing factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
something that triggers it, external event, like stressors, job loss, death |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
external events that trigger insomnia |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
personal and vocational difficulties |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
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Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
medical and psychiatric disorders |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
grief |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
changes in role identity (retirement) |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
factors that one practices and attributes that maintain the sleep complaint : |
Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
- excessive caffeine -alcohol use -cigaretts |
Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
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Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
spending excessive amounts of time in bed or napping, |
Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
worry about the consequences of insomnia |
Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
personal and vocational difficulties |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
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Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
medical and psychiatric disorders |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
grief |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
changes in role identity (retirement) |
Precipitating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
factors are sleep practices and attributes that maintain the sleep complaint such as: excessive caffeine -alcohol use, |
Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
spending excessive amounts of time in bed or napping |
Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
-worry about the consequences of insomnia |
Perpetuating factors:
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Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors
coffee, cigs, alcohol (keeps the problem going |
Perpetuating factors:
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Facilitative Statements (table 21-2 p 487)
when talking to a patient about a sensitive or awkward subject, whta should the nurse try to do? |
normalize things (go from something general to specific)
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Facilitative Statements (table 21-2 p 487)
it’s our job to teach about sexual side effects from medication (psychotropic meds is a primary offender.. what is an example of a drug? |
SSRIs can cause sexual dysfunction –someone not able to have an orgasm, main reason people go off meds)
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Facilitative Statements (table 21-2 p 487)
anxiety directly affects |
performance (someone who has ED has a problem with anxiety performance)
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Purpose and statements:
to provide a rationale for a question – |
“as a nurse, I am concerned about all aspects of your health. many individuals have concern about sexual matters, especially when they are sick or having other health problems
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Purpose and statements:
to give statements of generality or normality – |
“most people are hesitant to discuss… many people worry about feeling…many people have concerns about…”
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Purpose and statements:
to identify sexual dysfunction – |
“most people have difficulties sometime during their sexual relationships. what have yours been?”
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Purpose and statements:
-to obtain information – |
“the degree to which unmarried persons have sexual outlets varies considerably. some have sexual partners. some relieve sexual tension through masturbation. others need no outlet at all. what has been your pattern”
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Purpose and statements:
to identify sexual myths – |
“while growing up, most of us have heard some sexual myths or half truths that continue to puzzle us. are there any that come to mind”
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Purpose and statements:
to determine whether homosexuality is a source of conflict |
–“what is your attitude toward your homosexual orientation”
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Purpose and statements:
to identify an older person’s concerns about sexual function – |
“many people, as they get older, believe or worry that this signals the end of their sex life. much misinformation continues this myth. what is your understanding about sexuality during the later years? how has the passage of time affected your sexuality (sex life?)”
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Purpose and statements:
to obtain and give information (miscellaneous areas) – |
“frequently people have questions about… what questions do you have about…what would you like to know about…”
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Purpose and statements:
to close the history- |
“is there anything further in the are of sexuality that you would like to bring up now”
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NIC interventions for sexual counseling box 21-2 p489
use of an interactive helping process focusing on the need to make adjustments in sexual practice or to enhance coping with a sexual event or disorder |
use of an interactive helping process focusing on the need to make adjustments in sexual practice or to enhance coping with a sexual event or disorder
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NIC interventions for sexual counseling box 21-2 p489 -establish a therapeutic relationship based on (2) |
trust and respect
-provide privacy and ensure confidentiality |
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NIC interventions for sexual counseling box 21-2 p489
what should the nurse disucss? |
-discuss the effect of the illness or health situation on sexuality & -discuss the effect of medications on sexuality, as appropriate
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NIC interventions for sexual counseling box 21-2 p489
what should the nurse avoid? |
-avoid displaying aversion to an altered body part
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NIC interventions for sexual counseling box 21-2 p489
what should the nures do reguarding myths about sexual information? |
provide factual information about sexual myths and misinformation that patient may verbalize
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NIC interventions for sexual counseling box 21-2 p489
-include the spouse/sexual partner in the counseling as much as possible true or false |
true
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Health Teaching and Health promotion
-nurses should help pts weigh only the pros of any type of pharmacotherapy true or false |
false, a nurse must weight the pros AND cons
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Health Teaching and Health promotion
-many drugs can cause sexual SE (esp. psychotropic medications) –nurses tend to ignore sexual SE with these meds perhaps in an attempt to promote adherence |
-many drugs can cause sexual SE (esp. psychotropic medications) –nurses tend to ignore sexual SE with these meds perhaps in an attempt to promote adherence
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Health Teaching and Health promotion
-how can the nurse empowers the pts to choose the best course of action and increase their ability to be informed consumers of mental health? services |
-helping pts to evaluate for themselves the benefits vs the risks
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client tells the nurse that he is unable to relax when he gets into bed, so it takes him hours to fall asleep. An appropriate intervention would be to
A) teach the client how to do progressive relaxation. B) advise the client to drink an ounce or two of brandy at bedtime. C) suggest that the client seek a referral for polysomnography. D) point out that reducing stress at work would be advisable. |
A) teach the client how to do progressive relaxation.
Progressive relaxation relaxes muscle groups sequentially and generates a state of pleasant comfort and ease, a natural prelude to sleep. Text page: 476 |
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A client tells the nurse she sleeps poorly every night. She mentions that when she was younger she slept 8 to 10 hours nightly, whereas now she sleeps only 6 or 7 hours and has to take a nap each afternoon. The nurse can assess that the client
A) has a primary sleep disorder. B) is suffering from sleep apnea. C) has an age-related sleep pattern change. D) is displaying signs of sleep deprivation. |
C) has an age-related sleep pattern change.
The older the person gets, the more likely he or she is to have decreased total time sleeping, even though time in bed is increased. REM sleep is also reduced, and wakefulness during the night is increased. Text pages: 463, 464 |
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The nurse responds best to a client's report that, "I just don't sleep more than 5 hours at night" by asking:
A) "Are you aware that some people require less sleep than others?" B) "When did this pattern of sleep start for you?" C) "Do you usually feel rested and alert when you get up?" D) "Are you taking any medication that could affect your sleep?" |
C) "Do you usually feel rested and alert when you get up?"
The most accurate way to determine an individual's sleep requirements is to ask if they feel fully awake and function effectively on the sleep they are getting. Text page: 465 |
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One criteria for the diagnosis of primary insomnia is met when the client reports:
A) "I've actually missed work because I'm too tired to go." B) "I've been diagnosed with depression 2 months ago." C) "I've had problems falling asleep for 3 weeks now." D) "I have these terrible nightmares when I fall asleep." |
A) "I've actually missed work because I'm too tired to go."
" A criteria of DSM-IV-TR for primary insomnia includes a disruption to normal routine as a result of the sleep disturbance. Text page: 466 |
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7. When providing sleep hygiene information to a client reporting difficulty falling asleep, the nurse includes:
A) drinking a small amount of alcohol to relax just before bedtime B) taking a short nap after lunch whenever possible C) keeping the bedroom warm to induce 'coziness'. D) taking a 20 minute walk after dinner |
D) taking a 20 minute walk after dinner
Light, daily exercise often promotes sleep; the exercise should not be done right before bedtime. Text page: 467 |
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A depressed client is likely to report a sleep disorder that includes:
A) frequent awakenings during the night B) nightmares C) difficulty falling asleep D) sleepwalking |
A) frequent awakenings during the night
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Mr. T, a 76-year-old man, comes to the outpatient clinic with the report of difficulty with nighttime sleeping. He states that he is getting enough sleep each day; he takes an afternoon nap every day, but still feels tired. The nurse should help Mr. T understand that
A) an afternoon nap includes a great deal of REM sleep. B) a late afternoon nap does not compensate for a lack of nighttime sleep. C) a noontime nap includes very little REM sleep. D) the elderly always need fewer than 6 hours of sleep each night. |
B) a late afternoon nap does not compensate for a lack of nighttime sleep.
Daytime naps do not compensate for a lack of nighttime sleep. Daytime naps differ in structure from normal nighttime sleeping as a result of a circadian cycle. Text page: 464 |
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A 69-year-old male client is reporting symptomology that suggests REM sleep behavior disorder (RSBD). The nurse is correct in recognizing that this client is at risk for developing:
A) lymphoma B) hypertension C) acute renal failure D) Parkinson's disease |
D) Parkinson's disease
RSBD is seen in elderly males as they begin to develop neurological pathologies such as Parkinson's disease. Text page: 471 |
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When providing possible interventions to promote the safety of a client reporting symptoms of somnambulism, the nurse includes:
A) gating the stairways B) sleeping on a mattress placed on the floor C) regular bedtime dose of a benzodiazepine D) avoiding the use of serotonergic medications |
A) gating the stairways
Somnambulism or sleep walking can result in falls; gating the stairways may minimize that risk. Text page: 471 |
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The most effective nursing intervention regarding the accurate assessment of sleep disorders involves:
A) a sleep diary B) information regarding sleep cycles C) client description of the symptomology D) assessment for substance abuse |
a) sleep diary
Self reported sleep patterns may be biased and so clinical tools such as a sleep diary is helpful in accurately estimating total sleep time. Text page: 473 |
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The nurse appropriately assesses an obese, hypertensive, Type 2 diabetic client when asking:
A) "Do you regularly have nightmares?" B) "Is getting to sleep a problem for you?" C) "Do you snooze when you sleep?" D) "How much sleep do you usually get each night?" |
D
Short sleep duration had been associated with obesity, cardiovascular disease, hypertension and diabetes. Text page: 473 |
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The most beneficial nursing intervention directed towards minimizing the discomfort associated with conducting a sexually focused assessment is to:
A) Assure the client that the responses will be kept confidential B) Provide the client with a rationale for asking the questions C) Begin with the most relevant, non-personal question D) Project a relaxed, causal demeanor when questioning the client |
B) Provide the client with a rationale for asking the questions
Letting the client know why the questions are being asked increases openness and cooperation. Test page: 486 |
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The initial task of an outpatient clinic nurse working with a client who has a sexual disorder is to
A) establish trust with the client. B) explain the process to report illegal activities as the client reports them. C) explain that the nurse is a therapeutic agent. D) orient the client to the clinic's opportunities that he may use as part of his therapy. |
A) establish trust with the client.
The initial task of working with any client is to establish trust. Text page: 486 |