Factors Affecting Sleep and Rest

Every question here, with the answer

1. A patient reports difficulty falling asleep. The patient drinks four cups of coffee every morning and smokes cigarettes throughout the day up to bedtime. Which habit should the nurse address first as the primary concern for falling asleep?

   1. Adding an alcoholic drink at bedtime
   2. Increasing vigorous exercise immediately before sleep
   3. Stopping all morning coffee as the first priority
   4. Reducing nicotine use close to bedtime

   Answer: Reducing nicotine use close to bedtime

   Both caffeine and nicotine are stimulants, but the timing makes nicotine the priority because this patient uses it up to bedtime. The section specifically identifies nicotine as the primary habit of concern in this type of cue pattern.

2. The nurse is teaching a patient and significant other about a newly prescribed nonbenzodiazepine sleep aid, zolpidem. Which potential side or adverse effects should the nurse include? Select all that apply.

   1. Tolerance and dependence as the main expected effects
   2. Dizziness
   3. Gastrointestinal disturbances such as nausea, vomiting, or diarrhea
   4. Hallucinations or amnesia
   5. Parasomnias such as sleepwalking, sleep driving, or sleep shopping

   Answer: Dizziness, Gastrointestinal disturbances such as nausea, vomiting, or diarrhea, Hallucinations or amnesia, Parasomnias such as sleepwalking, sleep driving, or sleep shopping

   Zolpidem teaching should include potential adverse effects such as dizziness, hallucinations, amnesia, gastrointestinal disturbances, and parasomnias. Tolerance and dependence are discussed in the section as concerns associated with benzodiazepines, not as the listed teaching focus for zolpidem.

3. A parent asks whether diphenhydramine can be used to help an 18-month-old child sleep. Which response by the nurse is best?

   1. “Diphenhydramine commonly causes drowsiness in adults, so it will reliably cause sleepiness in young children.”
   2. “Diphenhydramine is safer for sleep when combined with a natural sleep aid.”
   3. “Diphenhydramine should not be used as a sleep aid for children, and it is not recommended for children under 2 years old for any reason.”
   4. “Diphenhydramine is an appropriate sleep aid for children if it is available over the counter.”

   Answer: “Diphenhydramine should not be used as a sleep aid for children, and it is not recommended for children under 2 years old for any reason.”

   The section warns against using diphenhydramine as a sleep aid for children and states it is not recommended under age 2 for any reason. It may also cause paradoxical excitation in children, so assuming it will reliably cause sleepiness is unsafe.

4. A nurse is assessing sleep habits for a patient who reports daytime sleepiness and poor sleep quality. Which findings related to electronics use may be contributing to the sleep problem? Select all that apply.

   1. The patient views screens right before bed.
   2. The patient reports delayed bedtime due to electronics use.
   3. The patient has difficulty falling asleep after time spent using electronics or social media.
   4. The patient performs moderate exercise five times weekly for thirty minutes each session.
   5. The patient responds to message alerts during the night.

   Answer: The patient views screens right before bed., The patient reports delayed bedtime due to electronics use., The patient has difficulty falling asleep after time spent using electronics or social media., The patient responds to message alerts during the night.

   The section links electronics use, screen exposure, nighttime phone use, delayed bedtime, and social media use with poor sleep quality or difficulty falling asleep. Moderate regular physical activity is described as supportive of sleep rather than a likely contributor to poor sleep.

5. A patient with advanced COPD reports poor-quality sleep. Which sleep-related problem should the nurse anticipate based on this condition?

   1. More restorative sleep due to increased time in REM
   2. Air hunger with frequent awakenings and changes in sleep position
   3. Sleep disruption only when fever or pain is present
   4. Unexpected and sudden daytime sleep episodes as the main feature

   Answer: Air hunger with frequent awakenings and changes in sleep position

   The section states that advanced COPD can affect sleep position and cause air hunger and frequent awakenings. Sudden daytime sleep episodes are associated with narcolepsy, and fever or pain are examples related to infection or pain rather than COPD specifically.

6. A pregnant patient reports waking frequently and having difficulty getting comfortable at night. Which pregnancy-related factors should the nurse recognize as possible contributors? Select all that apply.

   1. More frequent urination
   2. Heartburn or reflux causing wakefulness and position changes
   3. Falling directly into REM sleep for up to eighteen hours a day
   4. Shortness of breath
   5. Difficulty finding a comfortable sleep position

   Answer: More frequent urination, Heartburn or reflux causing wakefulness and position changes, Shortness of breath, Difficulty finding a comfortable sleep position

   Pregnancy-related physical changes can include gastrointestinal discomfort, frequent urination, difficulty finding a comfortable position, and shortness of breath. Falling directly into REM sleep for up to eighteen hours a day describes neonates, not pregnancy.