Gerontologic Nursing 5th Edition By Sue E. Meiner – Test Bank

Chapter 11: Sleep and Activity
Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. A patient reports to the nurse that he seems to be sleeping less at night but now regularly requires at least two short naps a day. He expresses a concern that “something is wrong.” The nurse responds that:
a. “Aging alters our sleep patterns, so what you describe is really quite common.”
b. “Circadian sleep rhythms are controlled by the hypothalamus, which is affected by age.”
c. “Sleep patterns are affected by so many things; have you been under a lot of stress lately?”
d. “Can you be more specific about what you think is wrong with your sleep pattern?”

ANS: A
The decrease in nighttime sleep and the increase in daytime napping that accompanies normal aging may result from changes in the circadian aspect of sleep regulation.

DIF: Understanding (Comprehension) REF: Page 203-4 OBJ: 11-1
TOP: Teaching-Learning MSC: Physiologic Integrity

2. What is the best bedtime snack for older adult patients with failure to thrive and insomnia?
a. Ice cream in a waffle cone
b. Bowl of grapes
c. Glass of milk and a macaroon cookie
d. Cup of cream of broccoli and cheese soup

ANS: D
This patient will benefit from a snack that includes protein and is warm while not providing excessive liquids.

DIF: Remembering (Knowledge) REF: Page 206 OBJ: 11-1
TOP: Nursing Process: Implementation MSC: Physiologic Integrity

3. An older patient is being admitted to an acute care unit after surgical repair of a fractured tibia. To minimize any negative factors affecting the patient’s ability to sleep, the nurse’s initial intervention is to:
a. be sure postoperative pain is being well managed.
b. manipulate the environment to manage light and noise.
c. plan care to minimize the number of times the patient is disturbed.
d. ask the patient about usual sleeping habits.

ANS: D
Nurses can promote sleep by first assessing the patient’s usual sleep habits and satisfaction with sleep. Managing postoperative pain, minimizing environmental stimuli, and encouraging undisturbed rest are also important, but the first step in the nursing process is assessment.

DIF: Applying (Application) REF: N/A OBJ: 11-3
TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. A confused older patient has been hospitalized for a cardiac problem that requires both antihypertensive and diuretic therapies. The nurse minimizes the patient’s risk of disturbed sleep by:
a. keeping the door shut so noise from the hallway is not disruptive.
b. organizing care to minimize the number of times the patient is awakened.
c. administering medications at least 4 hours before bedtime.
d. offering to toilet the patient whenever the nurse finds the patient awake during the night.

ANS: C
The diuretic is likely to cause the patient to urinate frequently during the night if not administered appropriately. Because the patient is confused, the door should be left open. Clustering cares is a good idea to promote sleep but is not the most important for this patient. Offering to assist the patient to the bathroom when awake is also a good idea, but it is preferable to decrease the number of times the patient is awake.

DIF: Applying (Application) REF: N/A OBJ: 11-3
TOP: Nursing Process: Implementation MSC: Physiologic Integrity

5. An older frail adult patient has begun displaying symptoms of sleep disturbance while being hospitalized. Since these symptoms were observed, the nurse has arranged for a bed alarm to be placed near the patient because:
a. lack of adequate sleep can result in delirium.
b. the patient has difficulty using the call light.
c. lack of sleep make the patient at risk for falls.
d. the patient will remember not to get out of bed.

ANS: A
One consequence of lack of sleep for elders is delirium; the bed alarm is an intervention often used to alert staff when a patient is likely to make an ill-advised attempt at getting out of bed. The patient may or may not be able to use the call light. The risk of falling increases with delirium. The alarm may or may not remind the patient not to get out of bed, but it will alert the staff to go into the room.

DIF: Applying (Application) REF: N/A OBJ: 11-3
TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

6. An older patient reports that sleep was being severely affected by the need to urinate frequently. The patient states he has begun restricting his fluid intake after 5 PM to help with the problem. The nurse responds:
a. “Have you seen a decrease in waking up since you cut back on fluids?”
b. “You need sufficient fluids, so don’t be too restrictive.”
c. “You need the same amount over 24 hours, so drink enough by dinnertime.”
d. “Have you had your prostate checked by your health care provider?”

ANS: C
It is important that older adults, who as a group are at risk for inadequate fluid intake and dehydration, not reduce the total amount of liquids drunk in 24 hours. This is a common issue in the older population, so the nurse educates the patient on the amount of fluid he or she needs in a 24-hour period. Telling the patient “don’t be too restrictive” does not give the patient information to make an informed decision on fluids. The other two questions are good assessment questions, but physiologic safety and maintenance are more important.

DIF: Understanding (Comprehension) REF: Page 206 OBJ: 11-7
TOP: Teaching-Learning MSC: Health Promotion

7. An older patient being treated for symptoms of seasonal allergies reports to the nurse that although she is careful about her caffeine intake, she has been having trouble getting to sleep at night. The nurse responds most appropriately to this patient when stating:
a. “Allergy reactions such as nasal stuffiness can cause sleep problems.”
b. “If you are using over-the-counter nasal decongestants, that could be the problem.”
c. “Many different foods contain hidden caffeine; be sure to check the labels.”
d. “There are many different causes of sleep disturbances besides caffeine intake.”

ANS: B
Over-the-counter medications that interfere with sleep include nasal decongestants containing amphetamine-like substances. This is most important for this patient who has allergies. Food labels do not always contain information on caffeine. Although there are different causes of sleep disturbances, this options does not really give the patient useful information.

DIF: Understanding (Comprehension) REF: Page 207 OBJ: 11-3
TOP: Teaching-Learning MSC: Physiologic Integrity

8. The daughter of an older cognitively impaired patient responds to the nurse’s suggestion to keep her father physically active by stating, “Dad is so easily agitated it would be a major battle to take him on a walk.” The nurse’s initial response is based on the understanding that:
a. caregivers are often overwhelmed by the challenges of caring for such patients.
b. physical exercise has been proven helpful in managing anger in such patients.
c. exercise such as walking is likely to appeal to patients such as her father.
d. her father’s general health and wellness will be positively affected by walking.

ANS: B
Physical exercise for the older adult with dementia is important for general physical well-being, but for this patient exercise may also reduce agitation. Exercise may also cause fatigue, leading to better sleep.

DIF: Understanding (Comprehension) REF: Page 211| Page 213
OBJ: 11-9 TOP: Teaching-Learning MSC: Physiologic Integrity

9. The nurse is preparing to instruct a family member regarding how to appropriately assist a 76-year-old patient incorporate a healthy daily walk into the family’s routine. The nurse includes a suggestion that:
a. a 30-minute walk after dinner is the best form of exercise for someone that age.
b. if the patient appears to be having difficulty talking while walking, it is time to stop.
c. the patient should be encouraged to walk a few feet farther each evening.
d. the family member selects a flat, easily accessible walking path to follow.

ANS: B
To measure the appropriate intensity while walking for exercise, many apply the “talk test”: the person exercising should be able to carry on a conversation while walking. Breathing may be slightly labored, but a conversation should still be possible. The walker should not be out of breath. The other suggestions may or may not be appropriate for individual patients.

DIF: Understanding (Comprehension) REF: Page 213 OBJ: 11-9
TOP: Teaching-Learning MSC: Health Promotion

10. An older adult patient who has been seen at a neighborhood clinic for years tells the nurse that he will be moving to live with his son in a neighboring state. The nurse impacts the patient’s health and wellness the most therapeutically when stating:
a. “Be sure to reestablish with a health care provider as soon as you get settled.”
b. “You seem to have a good relationship with your son; I’m sure this will be a good move.”
c. “You need to continue to be compliant with your plan of care regardless of where you live.”
d. “Moving often causes temporary sleep disturbances, so stick to your evening routine.”

ANS: D
Relocation often causes sleep disturbances as the person adjusts to a new environment. Maintaining an established evening routine will help the patient sleep better. The other statements do not affect sleep.

DIF: Understanding (Comprehension) REF: Page 205 OBJ: 11-7
TOP: Teaching-Learning MSC: Health Promotion