A nurse is teaching a client about the sleep-wake cycle. The nurse should include that which of the following factors can interfere with the sleep-wake cycle?
Drinking caffeinated beverages in the evening Emotional stress A bright light A 20 min nap during the day A regular bedtime schedule Drinki...
NUR 229 Exam 4 ATI Questions and
Correct Answers
A nurse is teaching a client about the sleep-wake cycle. The nurse should include that
which of the following factors can interfere with the sleep-wake cycle?
Drinking caffeinated beverages in the evening
Emotional stress
A bright light
A 20 min nap during the day
A regular bedtime schedule ✅Drinking caffeinated beverages in the evening is correct.
Caffeine is a stimulant that can interfere with the sleep-wake cycle. The client should
limit caffeine intake to the morning.
Emotional stress is correct. Stress can cause excessive worry that can interfere with the
sleep-wake cvcle. The client should try to perform relaxation activities to reduce stress
and increase sleep.
A bright light is correct. Darkness causes release of melatonin, which promotes sleep.
A 20 min nap during the day is incorrect. Naps should be limited to 20 min or less to
avoid interfering with the sleep-wake cycle.
A regular bedtime schedule is incorrect. A regular bedtime and wake-up schedule
promotes sleep
A nurse is caring for a client who reports abdominal pain. The nurse asks the client to
describe what the pain feels like. The nurse is using which of the following components
of the OLDCART mnemonic?
A. Characterisitics
B. Aggrivating
C. Onset
D. Location ✅Characteristics
Characteristics describe how the pain feels such as dull, achy, sharp, or severity.
A nurse is teaching a class about sleep disorders. The nurse should include that which
of the following conditions can cause obstructive sleep apnea (OSA)?
A. Opioid overdose
B. Brainstem injury
C. Enlarged tonsils
D. Heart failure ✅C. Enlarged tonsils
Enlarged tonsils can cause obstructive sleep apnea
,A nurse is assessing a client for manifestations of pain. Which of the following findings
is an objective indicator of pain?
A. The client states the pain is located on their abdomen.
B. The client rates their pain as an 8 on a scale of 0 to 10.
C. The client reports a burning sensation.
D. The client grimaces when they move. ✅The client grimaces when they move.
Objective indicators of pain are determined by manifestations the nurse can observe or
measure. Grimacing is an objective indicator of pain.
A nurse is assessing a client who received an opioid narcotic for incisional pain. Which
of the following findings is the priority?
A. Pain level
B. Level of sedation
C. Pulse oximetry
D. Blood pressure ✅Pulse oximetry
Using the airway, breathing, circulation framework, the nurse should identify that pulse
oximetry is the priority. The client is at risk for opioid-induced ventilatory impairment or
respiratory depression following an opioid narcotic.
A nurse is caring for a client who reports insomnia. The nurse should monitor the client
for which of the following adverse effects of sleep deprivation?
(Select all that apply.)
Altered taste
Tension headaches
Mood swings
Hyperreflexia
Depression ✅Tension headaches is correct. Sleep deprivation can cause migraine and
tension headaches.
Mood swings is correct. Sleep deprivation can cause mood swings and strokes.
Depression is correct. Sleep deprivation can cause depression and decreased
motivation.
Hyperreflexia is incorrect. Sleep deprivation can cause decreased reflexes and delayed
response time which places the client at risk for accidents.
Altered taste is is incorrect. Sleep deprivation can cause blurred vision.
A nurse is teaching a class about the stages of sleep. The nurse should explain that
vivid dreaming occurs during which of the following stages of sleep?
A. Stage 1
B. Stage 2
C. Stage 3
, D. Stage 4 ✅Stage 4
Stage 4 is the dreaming stage. During stage 4 sleep, there is a loss of skeletal muscle
tone and vivid, color dreams occur.
A nurse is teaching a client about over-the-counter medications used to treat insomnia.
The nurse should include that which of the following is an adverse reaction of
diphenhydramine?
A. Memory loss
B. Dry mouth
C. Hypertension
D. Hallucinations ✅Dry mouth
Diphenhydramine can cause dry mouth, blurred vision, tinnitus, and urinary retention.
The client should rinse their mouth out as needed and perform frequent oral hygiene to
reduce dry mouth.
A nurse is assessing a client for manifestations of pain. Which of the following findings
is a subjective indicator of pain?
A. The client reports a burning sensation.
B. The client is grimacing.
C. The client is restless.
D. The clients pupils are dilated. ✅The client reports a burning sensation.
Subjective indicators of pain are based on the client's report. These can include
location, severity, and characterization of pain.
A nurse is assessing a client who has obstructive sleep apnea (OSA). Which of the
following findings should the nurse expect?
A. Decreased energy
B. Hypotension
C. Pneumonia
D. Thyroid disease ✅Decreased energy
The client who has OSA is at risk for decreased energy and depression.
A nurse is assessing a client who is nonverbal for acute pain. Which of the following
findings is a manifestation of pain?
A. Constricted pupils
B. Decreased heart rate
C. Elevated blood pressure
D. Reduced respiratory rate ✅Elevated blood pressure
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