Chapter 16 - Pain Management, Comfort, Rest And Sleep
From Foundations of Nursing (6th edition) by Christensen and Kockrow, pages 394-415. For any question, email arnoldjr2@gmail. Com
- 1.
Singultus
- A.
Dyspnea
- B.
Hiccups
- C.
Flatus
- D.
Thirst
Correct Answer
B. HiccupsExplanation
p. 394Rate this question:
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- 2.
What does it mean to give comfort to a patient? Select all that apply:
- A.
Give strength and hope
- B.
To cheer
- C.
To ease the grief, pain or trouble of another
- D.
To provide all pain medication as the patient requests
Correct Answer(s)
A. Give strength and hope
B. To cheer
C. To ease the grief, pain or trouble of anotherExplanation
p. 394Rate this question:
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- 3.
The Nature of Pain. Select all that apply:
- A.
It is a complex, abstract, personal subjective experience
- B.
An unpleasant sensation caused by noxious stimulation of the sensory nerve endings
- C.
A cardinal symptom of inflammation
- D.
Pain is whatever the person says it is, existing whatever he says it does
- E.
Both the person in pain and the health care professional are experts about the pain
Correct Answer(s)
A. It is a complex, abstract, personal subjective experience
B. An unpleasant sensation caused by noxious stimulation of the sensory nerve endings
C. A cardinal symptom of inflammation
D. Pain is whatever the person says it is, existing whatever he says it doesExplanation
p. 395 - Only the person with pain, AND NOT THE HEALTH CARE PROFESSIONAL, is the expert about the pain: its onset, duration, location, intensity, quality, and pattern as well as the degree of pain relief obtained from therapyRate this question:
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- 4.
Behavioral characteristics of Patients in Pain. Select all that apply:
- A.
Self protective and has a narrow focus; withdraws from social contacts and impairs thought processes
- B.
Demonstrates distraction behavior: moaning, rocking, crying, pacing, restlessness or seeking out other people
- C.
Presents facial mask of pain; eyes that are dull, teeth clenched
- D.
Alterations in muscle tone, diaphoresis, changes in blood pressure and pulse
- E.
Displays perky, manic obsessive mood swings
Correct Answer(s)
A. Self protective and has a narrow focus; withdraws from social contacts and impairs thought processes
B. Demonstrates distraction behavior: moaning, rocking, crying, pacing, restlessness or seeking out other people
C. Presents facial mask of pain; eyes that are dull, teeth clenched
D. Alterations in muscle tone, diapHoresis, changes in blood pressure and pulseExplanation
p. 395Rate this question:
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- 5.
Definition of pain according to the American Pain society:
- A.
An unpleasant tactile and sentimental experience associated with the entrance of pathogens that causes a disrupted homeostasis
- B.
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
- C.
An unpleasant epidermal experience characterized by blisters and purulence which disrupts the balance of electrolytes.
- D.
A chaotic humoral experience that creates physiological disturbances and disorders
Correct Answer
B. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damageExplanation
p. 395Rate this question:
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- 6.
Pain is determined by tissue damage alone
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
p. 395 - Pain is not determined by tissue damage alone. No predictable relationship exists between identifiable tissue injury and the sensation of pain.Rate this question:
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- 7.
Suggests that pain impulses are regulated and blocked by mechanisms located along the CNS. The proposed location of this theory is in the dorsal horn of the spinal cord. Pain and other sensations of the skin and muscles travel the same pathways through the large nerves in the spinal cord.
- A.
Gate theory
- B.
Open impulse theory
- C.
Window Theory
- D.
Shutter theory
Correct Answer
A. Gate theoryExplanation
p. 396Rate this question:
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- 8.
Morphine-like substances composed of amino acids found in the pituitary gland and other areas of the CNS.
- A.
Adrenaline
- B.
Endorphins
- C.
Epinephrine
- D.
Corticosteroid
Correct Answer
B. EndorpHinsExplanation
p. 396Rate this question:
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- 9.
How does the "gate theory" explain the prevention or elimination of pain?
- A.
The stimuli for pain is shut off when chemical elements stimulate the gates that trigger pain receptors
- B.
When gates are closed, pain impulses are blocked. Sensory impulses such as back rub, heat of a warm compress, cold ice applications, will close the gates to painful stimuli because they are distracting the brain from interpreting a painful stimuli
- C.
The gate theory explains that pain is reduced because the compensatory mechanisms of the CNS emulates analgesia
- D.
The "gate theory" proposes that for every painful sensation, there is a defense mechanism the shuts off further transmission of pain
Correct Answer
B. When gates are closed, pain impulses are blocked. Sensory impulses such as back rub, heat of a warm compress, cold ice applications, will close the gates to painful stimuli because they are distracting the brain from interpreting a painful stimuliExplanation
p. 396Rate this question:
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- 10.
How do endorphins work to eliminate pain?
- A.
Endorphins are chemical substances directly responsible for shutting down the gates that simulate pain
- B.
Endorphins block sensory sites for pain
- C.
Endorphins are elements that take away sensation, therefore they take away pain
- D.
Stress and pain activate endorphins. Analgesia results when certain endorphins attach to opioid receptor sites in the brain and prevent the release of neurotransmitters, thereby inhibiting the transmission of pain impulses
Correct Answer
D. Stress and pain activate endorpHins. Analgesia results when certain endorpHins attach to opioid receptor sites in the brain and prevent the release of neurotransmitters, thereby inhibiting the transmission of pain impulsesExplanation
p. 396Rate this question:
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- 11.
The following are Joint Commission Standards about pain. Select all that are true:
- A.
Patients have the right to an appropriate assessment.
- B.
Patients will be treated for pain or referred for treatment
- C.
Patients do not need to be involved in making care decisions
- D.
Discharge planning and teaching will include continuing care based on the patient's needs at the time of discharge, including the need for pain management
- E.
Patients will be taught that pain management is part of treatment
Correct Answer(s)
A. Patients have the right to an appropriate assessment.
B. Patients will be treated for pain or referred for treatment
D. Discharge planning and teaching will include continuing care based on the patient's needs at the time of discharge, including the need for pain management
E. Patients will be taught that pain management is part of treatmentExplanation
p. 397 - Patients will be involved in making care decisionsRate this question:
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- 12.
Which of the following does NOT form part of the essential message about pain assessment
- A.
Ask patients about their pain, then respect and accept what they say.
- B.
Intervene to relieve their pain and ask them again about their pain.
- C.
Pain assessment is a linear task of assessment, intervention, and reassessment
- D.
Without assessment of the patient's pain, none of the pain relief measurement will be useful
Correct Answer
C. Pain assessment is a linear task of assessment, intervention, and reassessmentExplanation
p. 398 - Pain assessment is a circular task of assessment, intervention, and reassessmentRate this question:
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- 13.
Physical effects of unrelieved pain. Select all that apply:
- A.
Increased oxygen demand
- B.
Respiratory dysfunction,
- C.
Decreased GI motility, Anxiety, Depression, Irritability
- D.
Confusion, depressed immune response
- E.
Irrational exuberance
Correct Answer(s)
A. Increased oxygen demand
B. Respiratory dysfunction,
C. Decreased GI motility, Anxiety, Depression, Irritability
D. Confusion, depressed immune responseExplanation
p. 398Rate this question:
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- 14.
The following are physical nonpharmacological interventions for pain. Select all that apply:
- A.
Progressive muscle relaxation
- B.
Biofeedback
- C.
Transcutaneous electric nerve stimulation
- D.
Heat or cold application
- E.
Massage
Correct Answer(s)
A. Progressive muscle relaxation
C. Transcutaneous electric nerve stimulation
D. Heat or cold application
E. MassageExplanation
p. 399, Biofeedback is a psychological and cognitive interventionRate this question:
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- 15.
The following are psychological and cognitive interventions for pain. Which one of them is not?
- A.
TENS
- B.
Music
- C.
Biofeedback
- D.
Imagery
- E.
Education
Correct Answer
A. TENSExplanation
p. 399Rate this question:
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- 16.
A pocket sized, battery-operated device that provides a continuous, mild electric current to the skin via electrodes that re attached to a stimulator by flexible wires. Typically used for patients suffering post-operative or chronic pain.
- A.
PCA
- B.
WMA
- C.
TENS
- D.
SKG
Correct Answer
C. TENSExplanation
p. 399Rate this question:
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- 17.
Reasons why pain is oftentimes pharmacologically undertreated . Select all that apply:
- A.
Misunderstanding or insufficient knowledge of pharmacologic principles
- B.
The after taste is unbearable
- C.
Anxiety over administering too large a dose of an opioid analgesic
- D.
The cost is not affordable
- E.
Concerns about addiction
Correct Answer(s)
A. Misunderstanding or insufficient knowledge of pHarmacologic principles
C. Anxiety over administering too large a dose of an opioid analgesic
E. Concerns about addictionExplanation
p. 399Rate this question:
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- 18.
Most widely available and frequently used non-opioid analgesic group for mild to moderate pain
- A.
Acetaminophen (Tylenol)
- B.
Anesthetics
- C.
Anticonvulsives
- D.
Nonsteroidal anti-inflammatory drugs
Correct Answer(s)
A. AcetaminopHen (Tylenol)
D. Nonsteroidal anti-inflammatory drugsExplanation
p. 399Rate this question:
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- 19.
Examples of over the counter NSAID's. Select all that apply
- A.
Aspirin
- B.
Ibuprofen ( Advil, Motrin, Nuprin)
- C.
Bacitricin
- D.
Naproxen sodium (Aleve)
Correct Answer(s)
A. Aspirin
B. Ibuprofen ( Advil, Motrin, Nuprin)
D. Naproxen sodium (Aleve)Explanation
p. 399Rate this question:
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- 20.
Maximum recommended dosage of acetaminophen
- A.
4000 mg (4 g) in 24 hours
- B.
2000 mg (2 g) in 24 hours
- C.
3000 mg (3 g) in 12 hours
- D.
1000 mg (1 g) in 1 hours
Correct Answer
A. 4000 mg (4 g) in 24 hoursExplanation
p. 399Rate this question:
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- 21.
It blocks the pain impulses in the CNS and reduces inflammation
- A.
Penicillin
- B.
Aspirin
- C.
Bengay
- D.
Salonpas
Correct Answer
B. AspirinExplanation
p. 399Rate this question:
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- 22.
A group of analgesics that can pose the risk of gastrointestinal (GI) bleeding
- A.
Mono-Amine Oxidase Inhibitors
- B.
NSAIDs
- C.
ACE Inhibitors
- D.
Beta Blockers
Correct Answer
B. NSAIDsExplanation
p. 399Rate this question:
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- 23.
Examples of Opioid. Select all that apply
- A.
Hydromorphone (Dilaudid)
- B.
Meperidine (Demerol)
- C.
Morphine
- D.
Viagra
- E.
Fentanyl (Actiq, Duragesic)
Correct Answer(s)
A. HydromorpHone (Dilaudid)
B. Meperidine (Demerol)
C. MorpHine
E. Fentanyl (Actiq, Duragesic)Explanation
p. 400Rate this question:
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- 24.
Formerly called narcotics, they decrease the perception of pain by binding to pain receptor sites in the CNS. They are considered the cornerstone or gold standards for managing moderate to severe acute pain.
- A.
Proton Pump Inhibitors
- B.
Nonsteroidal anti-inflammatory drugs
- C.
Opioid analgesics
- D.
Monoamine oxidase inhibitors
Correct Answer
C. Opioid analgesicsExplanation
p. 400Rate this question:
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- 25.
The standard agent for opioid therapy, although it could compromise renal function
- A.
Morphine
- B.
Benzodiazepine
- C.
Sedatives
- D.
Benadryl
Correct Answer
A. MorpHineExplanation
p. 400Rate this question:
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- 26.
The danger of morphine and other opioid analgesics is their potential to cause ______________ of vital nervous system functions. Most significantly, opiates cause ____________ depression by depressing the __________ center of the brain stem.
- A.
Depression, respiratory, respiratory
- B.
Inflammation, gastric, temporal
- C.
Atrophy, pulmonary, respiratory
- D.
Malfunction, respiratory, parasympathetic
Correct Answer
A. Depression, respiratory, respiratoryExplanation
p. 400Rate this question:
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- 27.
Based on studies of IV and epidural administration routes for opioid, what is the likelihood of a clinically significant opioid-induced respiratory depression?
- A.
Less than 1%
- B.
Less than 5% but more than 1%
- C.
More than 5% but less than 10%
- D.
Between 1% and 2%
Correct Answer
A. Less than 1%Explanation
page 400Rate this question:
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- 28.
Because of its potential for producing seizures, it is no longer the drug of choice for pain management
- A.
Antitussive (Cordex)
- B.
Acetaminophen (Tylenol)
- C.
Meperidine (Demerol)
- D.
Antiemetic (Vomitus)
Correct Answer
C. Meperidine (Demerol)Explanation
p. 400Rate this question:
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- 29.
Meperidine administration is contraindicated against what? Select all that apply:
- A.
Monoamine oxidase inhibitors
- B.
Untreated hypothyroidism
- C.
Addison's disease
- D.
BPH, urethral structure
- E.
COPD
Correct Answer(s)
A. Monoamine oxidase inhibitors
B. Untreated hypothyroidism
C. Addison's disease
D. BpH, urethral structureExplanation
p. 400Rate this question:
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- 30.
The following are certain considerations needed when providing pain medication to an older adult. Select all that apply:
- A.
Changes n peripheral vascular function and skin as well as decreased transmission of pain impulses place the older adult at risk for being unable to sense pain
- B.
The effects of aging on the pain process re sometimes compounded in an older adult who has a chronic illness that affects the nervous system
- C.
The risk for gastric and renal toxicity from NSAIDs is increased in older adults
- D.
Meperidine is an ideal choice for pain control in the older adult
Correct Answer(s)
A. Changes n peripHeral vascular function and skin as well as decreased transmission of pain impulses place the older adult at risk for being unable to sense pain
B. The effects of aging on the pain process re sometimes compounded in an older adult who has a chronic illness that affects the nervous system
C. The risk for gastric and renal toxicity from NSAIDs is increased in older adultsExplanation
p. 400 Meperidine is a particularly poor choice for pain control in the older adult because of diminished renal functionRate this question:
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- 31.
Side effects of Opioid therapy. Select all that apply
- A.
Delays gastric emptying, slows bowel motility and decreases peristalsis
- B.
Reduces secretions from colonic mucosa
- C.
Gastrointestinal dysfunction can result in ileus, fecal impaction, and obstruction
- D.
Loose bowel movement is the most common side effect of opioids and the only one for which individuals develop tolerance
Correct Answer(s)
A. Delays gastric emptying, slows bowel motility and decreases peristalsis
B. Reduces secretions from colonic mucosa
C. Gastrointestinal dysfunction can result in ileus, fecal impaction, and obstructionExplanation
p. 401 - Constipation is the most common side effect of opioids and the only one for which individuals do not develop toleranceRate this question:
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- 32.
An inflammatory mediator released when cells are damaged that sensitizes nerves that carry information about pain. By inhibiting the release of this mediator, the drugs diminish trans mission of pain stimuli
- A.
Leukocytes
- B.
Prostaglandin
- C.
Fibrin
- D.
Platelets
Correct Answer
B. ProstaglandinExplanation
p. 401Rate this question:
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- 33.
An opioid antagonist that blocks or reverses all the actions of an opioid
- A.
Santyl
- B.
Mucomyst
- C.
Naloxone (Narcan)
- D.
Aspirin
Correct Answer
C. Naloxone (Narcan)Explanation
p. 401Rate this question:
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- 34.
Based on the idea that only the patient can feel the pain and only the patient knows how much analgesic will relieve it.
- A.
MAOI
- B.
NSAID
- C.
PCA
- D.
BSP
Correct Answer
C. PCAExplanation
p. 402Rate this question:
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- 35.
Difference between a PCA and a PRN medication
- A.
PCA and PRN are administered according to specific times as prescribed
- B.
PCA is administered by the patient which eliminates wait time for a nurse who usually administers a PRN
- C.
PCA is more effective than a PRN medication
- D.
PRN medication can also be administered by a patient without any supervision
Correct Answer
B. PCA is administered by the patient which eliminates wait time for a nurse who usually administers a PRNExplanation
p. 402Rate this question:
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- 36.
Which of the following statements regarding the use of patient controlled analgesia is not true, inappropriate or not applicable. Select all that apply
- A.
Any patient has the right to use a PCA if so preferred
- B.
Patients with respiratory problems and renal or hepatic complications are ideal candidates for PCA
- C.
PCA should be used by an alert oriented patient and should receive instructions before surgery
- D.
PCA is for patient use only delivered either through bolus dose or continuous infusion
- E.
Instruct patient on the purpose of PCA, operating instructions, lockout intervals, expected pain relief, precautions and potential side effects.
Correct Answer(s)
A. Any patient has the right to use a PCA if so preferred
B. Patients with respiratory problems and renal or hepatic complications are ideal candidates for PCAExplanation
pages 402-403 - Only an alert and oriented patient can use a PCA. He/she also needs to be able to follow instructions.
Patients with respirator complications are at high risk of taking IV Opioids of any type. Patients with renal or hepatic dysfunctions are not suitable for a PCARate this question:
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- 37.
Epidural Analgesia. Select all that apply:
- A.
Epidural medication diffuses slowly from the epidural space across the dura and arachnoid matters membranes into the CSF
- B.
Drugs used for epidural analgesia are morphine, fentanyl, and hydromorphone
- C.
It is an appropriate first-line route for moderate to severe acute pain expected to last for at least 24 hours.
- D.
Epidural analgesia is beneficial for controlling acute pain during labor and for relieving chronic pain, such as that seen in patients with advanced cancer
Correct Answer(s)
A. Epidural medication diffuses slowly from the epidural space across the dura and arachnoid matters membranes into the CSF
B. Drugs used for epidural analgesia are morpHine, fentanyl, and hydromorpHone
C. It is an appropriate first-line route for moderate to severe acute pain expected to last for at least 24 hours.
D. Epidural analgesia is beneficial for controlling acute pain during labor and for relieving chronic pain, such as that seen in patients with advanced cancerExplanation
p. 404Rate this question:
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- 38.
When choosing the right route, which of these are appropriate statements regarding pain medication
- A.
IV and oral routes are preferred; IM and SubQ are best avoided
- B.
IV and oral routes are best avoided; IM and SubQ are preferred
- C.
IV, oral, IM and SubQ are equally preferred
- D.
Oral, IM and SubQ should all be avoided
Correct Answer
A. IV and oral routes are preferred; IM and SubQ are best avoidedExplanation
p. 404Rate this question:
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- 39.
Selecting the Proper medication when more than one is ordered. Mark the statements that are true:
- A.
Use NSAIDs or milder opioids for mild to moderate pain
- B.
Use of NSAIDs can help reduce opioid side effects
- C.
Morphine and Hydromorphone are the opioids of choice for long term management of severe pain
- D.
Injectable medications act more quickly often relieving severe acute pain within an hour. Oral medications take as long as two hours
Correct Answer(s)
A. Use NSAIDs or milder opioids for mild to moderate pain
B. Use of NSAIDs can help reduce opioid side effects
C. MorpHine and HydromorpHone are the opioids of choice for long term management of severe pain
D. Injectable medications act more quickly often relieving severe acute pain within an hour. Oral medications take as long as two hoursExplanation
p. 404 - Older adults should avoid combination of opioidsRate this question:
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- 40.
What is the right time and interval for the administration of pain medication?
- A.
Only before a required wound dressing change or before physical therapy
- B.
Only as needed on a PRN basis according to the MAR
- C.
Do not give analgesics only on "as needed" schedule. An around the clock administration schedule is best
- D.
An hour before or after meal time
Correct Answer
C. Do not give analgesics only on "as needed" schedule. An around the clock administration schedule is bestExplanation
p. 404Rate this question:
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- 41.
What is the principle of effective pain management?
- A.
Failure to treat pain is patient abandonment. Every patient has the right to cure his pain
- B.
Failure to treat pain is inhumane and constitutes professional negligence. Every patient has the right to be free of pain.
- C.
Failure to treat pain is a violation against the patient's bill of rights. The patient has the right for a proper litigation
- D.
Failure to treat pain is against agency policy. The nurse may be terminated from employment for not doing so
Correct Answer
B. Failure to treat pain is inhumane and constitutes professional negligence. Every patient has the right to be free of pain.Explanation
p. 404Rate this question:
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- 42.
"Patient indicates improved pain relief within 1 hour of implementation of pain management techniques." Which part of the nursing process and/or care plan is this statement?
- A.
Patient Goals
- B.
Evaluation
- C.
Expected Outcomes
- D.
Nursing Interventions
Correct Answer
B. EvaluationExplanation
p. 406Rate this question:
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- 43.
"Chronic pain related to joint and muscle inflammation manifested by complaints of discomfort, anorexia, loss of focus and social withdrawal". What part of the nursing care plan is this statement?
- A.
Nursing Intervention
- B.
Nursing Diagnosis
- C.
Patient Goals and Expected Outcome
- D.
Evaluation
Correct Answer
B. Nursing DiagnosisExplanation
p. 406Rate this question:
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- 44.
Which of the following are pain rating scales? Select all that apply
- A.
Visual analog
- B.
Numerical
- C.
FACES
- D.
Braden Scale
- E.
Verbal Descriptive
Correct Answer(s)
A. Visual analog
B. Numerical
C. FACES
E. Verbal DescriptiveExplanation
p. 407Rate this question:
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- 45.
Which of the following are objective signs of pain? Select all that apply
- A.
Increased pulse rate, increased depth and frequency of respiration
- B.
Diaphoresis and Pallor, Nausea and vomiting (with severe pain)
- C.
Increased Blood Pressure
- D.
Dilated pupils, Muscle tension
- E.
Urticaria and Pruritus
Correct Answer(s)
A. Increased pulse rate, increased depth and frequency of respiration
B. DiapHoresis and Pallor, Nausea and vomiting (with severe pain)
C. Increased Blood Pressure
D. Dilated pupils, Muscle tensionExplanation
p. 408Rate this question:
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- 46.
Behavioral signs of pain. Select all that apply
- A.
Frowning, grimacing
- B.
Clenched teeth and clenched fist
- C.
Crying and Moaning
- D.
Muscular spasms
- E.
Rigid body position and restlessness
Correct Answer(s)
A. Frowning, grimacing
B. Clenched teeth and clenched fist
C. Crying and Moaning
E. Rigid body position and restlessnessExplanation
p. 408Rate this question:
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- 47.
Which of the following is not a guideline for individualizing pain therapy
- A.
Use different types of pain relief measures
- B.
Provide pain relief measures before pain becomes severe
- C.
Adapt the best practices on pain healing from different cultures across the board
- D.
Use measures the patient believes are effective
- E.
Consider the patient's ability or willingness to participate in pain relief measures
Correct Answer
C. Adapt the best practices on pain healing from different cultures across the boardExplanation
p. 408Rate this question:
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- 48.
Which of the following are guidelines for individualizing pain therapy? Select all that apply:
- A.
Choose pain relief measures appropriate to the severity of the pain as reflected by the patient's behavior
- B.
If therapy is ineffective at first, encourage the patient to try again before finally giving it up.
- C.
Keep a scientific mind about what has potential to relieve pain only in so far as patient compliance exists.
- D.
Keep trying
- E.
Protect the patient
Correct Answer(s)
A. Choose pain relief measures appropriate to the severity of the pain as reflected by the patient's behavior
B. If therapy is ineffective at first, encourage the patient to try again before finally giving it up.
D. Keep trying
E. Protect the patientExplanation
p. 409 - Keep an open mind about has potential to relieve paintRate this question:
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- 49.
Among older adults, which medication are often taken that takes away sleep? Select all that apply:
- A.
Diuretics
- B.
Antihistamine
- C.
Antitussive
- D.
Theophylline
Correct Answer(s)
A. Diuretics
D. TheopHyllineExplanation
p. 409Rate this question:
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- 50.
Sleep and Rest. Select all that is applicable and true:
- A.
Bed rest does not necessarily mean a patient is resting. Emotional or metabolic stressors naturally cause the patient to be restless
- B.
Sleep is a state of rest that occurs for a sustained period
- C.
The theory that sleep is associated with healing suggests that achieving optimum sleep quality is important for patient's recovery
- D.
The sleep of an older adult is less deep which increases the risk of early awakening and complaints of sleep disturbance.
- E.
Hospitals and other health care facilities are the best places for a person to sleep
Correct Answer(s)
A. Bed rest does not necessarily mean a patient is resting. Emotional or metabolic stressors naturally cause the patient to be restless
B. Sleep is a state of rest that occurs for a sustained period
C. The theory that sleep is associated with healing suggests that achieving optimum sleep quality is important for patient's recovery
D. The sleep of an older adult is less deep which increases the risk of early awakening and complaints of sleep disturbance.Explanation
p. 409 - Hospitals or other health care facilities are quick to disrupt a patient's sleep habits and patternsRate this question:
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