Question 1

An adolescent exhibits mild depressive symptoms and tells the primary care
pediatric nurse practitioner that he is most concerned about difficulty falling and staying asleep. The adolescent does not want to take medication to treat the depressive symptoms. What will the nurse practitioner recommend?
A. A program of sleep hygiene and gradual sleep extension
B. A sedativenarcotic will help both sleep and depression
C. Cognitive therapy can help the adolescent to sleep better
D. Using an antidepressant will improve sleep patterns

Accepted Answer

The nurse practitioner should recommend a program of sleep hygiene and gradual sleep extension. This approach does not involve medication and can address the adolescent's primary concern of difficulty falling and staying asleep. Additionally, improving sleep hygiene and extending sleep duration may also have a positive effect on the adolescent's mild depressive symptoms.

Question 2

The primary care pediatric nurse practitioner is counseling the parents of a
toddler about sleep. The parents report that the toddler has recently begun resisting sleep and is often more irritable during the day. What will the nurse practitioner recommend?
A. Cosleeping with the child to help alleviate possible nighttime fears
B. Referral to a sleep disorders clinic for evaluation of sleepdisordered breathing
C. Reintroducing a second, morning nap time to compensate for lost sleep
D. Understanding that sleep resistance is a common developmental problem

Accepted Answer

The nurse practitioner should inform the parent that sleep disorders at this age can have long-term impacts on learning. It is important to address sleep issues early on to prevent future problems. It is not accurate to state that most sleep disorders are benign and will be outgrown, as some may require intervention. It is also not accurate to assume that sleep disorders are solely symptomatic of underlying behavior problems, as they can result from a variety of factors. Finally, suggesting longer daytime naps to compensate for lost sleep does not address the underlying issue of sleep disorders and may not be an appropriate solution.

Question 3

The primary care pediatric nurse practitioner is performing a well baby
examination on a 2weekold infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent to keep a sleep log and will teach the parent that which amount of sleep per day is optimal for this infant?
A. 10 to 12 hours
B. 12 to 15 hours
C. 15 to 18 hours
D. 18 to 20 hours

15 to 18 hours

Accepted Answer

Newborn infants typically need 15 to 18 hours of sleep per day. It is important for the parent to keep track of the infant's sleep patterns to ensure they are getting enough sleep.

Question 4

The parent of a 3&#173;year&#173;old child tells the primary care pediatric nurse&#10;practitioner that after falling asleep in the living room and being awakened to go to bed one evening, the child appeared confused and disoriented for a period of time. What will the nurse practitioner counsel this parent?&#10;A. That if this occurs again, to question the child about nightmares&#10;B. That this is a sign of sleep walking and could be dangerous&#10;C. That this is a type of sleep terror which will resolve over time&#10;D. That this is probably a benign, temporary type of a sleep disorder

Accepted Answer

Based on the information provided by the parent, the child's confusion and disorientation were likely due to a normal, temporary type of sleep disorder called sleep inertia. This occurs when someone is awakened during a deep stage of sleep and may experience grogginess and confusion for a short time afterward. The nurse practitioner should reassure the parent that this is a common and usually harmless occurrence.

Question 5

During a well child examination, the primary care pediatric nurse practitioner
learns that a 5yearold child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with open eyes, and saying things that don't make sense. What will the nurse practitioner recommend?
A. Establishing a graduated extinction program and good sleep hygiene
B. Making sure that stairs are blocked and doors are locked
C. Referral to a sleep disorder clinic for evaluation of a parasomnia
D. To awaken the child when these occur and asking about nightmares

Accepted Answer

The answer of During a well child examination, the primary...

Question 6

The primary care pediatric nurse practitioner is performing a well child
examination on a 4yearold child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent?
A. Most sleep disorders are benign and will be outgrown.
B. Sleep disorders are symptomatic of underlying behavior problems.
C. Sleep disorders at this age can have longterm impacts on learning.
D. The child will need longer daytime naps to compensate for lost sleep.

Sleep disorders at this age can have longterm impacts on learning.

Accepted Answer

It is common for toddlers to resist sleep as they explore and are curious about their surroundings. The nurse practitioner can educate the parents about normal sleep patterns in toddlers and provide strategies for creating a consistent bedtime routine. Co-sleeping may not be the best option as it can create dependency and disrupt the parents' own sleep. Referral to a sleep disorders clinic may be necessary if there are other concerning symptoms or behaviors present. Reintroducing a morning nap may not be helpful if the child is already resisting sleep at night.

Question 7

The parent of a school&#173;age child tells the primary care pediatric nurse&#10;practitioner that the child is restless most nights and complains often that bugs are in the bed. After consultation with a sleep disorder specialist and subsequent evaluation of a ferritin level of 30, the nurse practitioner may expect to treat this child with&#10;A. clonazepam.&#10;B. ferrous sulfate.&#10;C. gabapentin.&#10;D. sertraline.

Accepted Answer

The child's restless nights and complaints of bugs in the bed may be symptoms of restless legs syndrome (RLS), which can be associated with low ferritin levels. Ferrous sulfate is an iron supplement that can help increase ferritin levels and improve RLS symptoms. Clonazepam, gabapentin, and sertraline are not typically used to treat RLS.

Question 8

The parent of a school&#173;age child who is overweight tells the primary care&#10;pediatric nurse practitioner that the child seems to crave high&#173;calorie, high&#173;carbohydrate foods, even when full. The nurse practitioner learns that the child is often irritable and sleepy at school in spite of sleeping 9 or 10 hours each night. What will the nurse practitioner recommend?&#10;A. Assessment of leptin and ghrelin hormone levels&#10;B. Consultation with a dietician to develop an appropriate diet&#10;C. Referral to a sleep disorder clinic for a sleep study&#10;D. Taking one or two naps each day to increase the amount of sleep

Accepted Answer

The answer of The parent of a school&#173;age child who...

Question 9

The primary care pediatric nurse practitioner is performing a well child
examination on a 4yearold child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent?
A. Most sleep disorders are benign and will be outgrown.
B. Sleep disorders are symptomatic of underlying behavior problems.
C. Sleep disorders at this age can have longterm impacts on learning.
D. The child will need longer daytime naps to compensate for lost sleep.

Accepted Answer

Bed-sharing with infants greatly increases the risk of SIDS. Breastfeeding has been shown to reduce the risk of SIDS. There is no evidence that infants who attend day care have a higher incidence of SIDS. Immunization has not been linked to an increased risk of SIDS.

Question 10

The parent of a 3&#173;year&#173;old child tells the primary care pediatric nurse&#10;practitioner that the child has never been able to fall asleep without a parent in the room. The child has a new sibling and the parent is concerned that the toddler's cries will awaken the infant. What will the nurse practitioner counsel the parent?&#10;A. Leaving the room as the child is falling asleep and returning at intervals to check on the child&#10;B. Offering a reward for each night the child falls asleep without the parent in the room&#10;C. Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors&#10;D. Taking away a favorite activity or video for each night the child fusses about the parent not being in the room

Accepted Answer

The most appropriate intervention in this scenario is to gradually decrease parental presence during sleep time. One evidence-based method to do this is the "gradual extinction" technique, which involves leaving the child in their bed and gradually increasing the amount of time the parent is out of the room. The parent should return at intervals to check on the child, but not give attention or comfort beyond brief reassurance. This technique has been found to be effective in reducing sleep onset delay and night waking in young children. It is important to note that punishing the child (such as with removing a favorite activity) for sleep interfering behaviors is not recommended and may only exacerbate the issue.

Question 11

The parent of a 4&#173;year&#173;old who has difficulty initiating and maintaining sleep&#10;has tried several nonpharmacological methods with variable success and asks about medications. What will the primary care pediatric nurse practitioner recommend?&#10;A. Diphenhydramine&#10;B. Lorazepam&#10;C. Melatonin&#10;D. Zolpidem

Accepted Answer

The answer of The parent of a 4&#173;year&#173;old who has...

Question 12

A child with Down syndrome who has sleepdisordered breathing with
obstructive sleep apnea continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse practitioner will refer the child to a sleep disorder clinic to discuss which therapy?
A. Craniofacial surgery
B. Oral appliances
C. Positive airway pressure therapy
D. Supplemental oxygen

Accepted Answer

The answer of A child with Down syndrome who has...

Deck 14: Sleep and Rest