Deck 20: Disorders of Hearing and Vestibular Function

Question 1

Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep?

A) The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping-waking cycles.
B) The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep.
C) The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle.
D) Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.

Answer 1

The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle.

Question 2

A client with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep?

A) "Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake."
B) "While you're obviously less aware of stimuli when you're asleep, your brain is actually more active when you're asleep than when you're awake."
C) "There are four types of brain activity, and actually all of them occur at different stages of sleep."
D) "Your brain alternates between periods of activity and periods of inactivity when you're asleep, and these correspond to your eye movement."

Answer 2

"Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake."

Question 3

Which of the following characteristics describe stage 2 non-REM sleep? Select all that apply.

A) It occurs at the onset of sleep and lasts approximately 7 minutes.
B) During this stage, theta waves are primarily seen on EEG.
C) This stage is known as deep sleep where heart rate and BP are decreased.
D) This stage has interruptions of spindle activity that helps with integration of new memories.
E) Muscles of the body are relaxed.

Answer 3

During this stage, theta waves are primarily seen on EEG.
This stage has interruptions of spindle activity that helps with integration of new memories.

Question 4

Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in REM sleep?

A) Rolling eye movements are observed, and she has moderate muscle activity.
B) Her motor movements are suppressed, and muscle tone is flaccid.
C) Delta waves are evident on her EEG, and the heart and respiration rates are slowed.
D) She has a low level of cerebral activity, and her EEG indicates low voltage and mixed frequencies.

Question 5

The nurse knows that which of the following observations of a client during a sleep study would be most likely considered a pathological finding?

A) The client experiences periods of apnea of 5 to 15 seconds in duration.
B) The client's intrinsic clock involves a sleep-wake cycle that is consistently 2 hours longer than the actual length of a day.
C) ^{The client's PCO}2 ^{level is increased, and his PO}2 ^{level decreased during deep} sleep.
D) The client spends the majority of his sleeping hours in deep REM sleep.

Question 6

Which of the following statements about over-the-counter (OTC) melatonin is accurate?

A) It has received the FDA approval for effectiveness as a sleep aid.
B) Long-term studies of melatonin conclude that it is nonaddicting.
C) It produces phase-shifting changes in the circadian rhythm.
D) Under strict clinical testing, potency and purity of melatonin have been shown to be consistent.

Question 7

When explaining an upcoming test, a polysomnography, the nurse should include which of the following education related to equipment placements the patient will have placed on his or her person during the sleep study? Select all that apply.

A) An ECG with lots of chest leads will monitor heart rate and rhythm.
B) A pulse oximeter placed on a finger is used to determine arterial oxygen saturation.
C) An EOG will be placed on the skin near the eye to record eye movements.
D) An EMG patch will be placed under the chin to record muscle movement.
E) An actigraph device will be placed on the wrists and ankles to measure body motion.

Question 8

The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour at night, as well as extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder?

A) Delayed sleep phase syndrome (DSPS)
B) Non-24-hour sleep-wake syndrome
C) Advanced sleep phase syndrome (ASPS)
D) Chronic insomnia

Question 9

A business traveler has just arrived in Japan from the United States. During a meeting with his customer, he begins to experience yawning and stretching with an inability to stay focused on the meeting. He also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms?

A) Advanced sleep phase syndrome
B) Delayed sleep phase syndrome
C) Free-running sleep disorder
D) Time zone change syndrome

Question 10

Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which of the following manifestations? Select all that apply.

A) Unable to sleep for a long period of time during the day
B) Falling asleep while sitting in front of a computer charting during the night
C) Finding it difficult to sleep when they have a night off
D) Heightened alertness and reflexes on their drive home after work
E) Increased hunger and thirst in the middle of the night

Question 11

An adult client is experiencing chronic insomnia related to a recent divorce and child custody proceedings. The client is requesting a renewable prescription for "sleeping pills." The nurse knows that which of the following interventions listed below will provide the most beneficial treatment for this client?

A) Sedatives and hypnotic drugs will not provide safe relief of the client's health problem.
B) The client is suffering from primary insomnia.
C) Melatonin supplements will be the safest and most effective long-term pharmacological treatment.
D) Behavioral therapies and education regarding sleep hygiene will provide assistance for the client.

Question 12

A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply

A) She repeatedly moves her large toe, ankle, and knee during sleep.
B) She complains of a powerful urge to move her legs when in bed at night.
C) She has frequently awakened unable to move or speak.
D) She believes that she experiences auditory hallucinations when she awakens.
E) Her sleep latency is normally around 1 hour.

Question 13

While working for a neurologist who is assessing a patient experiencing restless legs syndrome (RLS), the nurse should be prepared to answer the question about why the patient needs to have his iron level drawn? The nurse response should include,

A) "Many of the drugs we give for RLS can cause drastic decreases in your iron level."
B) "Many patients with RLS also have an iron deficiency anemia as well."
C) "You just look a little pale, and so we want to make sure you have normal blood levels."
D) "People with low iron levels do not have enough oxygen circulating to their legs."

Question 14

A 57-year-old female has presented to a clinic exasperated by the effect that restless legs syndrome is having on her sleep. The clinician has performed client teaching prior to choosing a treatment plan. Which of the following responses by the client demonstrates a sound understanding of her condition?

A) "Increasing my calcium intake is something simple that might help."
B) "Transcutaneous electrical nerve stimulation might be a treatment that can help me avoid needing drugs for this."
C) "This could be something that I'm simply prone to genetically."
D) "I'll try to get more exercise, since there aren't really any effective medications for restless legs syndrome."

Question 15

Which of the following individuals would be expected to have the highest risk of developing sleep apnea?

A) A woman with restless legs syndrome and chronic obstructive pulmonary disease
B) A male client with a diagnosis of unstable angina and peripheral arterial disease
C) A man with poorly controlled diabetes and hypertension
D) A female with chronic insomnia and atrial fibrillation that is treated with warfarin

Question 16

Which of the following motor disorders of sleep can be life threatening?

A) Narcolepsy
B) Periodic limb movement disorder
C) Obstructive apnea
D) Restless legs syndrome

Question 17

A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns?

A) "This is not an uncommon event that often accompanies older age."
B) "I'll likely prescribe a benzodiazepine for this when I next see your husband."
C) "This is understandably upsetting for you, but as long as the environment is safe, it's likely not significant."
D) "There may be something else going on with your husband such as delirium or a problem with his medications."

Question 18

The nurse is educating the new mother about the sleep patterns of a newborn. Which of the following statements should she include in her education?

A) "Newborns usually sleep approximately 16 to 20 hours/day."
B) "Newborns generally sleep 6 to 8 hours/day and then are awake for 2 to 4 hours."
C) "Don't worry about them sleeping too long; they will wake up when they are hungry."
D) "Most newborns will have their days and nights mixed up."

Question 19

A 5-year-old boy has starting sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the boy about this, he has no recollection. What should the nurse convey to the parents if this happens again?

A) Assist the boy in settling down without awakening him after an episode.
B) Watch him closely to see if he has any twitching or thrashing about.
C) Bring him back to the clinic if this keeps happening, so we can prescribe some sleep medicine.
D) Shake him to wake him up, and then comfort him and put him back in bed.

Question 20

A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following a recent fall resulting in a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? Select all that apply.

A) "I make sure that I take a long nap each afternoon to compensate for my frequent waking at night."
B) "I've got a bottle of diazepam at home, but I only take them once or twice a month."
C) "I try my best to get out for a walk after breakfast or after supper."
D) "I make it a rule not to drink any alcohol in the evening."
E) "Once my head hits the pillow, I am fast asleep."