Deck 14: Sleep and Rest

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

Answer 1

A program of sleep hygiene and gradual sleep extension

Question 2

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.

Answer 2

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

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

Answer 3

15 to 18 hours

Question 4

The parent of a 3­year­old child tells the primary care pediatric nurse
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?
A. That if this occurs again, to question the child about nightmares
B. That this is a sign of sleep walking and could be dangerous
C. That this is a type of sleep terror which will resolve over time
D. That this is probably a benign, temporary type of a sleep disorder

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

Question 6

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

Question 7

The parent of a school­age child tells the primary care pediatric nurse
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
A. clonazepam.
B. ferrous sulfate.
C. gabapentin.
D. sertraline.

Question 8

The parent of a school­age child who is overweight tells the primary care
pediatric nurse practitioner that the child seems to crave high­calorie, high­carbohydrate 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?
A. Assessment of leptin and ghrelin hormone levels
B. Consultation with a dietician to develop an appropriate diet
C. Referral to a sleep disorder clinic for a sleep study
D. Taking one or two naps each day to increase the amount of sleep

Question 9

The primary care pediatric nurse practitioner is counseling a new parent
about ways to reduce the risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing SIDS?
A. Bed­sharing with infants greatly increases the risk of SIDS.
B. Breastfeeding does not appear to have any influence on SIDS risk.
C. Infants who attend day care have a higher than usual incidence of SIDS.
D. There is no difference in SIDS rates in immunized versus non­immunized infants.

Question 10

The parent of a 3­year­old child tells the primary care pediatric nurse
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?
A. Leaving the room as the child is falling asleep and returning at intervals to check on the child
B. Offering a reward for each night the child falls asleep without the parent in the room
C. Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors
D. Taking away a favorite activity or video for each night the child fusses about the parent not being in the room

Question 11

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

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