Question 1

Which suggestions would be included when educating a patient concerning the management of a circadian rhythm sleep disorder? Select all that apply.&#10;A) Darken the bedroom.&#10;B) Go to sleep at the same time each night.&#10;C) Keep the bedroom environment calm and serene.&#10;D) Initially, retire 30 minutes earlier than usual.&#10;E) Take a low-dose over-the-counter sleep aid.

Accepted Answer

The primary aim when managing a circadian rhythm sleep disorder is positively affected by establishing regularity in the sleep-wake cycle by synchronizing sleep-wake patterns with typical daily schedules,identifying and managing external environmental factors that interfere with sleep,and encouraging the patient to sleep earlier than the previously established pattern.Sleep aids are not recommended.

Question 2

A 10-year-old is diagnosed with somnambulism as a result of frequent episodes of sleepwalking.Which topic should be included when considering patient and family education?&#10;A) Medication therapy seldom prescribed for this disorder&#10;B) Safety issues such as sleeping in the ground level bedroom&#10;C) The likely connection between sleepwalking and narcolepsy&#10;D) The need for short-term cognitive and behavioral therapy

Accepted Answer

Safety is a primary concern when managing sleepwalking since injury is quite likely as a result of the patient's inability to be aware of danger.Drugs that suppress stages 3 and 4 sleep,such as benzodiazepine hypnotics,have been used for the management of this disorder.There is no research to support a connection between this disorder and narcolepsy.This disorder is not treated with either of these therapies.

Question 3

Which of the statements made by the patient would be most indicative of dyssomnia?&#10;A) &#34;I think I am seeing things when I wake up.&#34;&#10;B) &#34;My wife says I snore and even stop breathing.&#34;&#10;C) &#34;I go to sleep okay but then wake up several times at night.&#34;&#10;D) &#34;My wife says I sit straight up in bed at 2 AM and then say strange things.&#34;

Accepted Answer

The dyssomnia known as insomnia is characterized by a predominant complaint of difficulty initiating or maintaining sleep.Snoring is a characteristic of obstructive sleep apnea.The other options are seen in narcolepsy.

Question 4

During the assessment interview,a patient tells the nurse he has &#34;sleep problems.&#34; Which question will assess for the use of substances that affect the quality of sleep? Select all that apply.&#10;A) &#34;Do you follow a low-fat diet?&#34;&#10;B) &#34;Are you a big coffee drinker?&#34;&#10;C) &#34;Do you indulge in an evening alcoholic drink?&#34;&#10;D) &#34;Have you been prescribed an opiate-based analgesic?&#34;&#10;E) &#34;Are you currently taking antianxiety medication?&#34;

Accepted Answer

Examples of substances that influence sleep includes alcohol,stimulants such as caffeine,
sedatives such as opiates,and antianxiety medications.Fats are not thought to influence sleep.

Question 5

A patient with obstructive sleep apnea (OSA)is being discharged.What patient statement indicates the need for further teaching?&#10;A) &#34;I hope to lose some weight.&#34;&#10;B) &#34;My antidepressants seem to be helping.&#34;&#10;C) &#34;I will try the oral appliance that the doctor suggested.&#34;&#10;D) &#34;A glass of wine at bedtime will help relax my airways.&#34;

Accepted Answer

Health care providers usually discourage patients with this disorder from using sedating substances such as alcohol,because these types of sedatives often exacerbate the problem by relaxing the airway,thus increasing the risk of longer apneic episodes throughout the night.The remaining options are all positive strategies to help with OSA.

Question 6

Which notations should be included in a sleep journal? Select all that apply.&#10;A) Any regular bedtime rituals&#10;B) Things that assist with sleep&#10;C) Time when patient went to bed&#10;D) Things that interfere with sleeping&#10;E) Foods eaten at dinner or last meal

Accepted Answer

Information about when the patient went to bed,sleep rituals,aides,and barriers to sleep should be included,but unless foods have been identified as an aid or barrier to sleep,they need not be included.

Question 7

Which outcome is appropriate for an adult patient recently diagnosed with primary insomnia?&#10;A) Demonstrate an understanding of the cerebral stimulants prescribed.&#10;B) Recognize that the prescribed flurazepam (Dalmane) can be used for up to 2 months.&#10;C) Demonstrate the proper use of continuous positive airway pressure (CPAP) ventilation.&#10;D) Recognize physical and psychosocial stressors that exacerbate the sleep disturbance.

Accepted Answer

The patient should identify physical and psychosocial stressors that exacerbate the sleep disturbance in order to attempt successful self-management of the problem.Neither stimulants nor CPAP therapy are prescribed for this disorder.The duration of flurazepam therapy is considerably shorter.

Question 8

An adult patient diagnosed with narcolepsy is being educated on the medication therapy that is prescribed.Which explanation is provided for the central nervous system stimulant dextroamphetamine (Dexedrine)?

A) The apnea will be lessened by this medication.
B) It will help control the sporadic loss of muscle tone.
C) This medication will minimize the daytime sleepiness.
D) Dexedrine will manage the inflammation that causes the snoring.

Accepted Answer

Central nervous system stimulants such as dextroamphetamine (Dexedrine,Dextrostat)may be prescribed to manage excessive daytime sleepiness.This medication has no affect on cataplexy,apnea,or snoring.Apnea and snoring are not symptoms of narcolepsy.

Question 9

Which physical assessment finding is supportive of a diagnosis of obstructive sleep apnea?&#10;A) Barrel chest&#10;B) Raccoon eyes&#10;C) Enlarged nasal nares&#10;D) Large neck circumference

Accepted Answer

Persons with obstructive sleep apnea often have a large neck circumference that appears to be related to pressure being applied to the trachea.Neither an enlarged chest nor enlarged nostrils would cause the airway obstruction associated with this disorder.Blackened eyes are related to trauma or allergies.

Question 10

A patient tells the nurse,&#34;I take herbal products like melatonin and valerian to help sleep.&#34; Which response will the nurse make to the patient?&#10;A) &#34;My aunt uses them, and they help her a lot.&#34;&#10;B) &#34;Studies show they are ineffective as sleep aids.&#34;&#10;C) &#34;They can cause serious side effects and should be avoided.&#34;&#10;D) &#34;Be aware that these products are uncontrolled, so preparations vary.&#34;

Accepted Answer

Herbal products (e.g.,melatonin,valerian)are not regulated by the U.S.Food and Drug Administration,and preparation concentrations may vary.It is not appropriate to give advice based on personal anecdote.There has not been systematic evaluation of the products,so there is no proof to support statements regarding effectiveness or severity of side effects.

Question 11

An adult patient diagnosed with insomnia is prescribed the antihistamine,diphenhydramine.Which side effects does the nurse educate the patient about? Select all that apply.&#10;A) Urinary retention&#10;B) Blurred vision&#10;C) Rhinorrhea&#10;D) Dry mouth&#10;E) Diarrhea

Accepted Answer

The answer of An adult patient diagnosed with insomnia is...

Question 12

Which comorbid conditions have been associated with sleep deprivation? Select all that apply.&#10;A) Depression&#10;B) Hypertension&#10;C) Anxiety disorders&#10;D) Gastric reflux disease&#10;E) Coronary artery disease

Accepted Answer

The answer of Which comorbid conditions have been associated with...

Question 13

When the family of a child diagnosed with a nightmare disorder asks the nurse about prognosis,the nurse replies with the knowledge that:&#10;A) The disorder is frequently self-limiting in children.&#10;B) If the child is obese, it is likely the nightmares will continue.&#10;C) High doses of diazepam (Valium) are needed to cure the disorder.&#10;D) With the use of antipsychotic medication, the disorder will not worsen.

Accepted Answer

The answer of When the family of a child diagnosed...

Question 14

Which intervention will best assess a narcoleptic patient for a commonly recognized comorbid psychiatric disorder?&#10;A) Observing for signs of self-mutilation&#10;B) Observing the patient for ritualistic behaviors&#10;C) Asking, &#34;Do you consider yourself to be depressed?&#34;&#10;D) Asking, &#34;Do you rely on alcohol to function socially?&#34;

Accepted Answer

The answer of Which intervention will best assess a narcoleptic...

Question 15

A pediatric patient has been diagnosed with obstructive sleep apnea (OSA).Which statement would the nurse use as a basis for explaining the etiology of this disorder?&#10;A) Melatonin is not being released in sufficient quantity.&#10;B) This condition is often due to adenotonsillar hypertrophy.&#10;C) Children have a high ratio of REM sleep that can result in frequent gasping.&#10;D) This can be related to a sleep position which compromises chest movement.

Accepted Answer

The answer of A pediatric patient has been diagnosed with...

Question 16

Which patient statement would support a diagnosis of a circadian rhythm sleep disturbance?&#10;A) &#34;I just started on the night shift at work.&#34;&#10;B) &#34;My mother was seriously depressed for years.&#34;&#10;C) &#34;I wake up gasping for breath, and it is really scary.&#34;&#10;D) &#34;I don't think I drink any more than my buddies do.&#34;

Accepted Answer

The answer of Which patient statement would support a diagnosis...

Question 17

Which assessment observation would not support a diagnosis of narcolepsy?&#10;A) Sleep study reports excessive, loud snoring.&#10;B) Sleep study shows evidence of sleep paralysis.&#10;C) Patient reports &#34;needing to drink pots of coffee to stay awake at work.&#34;&#10;D) Patient reports, &#34;When I get sleepy I actually see things that aren't really there.&#34;

Accepted Answer

The answer of Which assessment observation would not support a...

Question 18

Which statement indicates to the nurse that a patient requires additional education regarding appropriate sleep hygiene?&#10;A) &#34;I will try to avoid daytime napping.&#34;&#10;B) &#34;Relaxing music may help relax me for sleep.&#34;&#10;C) &#34;Exercising before bed will make me good and tired.&#34;&#10;D) &#34;I need to cut back on my four daily cups of coffee.&#34;

Accepted Answer

The answer of Which statement indicates to the nurse that...

Deck 19: Sleep Disorders: Dyssomnias and Parasomnias