Deck 20: Sleep Disorders

Question 1

The nurse provides health education for an adult with sleep deprivation.Which instruction has the highest priority?

A) "It's important to limit your driving to short periods.Sleep deprivation increases your risks for serious accidents."
B) "Sleep deprivation is usually a self-limiting health problem.See your doctor if it lasts more than a year."
C) "Turn the radio on with a soft volume as you prepare for bed each evening.It will help you relax."
D) "Three glasses of wine each evening helps many patients who suffer from sleep deprivation."

Answer 1

"It's important to limit your driving to short periods.Sleep deprivation increases your risks for serious accidents."

Question 2

A patient needs diagnostic evaluation of sleep problems.Which test will measure the patient's sleep?

A) Skull x-rays
B) Electroencephalogram (EEG)
C) Positron emission tomography (PET)
D) Single-photon emission tomography (SPECT)

Answer 2

Electroencephalogram (EEG)

Question 3

A home health nurse visits a patient with COPD who is on constant oxygen therapy and very demanding.The wife has cared for this patient for 6 years.When the nurse asks about her sleep the wife responds,"I don't need much sleep anymore.I must be able to hear if he calls out during the night." Select the nurse's most therapeutic response.

A) "It sounds like you are very devoted to your husband."
B) "Your husband is lucky to have you to caring for him rather than being placed in a nursing home."
C) "If you keep going like this,your health will be impaired also.Then who will take care of both you and your husband?"
D) "I noticed you fell asleep while I was assessing him.Sleep deprivation can lead to accidents.I'm concerned about both of you."

Answer 3

"I noticed you fell asleep while I was assessing him.Sleep deprivation can lead to accidents.I'm concerned about both of you."

Question 4

A nurse who works night shift says,"I am exhausted most of the time.I sleep through my alarm.Sometimes my brain does not seem to work right.I am worried that I might make a practice error." Which question should the nursing supervisor ask first?

A) "What stress are you experiencing in your life?"
B) "How much sleep do you get in a 24-hour period?"
C) "Would it help if you do some exercises just before going to bed?"
D) "Have you considered using a hypnotic medication to help you sleep?"

Question 5

Normally,most people sleep at night.What is the physiological rationale?

A) The master biological clock responds to darkness with sleep.
B) Darkness stimulates histamine release,which promotes sleep.
C) Cooler environmental temperatures stimulate retinal messages.
D) Stimulation of the sympathetic nervous system promotes sleep.

Question 6

Which season would be most associated with increased periods of wakefulness in the general population?

A) Summer
B) Winter
C) Spring
D) Fall

Question 7

A nurse provides health education for an adult with sleep deprivation.It is most important for the nurse to encourage caution when the patient engages in:

A) eating.
B) reading.
C) bathing.
D) driving.

Question 8

Which comment is most likely from a patient with chronic sleep deprivation?

A) "I turn on the television every night to get to sleep.I set the timer so it goes off in 30 minutes."
B) "I have diarrhea frequently and not much energy,so I stay at home most of the time."
C) "I only sleep about 7 hours a night,but I know I should sleep 8 or 9 hours."
D) "When my alarm clock goes off every morning,it seems like I was dreaming."

Question 9

A patient says,"It takes me about 15 minutes to go to sleep each night." This comment describes:

A) delta sleep.
B) parasomnia.
C) sleep latency.
D) rapid eye movement sleep.

Question 10

Which person would be most likely to experience sleep fragmentation?

A) 84-year-old
B) 47-year-old
C) 26-year-old
D) 15-year-old

Question 11

A 76-year-old man tells the nurse at the sleep disorder clinic,"I awaken almost nightly in the midst of violent dreams in which I am defending myself against multiple attackers.Then I realize I have been hitting and kicking my wife.She has bruises." Which health problem is most likely?

A) Sleep paralysis
B) Night terror disorder
C) Sleep-related bruxism
D) REM sleep behavior disorder

Question 12

A patient reports,"Nearly every night I awaken feeling frightened after a bad dream.The dream usually involves being hunted by people trying to hurt me.It usually happens between 4 and 5 AM." The nurse assesses this disorder as being most consistent with criteria for:

A) sleep talking.
B) nightmare disorder.
C) night terror disorder.
D) REM sleep behavior disorder.

Question 13

A person takes sertraline (Zoloft)100 mg PO daily for posttraumatic stress disorder.Which change in sleep is likely secondary to this medication? The patient will have:

A) more dreams.
B) less REM sleep.
C) excessive sleepiness.
D) less slow-wave sleep.

Question 14

A nurse cares for these four patients.Which patient has the highest risk for problems with sleep physiology?

A) Retiree who volunteers twice a week for Habitat for Humanity
B) Corporate accountant who travels frequently
C) Parent with three teenagers
D) Lawn care worker

Question 15

A patient reports,"The medication prescribed to help me get to sleep worked well for about a month,but now it's gone and my insomnia is worse than ever.I had nightmares the last 2 nights." Which type of medication did the health care provider most likely prescribe?

A) Hypnotic
B) Tricyclic antidepressant
C) Conventional antipsychotic
D) Central nervous system stimulant

Question 16

A patient with degenerative arthritis complains,"For the past month I have been having a lot of trouble sleeping.I cannot seem to fall asleep.When I finally do get to sleep,I wake up over and over during the night." Which information should the nurse seek initially?

A) "What have you done to try to improve your sleep?"
B) "What would be a good sleep pattern for you?"
C) "How much exercise are you getting?"
D) "Do you have pain at night?"

Question 17

A person takes lorazepam (Ativan)2 mg PO BID PRN for anxiety.When the person takes this medication,which change in sleep is anticipated? The patient will:

A) have fewer dreams.
B) enter sleep through REM.
C) have less slow-wave sleep.
D) have more complaints of pain.

Question 18

A patient with primary insomnia asks the nurse why day naps do not compensate for a lost night's sleep.Select the nurse's best reply.

A) "Circadian cycles give daytime naps a structure different from nighttime sleep."
B) "The body clock operates on a 25-hour cycle,making nap effectiveness unpredictable."
C) "It is a matter of habit and expectation.We expect to be more refreshed from a night's sleep."
D) "Sleep restores homeostasis but works more efficiently when aided by melatonin secreted at night."

Question 19

A person says,"I was dreaming about snow skiing down a huge mountain when I woke up this morning." Which rationale correctly explains the comment?

A) Sleep architecture changes during the sleep period,resulting in increased slow-wave sleep at the end of the cycle.
B) Cycles of rapid-eye-movement sleep increase in the second half of sleep and occupy longer periods.
C) Dreams occur more frequently when a person is experiencing unresolved conflicts or depression.
D) Dream content relates directly to developmental tasks.The person is likely feeling autonomous.

Question 20

A nurse counsels a patient on ways to determine the person's total sleep requirement.Which instruction would produce the most accurate results?

A) "For 1 full week,record what you remember about your dream content and related feelings as soon as you wake up.Bring the record to your next appointment."
B) "While off from work for 1 week,go to bed at your usual time and wake up without an alarm.Record how many hours you sleep,and then average the findings."
C) "For 2 full weeks,record how much time you sleep each night,and rate your daytime alertness on a scale of 1 to 10.Calculate your average alertness score."
D) "All adults need 7 or 8 hours of sleep to function properly.Let's design ways to help you reach that goal."

Question 21

Which neurotransmitters are most responsible for wakefulness? Select all that apply.

A) Gamma-aminobutyric acid (GABA)
B) Norepinephrine
C) Acetylcholine.
D) Dopamine
E) Serotonin.

Question 22

A night shift worker complains,"I'm having trouble getting to sleep after a night's work.I have a hearty breakfast with coffee,read the paper,do my exercises,and then go to bed.However,I just lie awake until it is nearly time to get up to be with my family for dinner." What change(s)should the nurse suggest? Select all that apply.

A) Drink juice with breakfast rather than coffee.
B) Exercise after awakening rather than before.
C) Turn on the television when going to bed.
D) Do not read the paper.
E) Eat a light breakfast.

Question 23

A patient tells the nurse,"Everyone says we should sleep 8 hours a night.I can only sleep 6 hours,no matter how hard I try.Am I doing harm to my body?" Select the nurse's best response.

A) "Tell me what you have tried to increase your total sleep hours."
B) "Lack of sleep acts as a stressor on the body and can cause physical changes."
C) "If you have really tried to sleep more,maybe you should consult your physician."
D) "If you function well with 6 hours of sleep,you are a short sleeper.That's normal for some people."

Question 24

Correctly sequence these sleep events.

A)Rapid-eye-movement sleep
B)Slow-wave or delta sleep
C)Sleep latency

Question 25

A patient tells the practitioner,"I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep." Which medication would be best for this patient?

A) Zolpidem (Ambien)
B) Flurazepam (Dalmane)
C) Risperidone (Risperdal)
D) Methylphenidate (Ritalin)

Question 26

A new patient at the sleep disorders clinic tells the nurse,"I have not slept well in a year,so I never feel good.I do not expect things will ever improve or be any different." Interventions the nurse should consider include: (Select all that apply. )

A) advising use of alcohol as a sedative.
B) counseling the patient to address cognitive distortions.
C) providing instruction in relaxation techniques.
D) health teaching regarding factors that influence sleep.
E) teaching fatigue-producing activities to become overtired.

Question 27

Which sleep disturbance would be most likely for a patient with bipolar I disorder?

A) Early morning awakening
B) Fragmentation of sleep
C) Decreased REM sleep
D) Hypersomnia