Question 1

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

Accepted Answer

Chronic sleep deprivation is characterized by consistently getting less sleep than needed. The comment "I sleep only about 5 hours a night, but I know I should sleep 7 or 8 hours" indicates awareness of insufficient sleep, which aligns with chronic sleep deprivation.

Question 2

Which person would be most likely to experience sleep fragmentation?

Accepted Answer

Obese adults experience more disruption of sleep stages, resulting in fragmentation. Obesity is the leading factor for obstructive sleep apnea, which causes sleep fragmentation. These changes are also associated with illness and some medications. The changes are evident on a hypnogram. An adolescent with anorexia nervosa would have a low body weight and therefore decreased risk for sleep fragmentation. Persons with arthritis have pain that may sometimes interrupt sleep, but it would not have as high risk as would obesity. Toddlers do not generally experience sleep fragmentation.

Question 3

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.

Accepted Answer

Some individuals require less sleep than others do. Those who need less are called "short sleepers," compared with "long sleepers," who require more than 8 hours. The distracters do not provide information the patient is seeking or are untrue.

Question 4

A person says, "I often feel like I have been dreaming just before I awake in the morning." Which rationale correctly explains the comment?

Accepted Answer

Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods,up to 1 hour.Dreaming occurs during REM sleep.The question relates to sleep architecture rather than dream content.

Question 5

A patient experiencing primary insomnia says she takes a nap during the day and asks the nurse, "Doesn't that make up for a lost night's sleep?" Select the nurse's best reply.

Accepted Answer

Daytime naps have a different structure due to circadian rhythms, which can affect the quality and restorative nature of the sleep compared to nighttime sleep.

Question 6

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

Accepted Answer

The instruction to limit driving is the highest priority as sleep deprivation significantly increases the risk for accidents while driving. It is important to address this safety concern first before addressing other strategies to improve sleep. The other options are either incorrect or lower priority compared to addressing the safety concern.

Question 7

A person is prescribed lorazepam (Ativan) 2 mg po bid prn for anxiety. When the person takes this medication, which change in sleep is anticipated?

Accepted Answer

Lorazepam, a benzodiazepine, typically reduces slow-wave sleep (deep sleep) and can alter sleep architecture.

Question 8

A patient reports, "The medicine prescribed to help me get to sleep worked well for about a month, but I don't have any more of those pills, and now 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?

Accepted Answer

The fact that the patient was prescribed medication to help them sleep suggests that they have insomnia. Hypnotics are medications that are commonly prescribed to treat insomnia. The statement that the medication worked well for a month before running out also suggests that it was a short-term medication, which is typical of hypnotics. Finally, the fact that the patient is now experiencing worse insomnia and nightmares (which can be a side effect of some hypnotics) suggests that they were taking a medication that affects sleep, like a hypnotic.

Question 9

A patient with rheumatoid arthritis reports, "For the past month I've been having a lot of trouble falling asleep. When I finally get to sleep, I wake up several times during the night." Which information should the nurse seek initially?

Accepted Answer

The patient's current sleep disturbance could be related to pain experienced during the night due to her rheumatoid arthritis. Therefore, the nurse should initially seek information about whether the patient is experiencing pain at night.

Question 10

A patient says, "It takes me about 15 minutes to go to sleep each night." Which of the following does this comment describe?

Accepted Answer

Sleep latency refers to the amount of time it takes for a person to transition from full wakefulness to sleep. The patient's comment about taking 15 minutes to fall asleep describes sleep latency.

Question 11

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

Accepted Answer

Frequent travel, especially across time zones, can disrupt circadian rhythms and lead to sleep disturbances, making the corporate accountant at higher risk for sleep problems.

Question 12

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?

Accepted Answer

REM sleep behavior disorder involves acting out vivid dreams, often with violent movements, which aligns with the patient's description of hitting and kicking during dreams.

Question 13

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

Accepted Answer

The master biological clock, located in the suprachiasmatic nucleus of the hypothalamus, responds to darkness and sends signals to the pineal gland to release melatonin, which promotes sleep. This is why most people sleep during the night when it is dark.

Question 14

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 which of the following?

Accepted Answer

Driving a car requires full attention and alertness, and sleep deprivation can significantly impair these abilities, increasing the risk of accidents.

Question 15

A person is prescribed a selective serotonin reuptake inhibitor (SSRI). Which change in sleep is likely to be secondary to this medication?

Accepted Answer

SSRIs are known to suppress REM sleep, leading to a reduction in the amount of REM sleep a person experiences.

Question 16

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

Accepted Answer

Longer daylight hours during the summer season may lead to more wakefulness in the general population. The increased exposure to sunlight can disrupt the body's natural sleep cycle and make it harder to fall asleep.

Question 17

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

Accepted Answer

The most accurate way to determine an individual's total sleep requirements is to allow them to sleep without an alarm and record how many hours they sleep for a week. This will give an accurate representation of the amount of sleep their body needs. Recording dream content or alertness ratings may be helpful in identifying sleep disorders or other issues, but it is not the most accurate way to determine total sleep needs. Similarly, while the general guideline for adults is 7-8 hours of sleep, this may not be true for every individual and it is best to determine their own unique needs through self-monitoring.

Question 18

A home care nurse assesses a very demanding patient with chronic obstructive pulmonary disease (COPD). Afterward, the nurse talks with the spouse, who has provided this patient's care for 6 years. The spouse says, "I don't need much sleep anymore. I might need to help him during the night." Select the nurse's most therapeutic response.

Accepted Answer

The nurse should express concern about the caregiver's well-being and encourage them to prioritize their own health. The spouse's statement indicates that they may be sacrificing their own rest and sleep to care for their partner, which can lead to burnout and health problems. Option A may come across as patronizing, and option C may not acknowledge the difficulty of caregiving. Option D may make the caregiver feel guilty or overwhelmed.

Question 19

A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems?

Accepted Answer

An Electroencephalogram (EEG) is used to evaluate electrical activity in the brain and is commonly used in sleep studies to diagnose sleep disorders.

Question 20

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?

Accepted Answer

The nursing supervisor should first inquire about the nurse's sleep habits, as sleep deprivation can affect cognitive function and increase the risk of errors. Stress management and sleep hygiene strategies can be implemented once the supervisor has a clear understanding of the nurse's sleep patterns. Hypnotic medication should only be considered as a last resort and under the guidance of a healthcare provider.

Quiz 20: Sleepwake Disorders