Question 1

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

Accepted Answer

The corporate accountant is likely to work long hours and have significant stress associated with work demands.Compounded by travel,these factors are likely to precipitate unstable sleep patterns and inadequate sleep time.The retiree and lawn care worker engage in physical activity during the day,which will promote natural fatigue and sleep.The parent's sleep is unlikely to be disturbed; teenagers sleep through the night.

Question 2

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

Accepted Answer

Sertraline (Zoloft)is an SSRI antidepressant medication,which suppresses REM sleep.Dreams would decrease because they occur during REM.Benzodiazepines reduce slow-wave sleep.SSRIs have a side effect of insomnia.

Question 3

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

Hypnotics can worsen existing sleep disturbances when they induce drug-dependency insomnia.Once the drug is discontinued,the individual may have rebound insomnia and nightmares.CNS stimulants worsen insomnia while they are in use.Tricyclic antidepressants and atypical antipsychotics may help insomnia but would not be used for initial therapy.

Question 4

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

Accepted Answer

A discrepancy between hours of sleep obtained and hours required leads to sleep deprivation.Adults with less than 6 hours of sleep per night often suffer from chronic sleep deprivation.Common complaints include poor general health,physical and mental distress,limitations in ADLs,depressive or anxious symptoms,and pain.One distracter indicates a problem with sleep hygiene [television].The remaining distracters do not indicate a problem.

Question 5

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

Sleep deprivation can cause accidents.The correct answer makes an observation,gives important information about safety,and communicates care and compassion for the spouse.The distracters do not invite further dialogue with the spouse.

Question 6

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

Accepted Answer

Sleep latency refers to the amount of time it takes a person to fall asleep.The distracters represent other phases of the sleep cycle.

Question 7

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 8

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

Total sleep hours should be ascertained before seeking to correct a sleep disorder.In this case,the patient describes sleep deprivation symptoms rather than a sleep disorder.The correct response is the only option that addresses total sleep hours.

Question 9

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

Accepted Answer

Circadian drive is associated with physiology.Light is the main exogenous factor that drives wakefulness.Days are longest in summer.

Question 10

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 11

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

Accepted Answer

Safety is the highest priority for this patient.Sleep deprivation causes psychomotor deficits.Driver drowsiness and fatigue lead to many automobile injuries and fatalities.Alcohol compounds problems associated with sleep deprivation.Sleep deprivation should be evaluated and treated; a 1-year delay is too long.

Question 12

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

Patients with diseases such as arthritis may have sleep disturbance related to nightly pain.Because the pain is chronic,the patient may fail to realize it is the reason for the inability to sleep.The other options do not follow the patient's lead or begin problem solving without an adequate baseline.

Question 13

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

Accepted Answer

Electroencephalogram (EEG)measures NREM and REM sleep.The distracters represent ways to diagnose structural and metabolic problems.

Question 14

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 most consistent with criteria for which problem?

Accepted Answer

Nightmares are long,frightening dreams from which people awaken in a frightened state.They occur during REM sleep late in the night.Night terror disorder occurs as arousal in the first third of the night during non-REM sleep and is accompanied by feelings of panic.REM sleep behavior disorder involves acting out a violent dream during REM sleep.Nightmare disorder may lead to sleep deprivation.

Question 15

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? The patient will:

Accepted Answer

Lorazepam is a benzodiazepine,which reduces slow-wave sleep.REM sleep would likely increase.Persons with narcolepsy often enter sleep through REM.

Question 16

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

Accepted Answer

The master biological clock in the suprachiasmatic nucleus (SCN)of the hypothalamus regulates sleep as well as other physiological processes.Darkness cues the clock for sleep.Light cues it for wakefulness.Light stimulates retinal messages.Histamine release is associated with wakefulness.Stimulation of the sympathetic nervous system promotes alertness.

Question 17

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

The scenario describes REM sleep behavior disorder in which the patient engages in violent and complex behaviors during REM sleep as though acting out his dreams.Older men have a higher incidence of this problem.Sleep paralysis refers to the sudden inability to perform voluntary movement at either sleep onset or awakening from sleep.Bruxism refers to grinding teeth during stage 2 sleep.Night terror disorder occurs as arousal in the first third of the night during non-REM sleep,accompanied by feelings of panic.

Question 18

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

Accepted Answer

Regular sleep cycles occur with nighttime sleep,with progression through two distinct physiological states: four stages of non-rapid eye movement and a period of REM sleep.Naps often contain different amounts of REM sleep,thus changing the physiology of sleep as well as the psychological and behavioral effects of sleep.

Question 19

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:

Accepted Answer

Safety is the highest priority for this patient.Sleep deprivation causes psychomotor deficits.Driver drowsiness and fatigue lead to many automobile injuries and fatalities.The distracters are less likely to be associated with serious injury.

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?

Accepted Answer

Sleep requirements are most accurately determined by going to bed at the usual time and waking up without an alarm for several nights,ideally on vacation.The average of these findings indicates the estimated requirements.Two distracters relate to dream content and daytime alertness.Some adults are long sleepers or short sleepers with different requirements for sleep from the general population.

Quiz 19: Sleep-Wake Disorders