Question 1

Which suggestions would be included when educating a patient concerning the management of a circadian rhythm sleep disorder? Select all that apply.

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?

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?

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 "sleep problems." Which question will assess for the use of substances that affect the quality of sleep? Select all that apply.

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?

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.

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?

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)?

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?

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,"I take herbal products like melatonin and valerian to help sleep." Which response will the nurse make to the patient?

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.

Accepted Answer

Such drugs as Sominex and Unisom contain diphenhydramine,which is an antihistamine that has both sedative and anticholinergic effects (e.g.,dry mouth,blurred vision,constipation,nasal congestion,urinary retention)and prescribed for insomnia.Rhinorrhea and diarrhea are not side effects of the anticholinergics.

Question 12

Which comorbid conditions have been associated with sleep deprivation? Select all that apply.

Accepted Answer

Sleep deprivation is associated with mood disorders such as depression and anxiety as well as stress-related medical conditions such as coronary artery disease and hypertension.There is currently no research to support a connection with gastric reflux disease.

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:

Accepted Answer

A child who is experiencing nightmares usually outgrows the disorder as he or she ages.Medications are not generally prescribed for this disorder.There is no research to support a correlation between obesity and nightmares.

Question 14

Which intervention will best assess a narcoleptic patient for a commonly recognized comorbid psychiatric disorder?

Accepted Answer

Research supports a link between insomnia and major depression.

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?

Accepted Answer

When OSA is found in children,it is usually the result of adenotonsillar hypertrophy,craniofacial abnormalities,and neuromuscular conditions,all of which result in airway obstruction during sleep.There is no research on OSA related to melatonin insufficiency,dreaming,or a particular sleep position.

Question 16

Which patient statement would support a diagnosis of a circadian rhythm sleep disturbance?

Accepted Answer

The shift work-type of circadian sleep disorder is usually the result of night shift work or frequently rotating shift work.Depression,breathing problems,and drinking indicate other types of sleep disturbances.

Question 17

Which assessment observation would not support a diagnosis of narcolepsy?

Accepted Answer

Snoring is a characteristic obstructive sleep apnea,not narcolepsy.Classic symptoms of narcolepsy include excessive daytime sleepiness,sleep paralysis,and hallucinations

Question 18

Which statement indicates to the nurse that a patient requires additional education regarding appropriate sleep hygiene?

Accepted Answer

Avoiding physical exercise or mental stimulation just before bedtime will usually support healthy sleep patterns.The remaining options are all good sleep hygiene practices.

Quiz 19: Sleep Disorders: Dyssomnias and Parasomnias