Question 1

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 2

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

Question 3

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

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 4

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 5

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 6

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 7

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 8

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 a person to fall asleep. The distracters represent other phases of the sleep cycle or a sleep disorder.

Question 9

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.

Question 10

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 nurse describes sleep deprivation symptoms rather than a sleep disorder. The correct response is the only option that addresses total sleep hours.

Question 11

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. People with arthritis have pain that may sometimes interrupt sleep, but arthritis would not have as high a risk as obesity would. Toddlers do not generally experience sleep fragmentation.

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

The scenario describes REM sleep behaviour disorder, in which the patient engages in violent and complex behaviours 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 either at sleep onset or on 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 13

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

Accepted Answer

A person prescribed a selective serotonin reuptake inhibitor (SSRI) would have suppressed REM sleep as this medication is a serotonergic drug. Dreams would decrease because they occur during REM. Benzodiazepines reduce slow-wave sleep. SSRIs have a side effect of insomnia.

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 a.m." 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 behaviour disorder involves acting out a violent dream during REM sleep. Nightmare disorder may lead to sleep deprivation.

Question 15

A nurse cares for the following 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 16

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 sleep problem.

Question 17

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

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 behavioural effects of sleep.

Question 18

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 19

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 20

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 (REM) 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.

Quiz 21: Sleep–Wake Disorders