Question 1

Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep?
A) The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping-waking cycles.
B) The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep.
C) The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle.
D) Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.

Accepted Answer

The sleep-wake cycle is rooted anatomically in the reticular formation and the interaction between the thalamus and cerebral cortex. Melatonin is produced by the pineal gland, and the hypothalamus and cerebellum are not central contributors to the sleep-wake cycle.

Question 2

A client with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep?
A) "Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake."
B) "While you're obviously less aware of stimuli when you're asleep, your brain is actually more active when you're asleep than when you're awake."
C) "There are four types of brain activity, and actually all of them occur at different stages of sleep."
D) "Your brain alternates between periods of activity and periods of inactivity when you're asleep, and these correspond to your eye movement."

Accepted Answer

Brain activity during sleep is lessened but is more synchronous than during waking. The brain is not more active during sleep, and alpha and beta rhythms are not associated with sleep. The brain is never truly inactive during sleep.

Question 3

Which of the following characteristics describe stage 2 non-REM sleep? Select all that apply.
A) It occurs at the onset of sleep and lasts approximately 7 minutes.
B) During this stage, theta waves are primarily seen on EEG.
C) This stage is known as deep sleep where heart rate and BP are decreased.
D) This stage has interruptions of spindle activity that helps with integration of new memories.
E) Muscles of the body are relaxed.

Accepted Answer

Stage 2 non-REM sleep lasts approximately 10 to 25 minutes, where on EEG activity includes predominantly theta waves that are interrupted by sleep spindles consisting of bursts of high-frequency (12 to 14 Hz) waves. Answer choice A relates to stage 1 sleep that occurs at the onset of sleep and lasts approximately 7 minutes. Answer choices C and E relate to stages 3 and 4 of non-REM sleep, known as deep sleep where heart rate and BP are decreased and the muscles of the body are relaxed.

Question 4

Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in REM sleep?
A) Rolling eye movements are observed, and she has moderate muscle activity.
B) Her motor movements are suppressed, and muscle tone is flaccid.
C) Delta waves are evident on her EEG, and the heart and respiration rates are slowed.
D) She has a low level of cerebral activity, and her EEG indicates low voltage and mixed frequencies.

Accepted Answer

REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves, and low levels of cerebral activity are associated with stages 1 through 4 of sleep.

Question 5

The nurse knows that which of the following observations of a client during a sleep study would be most likely considered a pathological finding? A) The client experiences periods of apnea of 5 to 15 seconds in duration. B) The client's intrinsic clock involves a sleep-wake cycle that is consistently 2 hours longer than the actual length of a day. C) ^{The client's PCO}2 ^{level is increased, and his PO}2 ^{level decreased during deep} sleep. D) The client spends the majority of his sleeping hours in deep REM sleep.

Accepted Answer

While vital, REM sleep does not normally occupy the majority of sleeping hours. The brain is highly active during REM sleep, and it accounts for 20% to 25% of normal sleep. Brief apneic spells are not uncommon, and the circadian rhythm often does not ^{match the 24-hour length of day. It is normal for PCO}2 ^{to increase and PO}2 ^{to decrease}during deep sleep.

Question 6

Which of the following statements about over-the-counter (OTC) melatonin is accurate?
A) It has received the FDA approval for effectiveness as a sleep aid.
B) Long-term studies of melatonin conclude that it is nonaddicting.
C) It produces phase-shifting changes in the circadian rhythm.
D) Under strict clinical testing, potency and purity of melatonin have been shown to be consistent.

Accepted Answer

Administration of melatonin produces phase-shifting changes in the circadian rhythm similar to those caused by light. Synthetic forms of melatonin are available without prescription in health food stores and pharmacies. However, synthetic forms of melatonin are not regulated by the FDA; therefore, their potency, purity, safety, and effectiveness cannot be ensured. There is a lack of clinical trial evidence about dosage, adverse effects, and drug interactions with over-the-counter forms of melatonin.

Question 7

When explaining an upcoming test, a polysomnography, the nurse should include which of the following education related to equipment placements the patient will have placed on his or her person during the sleep study? Select all that apply.
A) An ECG with lots of chest leads will monitor heart rate and rhythm.
B) A pulse oximeter placed on a finger is used to determine arterial oxygen saturation.
C) An EOG will be placed on the skin near the eye to record eye movements.
D) An EMG patch will be placed under the chin to record muscle movement.
E) An actigraph device will be placed on the wrists and ankles to measure body motion.

Accepted Answer

The ECG, which measures heart rate, is used to detect cardiac rhythm disorders, and the pulse oximeter is used to determine arterial oxygen saturation, which indicates adequacy of ventilation. The EOG, which records eye movements, and the EMG, which records muscle movement, will also be attached. During REM sleep, the eyes move rapidly, but the muscles are paralyzed. Periods during which the EOG recorded lots of movement, and the EMG recorded very little, would indicate REM sleep. An actigraph device will be placed on the wrists and ankles to measure body motion for obtaining objective measurements of sleep duration.

Question 8

The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour at night, as well as extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder?
A) Delayed sleep phase syndrome (DSPS)
B) Non-24-hour sleep-wake syndrome
C) Advanced sleep phase syndrome (ASPS)
D) Chronic insomnia

Accepted Answer

The teen's sleep patterns are characteristic of DSPS. Non-24-hour sleep-wake syndrome is characterized by a sleep cycle that greatly exceeds 24 hours, and ASPS is the opposite of DSPS. Chronic insomnia would likely include afternoon and evening drowsiness.

Question 9

A business traveler has just arrived in Japan from the United States. During a meeting with his customer, he begins to experience yawning and stretching with an inability to stay focused on the meeting. He also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms?
A) Advanced sleep phase syndrome
B) Delayed sleep phase syndrome
C) Free-running sleep disorder
D) Time zone change syndrome

Accepted Answer

All of the symptoms are manifestations of jet lag syndrome. Answer choice A relates to early sleep onset and early arising, where people have trouble staying awake in the evening. Answer choice B relates to difficulty in falling asleep at a conventional hour of night and awakening on time in the morning. Answer choice C relates to a lack of synchronization between the internal sleep-wake rhythm and the external 24-hour day, seen commonly in blind people.

Question 10

Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which of the following manifestations? Select all that apply.
A) Unable to sleep for a long period of time during the day
B) Falling asleep while sitting in front of a computer charting during the night
C) Finding it difficult to sleep when they have a night off
D) Heightened alertness and reflexes on their drive home after work
E) Increased hunger and thirst in the middle of the night

Accepted Answer

Manifestations of sleep disorders of night shift workers include shortened and interrupted daytime sleep after the night shift, somnolence and napping at work, sleepiness while commuting home, and insomnia on the nights off from work.

Question 11

An adult client is experiencing chronic insomnia related to a recent divorce and child custody proceedings. The client is requesting a renewable prescription for "sleeping pills." The nurse knows that which of the following interventions listed below will provide the most beneficial treatment for this client?
A) Sedatives and hypnotic drugs will not provide safe relief of the client's health problem.
B) The client is suffering from primary insomnia.
C) Melatonin supplements will be the safest and most effective long-term pharmacological treatment.
D) Behavioral therapies and education regarding sleep hygiene will provide assistance for the client.

Accepted Answer

Behavioral therapies may be beneficial in the treatment of insomnia. Sleep hygiene establishing a regular wake-up time to help set the circadian clock and regularity of sleep onset are encouraged. Drugs may be of use in the short term and should be used judiciously rather than completely avoiding them. The efficacy of melatonin is unproven, and his insomnia would likely be categorized as secondary insomnia, given the obvious contribution of stressors.

Question 12

A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply
A) She repeatedly moves her large toe, ankle, and knee during sleep.
B) She complains of a powerful urge to move her legs when in bed at night.
C) She has frequently awakened unable to move or speak.
D) She believes that she experiences auditory hallucinations when she awakens.
E) Her sleep latency is normally around 1 hour.

Accepted Answer

Sleep paralysis and hypnopompic hallucinations are symptoms of narcolepsy. Repeated toe, ankle, and leg movements are associated with periodic limb movement disorder, while an urge to move her legs would suggest restless legs syndrome. Narcolepsy is not normally associated with long sleep latency periods.

Question 13

While working for a neurologist who is assessing a patient experiencing restless legs syndrome (RLS), the nurse should be prepared to answer the question about why the patient needs to have his iron level drawn? The nurse response should include,
A) "Many of the drugs we give for RLS can cause drastic decreases in your iron level."
B) "Many patients with RLS also have an iron deficiency anemia as well."
C) "You just look a little pale, and so we want to make sure you have normal blood levels."
D) "People with low iron levels do not have enough oxygen circulating to their legs."

Accepted Answer

RLS may be a symptom of iron deficiency, so the patient should undergo testing for serum ferritin and iron saturation levels. Iron deficiency is frequently present in the absence of anemia. Answer choice A is incorrect since one of the ways RLS is treated is by administering medication to correct the iron deficiency. Answer choice C is a common sign of anemia. Answer choice D is incorrect since the number of RBCs will decrease the oxygen carrying capacity to the body, not iron levels. Low iron levels can be caused by infection, cancer, chronic blood loss, or dietary deficiencies to name a few.

Question 14

A 57-year-old female has presented to a clinic exasperated by the effect that restless legs syndrome is having on her sleep. The clinician has performed client teaching prior to choosing a treatment plan. Which of the following responses by the client demonstrates a sound understanding of her condition?
A) "Increasing my calcium intake is something simple that might help."
B) "Transcutaneous electrical nerve stimulation might be a treatment that can help me avoid needing drugs for this."
C) "This could be something that I'm simply prone to genetically."
D) "I'll try to get more exercise, since there aren't really any effective medications for restless legs syndrome."

Accepted Answer

There is a strong suggestion of a genetic component to RLS. Calcium intake is not noted to influence RLS, and TENS is not a noted treatment modality. Pharmacologic treatments exist for the problem.

Question 15

Which of the following individuals would be expected to have the highest risk of developing sleep apnea?
A) A woman with restless legs syndrome and chronic obstructive pulmonary disease
B) A male client with a diagnosis of unstable angina and peripheral arterial disease
C) A man with poorly controlled diabetes and hypertension
D) A female with chronic insomnia and atrial fibrillation that is treated with warfarin

Accepted Answer

Male gender, diabetes, and hypertension are all associated with sleep apnea. COPD, angina, PAD, and atrial fibrillation are not noted to be strongly associated with sleep apnea.

Question 16

Which of the following motor disorders of sleep can be life threatening?
A) Narcolepsy
B) Periodic limb movement disorder
C) Obstructive apnea
D) Restless legs syndrome

Accepted Answer

Obstructive apnea causes poor ventilation, poor-quality sleep, and daytime sleepiness, at best. At worst, it can contribute to depression, auto- and work-related accidents, cardiac dysrhythmias, and hypertension. Severe apnea can lead to pulmonary hypertension, polycythemia, or cor pulmonale. Periodic limb movement disorder and restless legs syndrome, although distressing and possibly indicative of a disease, are not of themselves life threatening. Narcolepsy is not a motor disorder of sleep.

Question 17

A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns?
A) "This is not an uncommon event that often accompanies older age."
B) "I'll likely prescribe a benzodiazepine for this when I next see your husband."
C) "This is understandably upsetting for you, but as long as the environment is safe, it's likely not significant."
D) "There may be something else going on with your husband such as delirium or a problem with his medications."

Accepted Answer

New-onset sleepwalking in the elderly is usually a manifestation of another problem such as delirium, drug toxicity, or a seizure disorder. It is not a normal age-related change, and a benzodiazepine is not a prudent initial treatment.

Question 18

The nurse is educating the new mother about the sleep patterns of a newborn. Which of the following statements should she include in her education?
A) "Newborns usually sleep approximately 16 to 20 hours/day."
B) "Newborns generally sleep 6 to 8 hours/day and then are awake for 2 to 4 hours."
C) "Don't worry about them sleeping too long; they will wake up when they are hungry."
D) "Most newborns will have their days and nights mixed up."

Accepted Answer

Newborns usually sleep approximately 16 to 20 hours/day. Equally distributed over night and daytime, sleep periods generally last for 1 to 4 hours interspersed with 1- to 2-hour periods of wakefulness. Initially, sleep-wake patterns are based on hunger.

Question 19

A 5-year-old boy has starting sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the boy about this, he has no recollection. What should the nurse convey to the parents if this happens again?
A) Assist the boy in settling down without awakening him after an episode.
B) Watch him closely to see if he has any twitching or thrashing about.
C) Bring him back to the clinic if this keeps happening, so we can prescribe some sleep medicine.
D) Shake him to wake him up, and then comfort him and put him back in bed.

Accepted Answer

Treatment for sleep terrors in children consists primarily of educating and reassuring the family. The child should be assisted in settling down without awakening. The child must be protected if he gets up and walks during these episodes.

Question 20

A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following a recent fall resulting in a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? Select all that apply.
A) "I make sure that I take a long nap each afternoon to compensate for my frequent waking at night."
B) "I've got a bottle of diazepam at home, but I only take them once or twice a month."
C) "I try my best to get out for a walk after breakfast or after supper."
D) "I make it a rule not to drink any alcohol in the evening."
E) "Once my head hits the pillow, I am fast asleep."

Accepted Answer

Daytime sleeping can interfere with the normal sleep-wake cycle. Diazepam is a
 long-acting benzodiazepine, and occasional use is acceptable. However, excessive use could lead to falls. Moderate exercise not performed before bedtime can help with insomnia. Alcohol can inhibit sleep in the elderly.

Quiz 20: Disorders of Hearing and Vestibular Function

Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep?

A client with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep?

Which of the following characteristics describe stage 2 non-REM sleep? Select all that apply.

Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in REM sleep?

The nurse knows that which of the following observations of a client during a sleep study would be most likely considered a pathological finding?

Which of the following statements about over-the-counter (OTC) melatonin is accurate?

When explaining an upcoming test, a polysomnography, the nurse should include which of the following education related to equipment placements the patient will have placed on his or her person during the sleep study? Select all that apply.

Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which of the following manifestations? Select all that apply.

A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply

While working for a neurologist who is assessing a patient experiencing restless legs syndrome (RLS) , the nurse should be prepared to answer the question about why the patient needs to have his iron level drawn? The nurse response should include,

Which of the following individuals would be expected to have the highest risk of developing sleep apnea?

Which of the following motor disorders of sleep can be life threatening?

A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns?

The nurse is educating the new mother about the sleep patterns of a newborn. Which of the following statements should she include in her education?

A 5-year-old boy has starting sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the boy about this, he has no recollection. What should the nurse convey to the parents if this happens again?