Deck 12: Sleep-Wake Disorders

Question 1

The nurse is caring for a patient with suspected shift work disorder. In order for the patient to be diagnosed with this disorder, what must criteria must the patient meet?

A) The criteria for at least one other physiological disorder
B) Sleep loss of more than 2 hours per day due to the shift work
C) The criteria for other sleep circadian-rhythm disorders
D) Absence of any physiological disorders that may cause the symptoms

Answer 1

Absence of any physiological disorders that may cause the symptoms

Question 2

The nurse admits a patient with narcolepsy to the psychiatric-mental health unit. Which statements best describe the medication choices for this disorder? Select all that apply.

A) Sodium oxybate is given at night to consolidate sleep.
B) Traditional stimulants are given to increase wakefulness.
C) Antidepressants are used because they are known to suppress REM sleep.
D) Diphenhydramine is often the first line drug because of its safety profile.
E) Antipsychotics may be prescribed to reduce cataplexy.

Answer 2

Sodium oxybate is given at night to consolidate sleep.
Traditional stimulants are given to increase wakefulness.
Antidepressants are used because they are known to suppress REM sleep.

Question 3

The nurse is assessing a patient who is being admitted to the psychiatric inpatient unit. The patient reports that he has had insomnia "for years." The nurse will assess for which behaviors related to chronic insomnia? Select all that apply.

A) Spending more time in bed
B) Watching television in bed
C) Staying up as late as possible
D) Taking hot showers at bedtime
E) Spending more time with others

Answer 3

Spending more time in bed
Watching television in bed
Taking hot showers at bedtime

Question 4

When providing patient teaching to an older adult patient and her daughter, the nurse cautions them about avoiding which over-the-counter medication often used by patients with sleep-wake disorders?

A) Zolpidem
B) Ramelteon
C) Trazodone
D) Diphenhydramine

Question 5

A patient with a sleep-wake disorder tells the nurse that she has been drinking a couple glasses of wine before bed to make herself sleepy. What is the best response by the nurse?

A) "That's a reasonable thing to do if it makes you sleepy at bedtime."
B) "If that works for you, try to drink red wine for the antioxidant benefit."
C) "If you drink wine to go to sleep, make sure you don't take it with medication."
D) "Alcohol might make you sleepy but it contributes to awakenings later in the night."

Question 6

Because of its presentation and effects on the body, which disorder is most likely to cause significant disruption to a patient's autonomy and employment?

A) Insomnia
B) Narcolepsy
C) Restless legs syndrome
D) Breathing-related sleep disorders

Question 7

The nurse suggests the use of meditation before bedtime for a patient diagnosed with a sleep-wake disorder. Which type of cognitive-behavioral therapy is the nurse suggesting?

A) Sleep hygiene
B) Cognitive therapy
C) Relaxation training
D) Stimulus control therapy

Question 8

The care plan for a newly admitted patient includes orders for stimulant medication and two scheduled naps per day. The nurse knows these are standard treatments for which sleep-wake disorder?

A) Narcolepsy
B) Central sleep apnea
C) Hypersomnolence disorder
D) Circadian rhythm disorder

Question 9

The nurse is providing patient teaching to a patient newly diagnosed with sleep apnea. The patient asks the nurse how it works to correct his sleep apnea. Which is the most appropriate statement by the nurse?

A) "The machine is set up to breathe for you when you stop breathing during the night."
B) "The machine's positive airway pressure provides a reminder to breathe during periods of apnea. "
C) "The machine's positive airway pressure keeps the upper airway structures from collapsing during sleep."
D) "The machine is set to give you oxygen during the times when you stop breathing and keep you from snoring."

Question 10

What clinical manifestation related to sleep is most likely in a patient who is obese and has hypertension?

A) Wakefulness
B) Periodic apnea
C) Hypersomnolence
D) Periodic limb movements

Question 11

Which alteration of the psychological domain may occur in patients with sleep disorders?

A) Decreased immune function
B) Impaired cognitive functioning
C) Inability to perform work tasks
D) Decreased enjoyment in social activities

Question 12

The nurse is working with a patient who has been diagnosed with restless leg syndrome (RLS). The nurse recognizes this disorder may result in which symptoms or complications for the patient in the psychological domain? Select all that apply.

A) Irritability and inability to concentrate
B) Disruption of bed partner's sleep
C) Inability to attend social functions due to discomfort
D) Fragmented sleep
E) Anxiety and mood changes

Question 13

The patient is diagnosed with restless leg syndrome (RLS) and asks the nurse, "What sort of disorder is it?" What is the nurse's best response?

A) "It is an anxiety disorder."
B) "It is a physical disorder."
C) "It is a neurological disorder."
D) "It is an obsessive-compulsive disorder."

Question 14

A patient was recently diagnosed with obstructive sleep apnea (OSA) expresses to the nurse that he is afraid he will die in his sleep, despite the use of CPAP. What is the most appropriate statement by the nurse?

A) "It does happen sometimes, but you should be fine with the CPAP."
B) "That is not likely because the CPAP can breathe for you if you stop breathing."
C) "Don't worry, we'll be monitoring your oxygen saturation and we'll wake you up before that happens."
D) "That is not likely, because when your body has is not getting enough oxygen, it sends an awakening alert."

Question 15

The nurse is instructing a patient on sleep hygiene for his sleep-wake disorder. Which guidelines will the nurse include for this patient? Select all that apply.

A) Arise at the same day every day, all 7 days of the week.
B) Cut down on any food or beverage that contains caffeine.
C) Take periodic naps to avoid becoming stressed.
D) Eat healthy meals and do not go to bed hungry.
E) Drink one glass of wine before bed to aid relaxation.

Question 16

The nurse is planning patient education on obstructive sleep apnea (OSA)? Which will she include as a risk factor for OSA?

A) Opioid addiction
B) Hypertension
C) Narcolepsy
D) Hypersomnolence

Question 17

Which questions should the nurse ask to determine if a patient has an underlying sleep-wake disorder? Select all that apply.

A) "Do you have issues with snoring?"
B) "Do you wake feeling tired and not restored?"
C) "Do you suffer from excessive daytime sleepiness?"
D) "Do you apply appropriate sleep hygiene to your routine?"
E) "Do you think your sleep is affecting your daytime functioning"

Question 18

What clinical manifestation is most likely to occur in a patient who is not adhering to the treatments used to treat the patient's obstructive sleep apnea (OSA)?

A) Hypotension
B) Hyperglycemia
C) Acute renal failure
D) Hypnogogic hallucinations

Question 19

What health promotion and lifestyle strategies will the nurse suggest to a patient with shift work disorder? Select all that apply.

A) Avoid working excessive overtime.
B) Arrive to work as rested as possible.
C) Use caffeine to stay awake while driving home.
D) Exercise regularly, especially if job is sedentary.
E) Allow at least a 5 hour sleep period without interruption.

Question 20

A patient with obstructive sleep apnea is unhappy using CPAP therapy and asks the nurse if there is something else he can try. What is the best statement by the nurse?

A) "Perhaps a class in sleep hygiene would be helpful."
B) "Certain classes of sleeping pills are sometimes effective in OSA."
C) "Cognitive-behavioral therapy works for some people with OSA."
D) "Oral-pharyngeal surgery, some appliances, or weight loss are sometimes utilized."

Question 21

The nurse is caring for a patient who is having a great deal of difficulty going to sleep and staying asleep. The nurse suggests implementing which strategies? Select all that apply.

A) Providing relaxation with music or a massage before bed
B) Making sure the room is dark to facilitate sleeping
C) Ensuring that the environment is quiet by reducing staff noise
D) Arranging for the provider to order benzodiazepines at bedtime
E) Coordinating care to avoid waking the patient during the night, if possible

Question 22

When caring for a patient with a sleep-wake disorder, the nurse notes that the patient takes an MAO inhibitor for depression. Which medication order for the patient will the nurse question? Select all that apply.

A) Zaleplon (Sonata)
B) Zolpidem (Ambien)
C) Amitriptyline (Elavil)
D) Nortriptyline (Aventyl)
E) Chloral hydrate (Leukeran)

Question 23

The nurse is caring for a patient who is a poor historian and cannot give much detail about his broken sleep. When evaluating his disorder and developing a treatment plan, what would be most helpful?

A) The results of a sleep study
B) A list of the patient's allergies to medications
C) The results of the Epworth Sleepiness Scale
D) A conversation with the patient's bed partner

Question 24

A patient admitted to the psychiatric-mental health unit tells the nurse she is having trouble sleeping because of "all the commotion" in the hospital. The patient adds that she does not normally have problems with sleep. What is the best statement by the nurse?

A) "You should go on a brisk walk right before bed."
B) "You should turn on the TV to mask the noises on the unit."
C) "I'll talk to the doctor and ask him to order you a sleeping pill."
D) "I will get you some ear plugs so that you won't hear as much noise at night."

Question 25

When developing a care plan for a patient with a sleep-wake disorder, the nurse must ask which questions? Select all that apply.

A) Is the patient exhibiting drug-seeking behavior?
B) Does the patient really have a sleep-wake disorder?
C) Which symptom is most distressing or upsetting to the patient?
D) Is the patient able to work with the team to develop his care plan?
E) What specific goal is the patient wanting to achieve with his sleep?

Question 26

The nurse is caring for a patient with a sleep phase disorder who is seeking care for the treatment of the condition. The nurse should anticipate which medication being ordered for this patient?

A) Zolpidem (Ambien)
B) Zaleplon (Sonata)
C) Ramelteon (Rozerem)
D) Chloral hydrate (Leukeran)

Question 27

The nurse is caring for a patient with a sleep-wake disorder. What outcome would be most appropriate for this patient?

A) The patient will state a feeling of rest upon awakening.
B) The patient will increase amount of time slept in 3 days.
C) The patient will increase sleep time from 5 hours per night to 7 hours per night.
D) The patient will increase sleep time from 5 hours per night to 7 hours per night in 3 days.

Question 28

A patient tells the nurse she takes Advil PM (ibuprofen plus diphenhydramine) every night for sleep along with the use of CPAP for sleep apnea. She states that lately she is feeling "hung over" in the morning. What is the best response by the nurse?

A) "Are you using the CPAP regularly the way it was ordered?"
B) "That medication is not recommended for people with sleep apnea."
C) "That's a safe over-the-counter medication. What other meds do you take?"
D) "I will let the physician know so that she can order a new sleep study for you."