Deck 21: Sleep–Wake Disorders

Question 1

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

A) Skull X-rays
B) Electroencephalogram (EEG)
C) Positron emission tomography (PET)
D) Single-photon emission computed tomography (SPECT)

Answer 1

Electroencephalogram (EEG)

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?

A) The patient will have fewer dreams.
B) The patient will have less slow-wave sleep.
C) The patient will experience extended sleep latency.
D) The patient will enter sleep through rapid eye movement (REM) sleep.

Answer 2

The patient will have less slow-wave sleep.

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?

A) Using a vacuum cleaner
B) Cooking a meal
C) Driving a car
D) Bathing

Answer 3

Driving a car

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.

A) "It sounds like you are very devoted to your spouse."
B) "I noticed you fell asleep while I was assessing your spouse. I'm concerned about you."
C) "Your spouse is lucky to have you to provide care rather than being placed in a nursing home."
D) "If you keep going like this, your health will be impaired also. Then who will take care of both of you?"

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?

A) "What have you done to try to improve your sleep?"
B) "What would be a good sleep pattern for you?"
C) "How much exercise are you getting?"
D) "Do you have pain at night?"

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?

A) Hypnotic
B) Tricyclic antidepressant
C) Conventional antipsychotic
D) Central nervous system stimulant

Question 7

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

A) The master biological clock responds to darkness with sleep.
B) Darkness stimulates histamine release, which promotes sleep.
C) Cooler environmental temperatures stimulate retinal messages.
D) Stimulation of the sympathetic nervous system promotes sleep.

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?

A) Delta sleep
B) Parasomnia
C) Sleep latency
D) Rapid eye movement sleep

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?

A) "For 1 full week, record what you remember about your dream content and related feelings as soon as you wake up. Bring the record to your next appointment."
B) "While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings."
C) "For 2 full weeks, record how much time you sleep each night and rate your daytime alertness on a scale of 1 to 10. Calculate your average alertness score."
D) "All adults need 7 or 8 hours of sleep to function properly. Let's design ways to help you reach that goal."

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?

A) "What stress are you experiencing in your life?"
B) "How much sleep do you get in a 24-hour period?"
C) "Would it help if you do some exercises just before going to bed?"
D) "Have you considered using a hypnotic medication to help you sleep?"

Question 11

Which person would be most likely to experience sleep fragmentation?

A) An obese adult
B) A toddler who attends day care
C) A person diagnosed with mild osteoarthritis
D) An adolescent diagnosed with anorexia nervosa

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?

A) Sleep paralysis
B) Night terror disorder
C) Sleep-related bruxism
D) Rapid eye movement (REM) sleep behaviour disorder

Question 13

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

A) The patient will have more dreams.
B) The patient will have excessive sleepiness.
C) The patient will have less slow-wave sleep.
D) The patient will have less rapid eye movement (REM) sleep.

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?

A) Sleep deprivation
B) Nightmare disorder
C) Night terror disorder
D) REM sleep behaviour disorder

Question 15

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

A) Retiree who volunteers twice a week at Habitat for Humanity
B) Corporate accountant who travels frequently
C) Parent with three teenagers
D) Lawn care worker

Question 16

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

A) "I turn on the television every night to get to sleep. I set the timer so it goes off in 30 minutes."
B) "I have diarrhea frequently and not much energy, so I stay at home most of the time."
C) "I sleep only about 5 hours a night, but I know I should sleep 7 or 8 hours."
D) "When my alarm clock goes off every morning, it seems like I am dreaming."

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.

A) "Circadian drives give daytime naps a structure different from nighttime sleep."
B) "The body clock operates on a 24-hour cycle, making nap effectiveness unpredictable."
C) "It is a matter of habit and expectation. We expect to be more refreshed from a night's sleep."
D) "Sleep restores homeostasis but works more efficiently when aided by melatonin secreted at night."

Question 18

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

A) Summer
B) Winter
C) Spring
D) Fall

Question 19

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

A) "It's important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents."
B) "Sleep deprivation is usually self-limiting. See your health care provider if it lasts more than a year."
C) "Turn the radio on with a soft volume as you prepare for bed each evening. It will help you relax."
D) "Three glasses of wine each evening help many patients who suffer from sleep deprivation."

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?

A) Sleep architecture changes during the sleep period, resulting in increased slow-wave sleep at the end of the cycle.
B) Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods.
C) Dreams occur more frequently when a person is experiencing unresolved conflicts or depression.
D) Dream content relates directly to developmental tasks. The person is likely feeling autonomous.

Question 21

Which neurotransmitters are most responsible for wakefulness? Select all that apply.

A) Gamma-aminobutyric acid (GABA)
B) Norepinephrine
C) Acetylcholine
D) Dopamine
E) Galanin

Question 22

A night shift worker reports, "I'm having trouble getting to sleep after a night's work. I have a hearty breakfast with coffee, read the paper, do my exercises, and then go to bed. However, I just lie awake until it is nearly time to get up to be with my family for dinner." What changes should the nurse suggest? Select all that apply.

A) Drink juice with breakfast rather than coffee.
B) Exercise after awakening rather than before.
C) Turn on the television when going to bed.
D) Do not read the paper.
E) Eat a light breakfast.

Question 23

A young adult says to the nurse, "I go to sleep without any problem, but I often wake up during the night because it feels like there are rubber bands in my legs." Which assessment question should the nurse ask to assess for restless legs syndrome (RLS)?

A) "What type of birth control do you use?"
B) "How much caffeine do you use every day?"
C) "How much exercise do you get in a typical day?"
D) "Is the sensation relieved by stretching or flexing your legs?"

Question 24

A new patient at the sleep disorders clinic tells the nurse, "I have not slept well in a year, so I never feel good. I do not expect things will ever improve or be any different." Which of the following interventions should the nurse consider doing? Select all that apply.

A) Suggest using alcohol as a sedative
B) Provide instruction in relaxation techniques
C) Counsel the patient to address cognitive distortions
D) Teach the patient about factors that influence sleep
E) Teach fatigue-producing activities to become overtired

Question 25

A patient tells the nurse, "Everyone says we should sleep 8 hours a night. I can only sleep 6 hours, no matter how hard I try. Am I doing harm to my body?" Select the nurse's best response.

A) "Tell me about strategies you have tried to increase your total sleep hours."
B) "Lack of sleep acts as a stressor on the body and can cause physical changes."
C) "If you have really tried to sleep more, maybe you should consult your health care provider."
D) "If you function well with 6 hours of sleep, you are a short sleeper. That's normal for some people."

Question 26

A patient says, "I have trouble falling asleep at night and might lie awake until 3 or 4 a.m. before falling sleep." Which medication would the nurse expect a health care provider to prescribe for this patient?

A) Triazolam
B) Flurazepam (Dalmane)
C) Risperidone (Risperdal)
D) Methylphenidate (Ritalin)