Chapter 19: Sleep Disorders: Dyssomnias and Parasomnias My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 19: Sleep Disorders: Dyssomnias and Parasomnias

Test Bank

MULTIPLE CHOICE

1. Which assessment observation would not support a diagnosis of narcolepsy?

a.

Sleep study reports excessive, loud snoring.

b.

Sleep study shows evidence of sleep paralysis.

c.

Patient reports needing to drink pots of coffee to stay awake at work.

d.

Patient reports, When I get sleepy I actually see things that arent really there.

ANS: A

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

DIF: Cognitive Level: Application REF: Page 446

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

2. 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)?

a.

The apnea will be lessened by this medication.

b.

It will help control the sporadic loss of muscle tone.

c.

This medication will minimize the daytime sleepiness.

d.

Dexedrine will manage the inflammation that causes the snoring.

ANS: C

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.

DIF: Cognitive Level: Application REF: Page 451

TOP: Nursing Process: Implementation

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

3. 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?

a.

Melatonin is not being released in sufficient quantity.

b.

This condition is often due to adenotonsillar hypertrophy.

c.

Children have a high ratio of REM sleep that can result in frequent gasping.

d.

This can be related to a sleep position which compromises chest movement.

ANS: B

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.

DIF: Cognitive Level: Application REF: Page 445 TOP: Nursing Process: Planning

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

4. Which outcome is appropriate for an adult patient recently diagnosed with primary insomnia?

a.

Demonstrate an understanding of the cerebral stimulants prescribed.

b.

Recognize that the prescribed flurazepam (Dalmane) can be used for up to 2 months.

c.

Demonstrate the proper use of continuous positive airway pressure (CPAP) ventilation.

d.

Recognize physical and psychosocial stressors that exacerbate the sleep disturbance.

ANS: D

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.

DIF: Cognitive Level: Application REF: Page 448 TOP: Nursing Process: Planning

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

5. 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?

a.

Medication therapy seldom prescribed for this disorder

b.

Safety issues such as sleeping in the ground level bedroom

c.

The likely connection between sleepwalking and narcolepsy

d.

The need for short-term cognitive and behavioral therapy

ANS: B

Safety is a primary concern when managing sleepwalking since injury is quite likely as a result of the patients 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.

DIF: Cognitive Level: Application REF: Page 452 TOP: Nursing Process: Planning

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

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

a.

I just started on the night shift at work.

b.

My mother was seriously depressed for years.

c.

I wake up gasping for breath, and it is really scary.

d.

I dont think I drink any more than my buddies do.

ANS: A

The shift worktype 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.

DIF: Cognitive Level: Application REF: Page 447

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

7. Which physical assessment finding is supportive of a diagnosis of obstructive sleep apnea?

a.

Barrel chest

b.

Raccoon eyes

c.

Enlarged nasal nares

d.

Large neck circumference

ANS: D

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.

DIF: Cognitive Level: Application REF: Page 446

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

8. When the family of a child diagnosed with a nightmare disorder asks the nurse about prognosis, the nurse replies with the knowledge that:

a.

The disorder is frequently self-limiting in children.

b.

If the child is obese, it is likely the nightmares will continue.

c.

High doses of diazepam (Valium) are needed to cure the disorder.

d.

With the use of antipsychotic medication, the disorder will not worsen.

ANS: A

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.

DIF: Cognitive Level: Application REF: Pages 445-446

TOP: Nursing Process: Implementation

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

9. Which of the statements made by the patient would be most indicative of dyssomnia?

a.

I think I am seeing things when I wake up.

b.

My wife says I snore and even stop breathing.

c.

I go to sleep okay but then wake up several times at night.

d.

My wife says I sit straight up in bed at 2 AM and then say strange things.

ANS: C

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.

DIF: Cognitive Level: Application REF: Page 446

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

10. A patient with obstructive sleep apnea (OSA) is being discharged. What patient statement indicates the need for further teaching?

a.

I hope to lose some weight.

b.

My antidepressants seem to be helping.

c.

I will try the oral appliance that the doctor suggested.

d.

A glass of wine at bedtime will help relax my airways.

ANS: D

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.

DIF: Cognitive Level: Application REF: Page 452 TOP: Nursing Process: Evaluation

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

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

a.

I will try to avoid daytime napping.

b.

Relaxing music may help relax me for sleep.

c.

Exercising before bed will make me good and tired.

d.

I need to cut back on my four daily cups of coffee.

ANS: C

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

DIF: Cognitive Level: Application REF: Page 452 TOP: Nursing Process: Evaluation

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

12. 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?

a.

My aunt uses them, and they help her a lot.

b.

Studies show they are ineffective as sleep aids.

c.

They can cause serious side effects and should be avoided.

d.

Be aware that these products are uncontrolled, so preparations vary.

ANS: D

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.

DIF: Cognitive Level: Application REF: Page 451

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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

a.

Observing for signs of self-mutilation

b.

Observing the patient for ritualistic behaviors

c.

Asking, Do you consider yourself to be depressed?

d.

Asking, Do you rely on alcohol to function socially?

ANS: C

Research supports a link between insomnia and major depression.

DIF: Cognitive Level: Application REF: Page 445

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

MULTIPLE RESPONSE

1. 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

a.

Urinary retention

b.

Blurred vision

c.

Rhinorrhea

d.

Dry mouth

e.

Diarrhea

ANS: A, B, D

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.

DIF: Cognitive Level: Comprehension REF: Pages 450-451

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. 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.

a.

Do you follow a low-fat diet?

b.

Are you a big coffee drinker?

c.

Do you indulge in an evening alcoholic drink?

d.

Have you been prescribed an opiate-based analgesic?

e.

Are you currently taking antianxiety medication?

ANS: B, C, D, E

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.

DIF: Cognitive Level: Application REF: Page 444

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

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

a.

Darken the bedroom.

b.

Go to sleep at the same time each night.

c.

Keep the bedroom environment calm and serene.

d.

Initially, retire 30 minutes earlier than usual.

e.

Take a low-dose over-the-counter sleep aid.

ANS: A, B, C, D

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.

DIF: Cognitive Level: Application REF: Page 453

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

4. Which notations should be included in a sleep journal? Select all that apply.

a.

Any regular bedtime rituals

b.

Things that assist with sleep

c.

Time when patient went to bed

d.

Things that interfere with sleeping

e.

Foods eaten at dinner or last meal

ANS: A, B, C, D

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.

DIF: Cognitive Level: Application REF: Page 449

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

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

a.

Depression

b.

Hypertension

c.

Anxiety disorders

d.

Gastric reflux disease

e.

Coronary artery disease

ANS: A, B, C, E

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.

DIF: Cognitive Level: Comprehension REF: Page 441

TOP: Nursing Process: Assessment

MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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