A patient’s partner informs the nurse that the patient snores very loudly and often stops breathing for 15-20 seconds at a time while sleeping, followed by a loud snort. The patient complains of being tired all the time. The nurse recognizes these symptoms as characteristic of which sleep disorder?
A. Narcolepsy
B. Insomnia
C. Obstructive sleep apnea (OSA)
D. Restless legs syndrome
Correct Answer: C. Obstructive sleep apnea (OSA)
Rationale: The key signs described—loud snoring, periods of apnea (cessation of breathing), and excessive daytime sleepiness (being “tired all the time”)—are the classic triad for obstructive sleep apnea (OSA).
A 24-year-old patient reports feeling an “uncontrollable urge to move” their legs, especially in the evening when trying to relax. The patient describes the sensation as “crawling or tingling.” Which sleep disorder do these symptoms most closely align with?
A. Somnambulism
B. Bruxism
C. Cataplexy
D. Restless legs syndrome
Correct Answer: D. Restless legs syndrome
Rationale: Restless legs syndrome is a dyssomnia characterized by an uncontrollable urge to move the legs, often accompanied by abnormal tingling or crawling sensations that are worse during periods of rest, especially in the evening.
A nurse is developing a discharge teaching plan for a patient diagnosed with chronic insomnia. Which of the following patient statements would indicate a need for further education regarding sleep hygiene?
A. “I will limit my caffeine intake to the morning hours.”
B. “I should use my bedroom only for sleep and intimacy, not for watching TV.”
C. “I’ll have a small glass of wine each night before bed to help me relax.”
D. “I will try to maintain a consistent sleep-wake schedule, even on weekends.”
Correct Answer: C. “I’ll have a small glass of wine each night before bed to help me relax.”
Rationale: This statement requires correction. While alcohol is a sedative and may initially cause drowsiness, it fragments sleep, suppresses REM sleep, and often leads to middle-of-the-night awakenings. Good sleep hygiene includes avoiding or limiting alcohol, especially before bed. Options A, B, and D are all correct components of sleep hygiene.
The parents of a 7-year-old child report to the nurse that they have found their child walking around the house in the middle of the night. They state the child appears “glassy-eyed” and has no memory of the event the next morning. The nurse identifies this behavior as which parasomnia?
A. Nocturnal enuresis
B. Somnambulism
C. Sleep terrors
D. Bruxism
Correct Answer: B. Somnambulism
Rationale: Somnambulism, or sleepwalking, is a parasomnia that involves walking or performing other complex behaviors while in a state of deep sleep, with no subsequent memory of the event.
A college student reports frequent, uncontrollable “sleep attacks” during the day, even after a full night’s sleep. The student also describes episodes of sudden, brief muscle weakness when experiencing strong emotions like laughter. The nurse suspects the patient may be experiencing narcolepsy with which associated symptom?
A. Cataplexy
B. Hypersomnia
C. Insomnia
D. Sleep deprivation
Correct Answer: A. Cataplexy
Rationale: Narcolepsy is a chronic neurologic disorder characterized by overwhelming daytime sleepiness (sleep attacks). Cataplexy, which is a sudden, brief loss of voluntary muscle tone triggered by strong emotions (like laughter or surprise), is a highly specific symptom associated with narcolepsy.
A patient’s partner reports that the patient grinds their teeth loudly during the night. The patient complains of jaw pain and headache upon waking. The nurse recognizes this as which parasomnia?
A. Somnambulism
B. Cataplexy
C. Nocturnal enuresis
D. Bruxism
Correct Answer: D. Bruxism
Rationale: Bruxism is a parasomnia characterized by the clenching or grinding of teeth from side to side during sleep. This can lead to jaw pain (temporomandibular joint dysfunction) and morning headaches.
A nurse is teaching a student about the normal sleep cycle. Which statement by the student indicates an accurate understanding of non–rapid eye movement (NREM) sleep?
A. “This is when vivid, colorful dreaming is most likely to occur.”
B. “Brain waves, heart rate, and blood pressure are all reduced during NREM sleep.”
C. “This stage starts about 90 minutes after sleep begins and is associated with muscle paralysis.”
D. “NREM sleep is a light stage of sleep that only occurs at the beginning of the night.”
Correct Answer: B. “Brain waves, heart rate, and blood pressure are all reduced during NREM sleep.”
Rationale: Non–rapid eye movement (NREM) sleep is a period of reduced physiologic activity. Brain waves, breathing, and heart rate slow down, and blood pressure drops. Vivid dreaming (Option A) and muscle paralysis (Option C) are characteristic of REM sleep. NREM sleep has multiple stages, including the deepest stages of sleep (Option D is incorrect).
A patient is admitted to the intensive care unit (ICU) and is frequently awakened by alarms, vital sign checks, and procedures. The patient becomes irritable, has difficulty concentrating, and reports nausea. The nurse identifies these as symptoms of what condition?
A. Obstructive sleep apnea
B. Narcolepsy
C. Sleep deprivation
D. Hypersomnia
Correct Answer: C. Sleep deprivation
Rationale: Sleep deprivation results from a prolonged lack of good-quality sleep. Hospitalization, especially in critical care, is a major risk factor due to environmental factors. Symptoms include irritability, decreased concentration, fatigue, and even nausea or increased sensitivity to pain.
A nurse is working the night shift. The nurse understands that this schedule disrupts the body’s 24-hour, day-night cycle. What is the correct term for this biologic rhythm?
A. Sleep-wake cycle
B. Parasomnia
C. Circadian rhythm
D. Polysomnography
Correct Answer: C. Circadian rhythm
Rationale: Circadian rhythms are the 24-hour, day-night biologic rhythms that influence patterns of biologic and behavioral functions, including the sleep-wake cycle. Shift work is a common cause of circadian rhythm disruption.
A physician schedules a diagnostic test for a patient with suspected obstructive sleep apnea. The test will record the patient’s brain waves, eye movements, heart rate, and airflow during an entire night of sleep. The nurse prepares to educate the patient about which test?
A. Multiple sleep latency test
B. Polysomnography
C. A sleep hygiene assessment
D. Epworth Sleepiness Scale
Correct Answer: B. Polysomnography
Rationale: Polysomnography is the definitive diagnostic test for many sleep disorders. It involves recording multiple physiologic variables during sleep, including brain waves (EEG), eye movements (EOG), muscle activity (EMG), heart rate (ECG), and respiratory airflow.
11 A patient with chronic insomnia is prescribed a hypnotic medication. The nurse is providing discharge education. Which patient statement indicates a need for further teaching?
A. “I will take this medication about 15 minutes before I plan to go to sleep.”
B. “I should avoid drinking wine or other alcoholic beverages while taking this.”
C. “I may feel a little groggy in the morning, especially the first few times I take it.”
D. “This medication is safe to take with my over-the-counter allergy medication.”
Correct Answer: D. “This medication is safe to take with my over-the-counter allergy medication.”
Rationale: This statement requires correction. Many over-the-counter (OTC) allergy medications, especially those containing antihistamines, also cause drowsiness and are central nervous system (CNS) depressants. Taking them with a hypnotic (which is also a CNS depressant) can cause a dangerous synergistic effect, leading to excessive sedation, dizziness, and an increased risk of falls.
A patient reports sleeping more than 9 hours every night but continues to experience overwhelming daytime sleepiness, difficulty concentrating, and a strong urge to nap daily. This condition, which is not caused by disturbed sleep or a circadian rhythm problem, is best defined as:
A. Hypersomnia
B. Insomnia
C. Cataplexy
D. Sleep deprivation
Correct Answer: A. Hypersomnia
Rationale: Hypersomnia is a sleep disorder characterized by excessive daytime sleepiness or prolonged nighttime sleep, despite getting an adequate amount (or more) of sleep. The patient’s report of overwhelming sleepiness even after 9+ hours of sleep directly aligns with this definition.
The parents of a 9-year-old child are concerned because the child, who has been toilet-trained since age 3, has recently started wetting the bed 2-3 times per week. The nurse identifies this as secondary nocturnal enuresis. What is the nurse’s priority assessment question?
A. “Does the child drink a large amount of water right before bedtime?”
B. “Is the child a very deep sleeper?”
C. “Have there been any recent changes or stressful events at home or school?”
D. “Does bedwetting run in your family?”
Correct Answer: C. “Have there been any recent changes or stressful events at home or school?”
Rationale: Secondary nocturnal enuresis (bedwetting after a child has been consistently dry for at least 6 months) is often linked to new psychosocial stressors, such as a new sibling, a divorce, bullying, or academic pressure. It can also be a sign of a medical issue like a UTI or diabetes. Therefore, assessing for new stressors is a priority. While the other options are relevant, they are less likely to be the cause of a new onset of enuresis.
A nurse is developing a plan of care for a patient in the intensive care unit (ICU) who has been experiencing frequent awakenings due to monitor alarms, staff conversations, and vital sign checks. The patient is irritable, reports difficulty concentrating, and complains of a persistent headache. Which nursing diagnosis is the priority for this patient?
A) Fatigue related to underlying illness
B) Anxiety related to the critical care environment
C) Sleep Deprivation related to environmental factors and interruptions
D) Impaired Comfort related to required medical procedures
Answer: C
Rationale: The patient’s cues (irritability, difficulty concentrating, headache) combined with the known, controllable interruptions in the ICU environment (alarms, staff, procedures) directly support the nursing diagnosis of Sleep Deprivation. While fatigue, anxiety, and impaired comfort may also be present, the cluster of symptoms and the clear cause point to Sleep Deprivation as the priority problem that nursing interventions can most directly address.
A nurse is teaching a patient with chronic insomnia about practices to improve sleep. Which of the following patient statements indicates a need for further education regarding sleep hygiene?
A) “I will try to go to bed and wake up at the same time every day, even on the weekends.”
B) “I’ve stopped drinking coffee and cola after 3 PM to help me wind down.”
C) “If I can’t fall asleep within 20 minutes, I will get up and read a book in the living room.”
D) “I do my work emails in bed every night; it helps me feel tired and ready for sleep.”
Answer: D
Rationale: Good sleep hygiene involves creating an environment and routines that are conducive to sleep. Using the bed for activities other than sleep and intimacy, such as working on a laptop, weakens the mental association between the bedroom and sleep. Furthermore, the blue light from electronic devices can suppress melatonin production, making it harder to fall asleep. Options A, B, and C are all correct examples of good sleep hygiene.
The parent of an 8-year-old child tells the nurse they are worried because they found their child walking in the hallway last night with their eyes open, appearing “glassy.” The parent was able to gently guide the child back to bed without the child fully waking. The nurse recognizes this as characteristic of which parasomnia?
A) Nocturnal enuresis
B) Somnambulism
C) Bruxism
D) Sleep terrors
Answer: B
Rationale: Somnambulism, or sleepwalking, is a parasomnia characterized by getting up and walking around while in a state of sleep. The person often has glassy eyes and is difficult to awaken. Gently guiding the person back to bed is the recommended safety intervention. Nocturnal enuresis is bedwetting, bruxism is teeth grinding, and sleep terrors involve waking in a terrified state.
A patient is admitted to the hospital and reports chronic difficulty sleeping. Which goal is most appropriate for the nursing diagnosis Impaired Sleep?
a. The patient will sleep for 8 hours uninterrupted each night.
b. The nurse will administer a sedative nightly at 9 p.m.
c. The patient will report feeling more rested upon awakening within 3 days.
d. The patient will identify all factors interfering with sleep by discharge.
Answer: c
Rationale: This goal is patient-centered, realistic, and measurable. Reporting feeling rested is a key indicator of sleep quality (p. 750). An 8-hour uninterrupted goal may be unrealistic in a hospital (p. 745), and administering medication is a nursing intervention, not a patient goal.
The nurse is developing a plan of care for the case study patient, S. A., who is diagnosed with Sleep Deprivation. Which short-term goal is the highest priority?
a. Patient will state the side effects of sleep medications.
b. Patient will fall asleep within 30 minutes of going to bed within 1 week.
c. Patient will join a support group for stress within 1 month.
d. Patient will eliminate all caffeine and alcohol from her diet immediately.
Answer: b
Rationale: This is a specific, measurable, and patient-centered goal that directly addresses S. A.’s primary complaint of taking 60-90 minutes to fall asleep (p. 736, Case Study). The other options are either interventions or long-term goals.
A patient is in the intensive care unit (ICU). The nurse identifies the diagnosis Impaired Sleep related to the environment. What is a realistic goal for this patient?
a. Patient will sleep for 90- to 120-minute intervals during the night.
b. Patient will experience no awakenings for 8 hours.
c. Patient will remain in NREM stage 3 sleep all night.
d. Patient will be moved to a private room by the next shift.
Answer: a
Rationale: The text states that clustering care to allow for 90- to 120-minute blocks of uninterrupted sleep allows for the completion of all sleep stages (p. 745). This is a realistic goal in a critical care setting, whereas an 8-hour uninterrupted sleep is not.
A patient is newly diagnosed with obstructive sleep apnea (OSA). Which goal is most important for this patient?
a. Patient will demonstrate correct use of the CPAP machine before discharge.
b. Patient will lose 20 pounds in the next month.
c. Patient will report dreaming 3-5 times per night.
d. Patient will be able to identify all causes of sleep apnea.
Answer: a
Rationale: The primary treatment for OSA is CPAP (p. 746). Therefore, a high-priority goal is ensuring the patient can use the equipment correctly to maintain airway patency and prevent hypoxia.
When writing a patient goal for a sleep disturbance, which component is essential for evaluation?
a. It must be nurse-focused.
b. It must be measurable and time-limited.
c. It must include a nursing diagnosis.
d. It must involve pharmacologic interventions.
Answer: b
Rationale: To evaluate the effectiveness of a plan of care, the goal must be measurable (e.g., “sleeps for 6 hours,” “reports feeling rested”) and have a timeframe (e.g., “within 1 month,” “by discharge”) (p. 744).
The nurse is developing goals for a patient with Sleep Deprivation related to high stress and poor sleep hygiene. Which goals are appropriate? (Select all that apply.)
a. Patient will identify factors that interfere with sleep.
b. Nurse will teach relaxation techniques at bedtime.
c. Patient will report sleeping for 6-7 hours per night within 1 month.
d. Patient will use a variety of techniques to promote sleep.
e. Patient will stop drinking all coffee.
Answer: a, c, d
Rationale: These are patient-centered, measurable goals that align with the evaluation criteria listed on page 750. Teaching (b) is an intervention, and “stop drinking all coffee” (e) is an intervention that may not be a realistic goal (whereas limiting coffee is).
For a patient with narcolepsy, which goal would be the priority?
a. Patient will report an absence of vivid dreaming.
b. Patient will remain safe and free from injury related to sleep episodes.
c. Patient will be able to stay awake for 24 hours without napping.
d. Patient will join a gym to increase vigorous exercise.
Answer: b
Rationale: Narcolepsy involves “uncontrollable onset of sleep” (p. 738), which places the patient at high risk for falls, driving accidents, and other injuries. Safety is the highest priority.
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Pharmacology Week 318
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