Chapter 8: Sleep and Sleep Disorders

Test Bank

MULTIPLE CHOICE

1. A patient complains of difficulty falling asleep and daytime fatigue for the past 6 weeks. What
is the best initial action for the nurse to take in determining whether this patient has chronic
insomnia?
a. Schedule a polysomnography (PSG) study.
b. Arrange for the patient to have a sleep study.
c. Ask the patient to keep a 2-week sleep diary.
d. Teach the patient about the use of an actigraph.
ANS: C
The diagnosis of insomnia is made on the basis of subjective complaints and an evaluation of
a 1- to 2-week sleep diary completed by the patient. Actigraphy and PSG studies/sleep studies
may be used for determining specific sleep disorders but are not necessary to make an initial
insomnia diagnosis.

DIF: Cognitive Level: Apply (application) REF: 105

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

2. A patient with chronic insomnia asks the nurse about ways to improve sleep quality. What is
the nurses best response?
a. Avoid aerobic exercise during the day.
b. Read in bed for a few minutes each night.
c. Keep the bedroom temperature slightly warm.
d. Try to go to bed at the same time every evening.
ANS: D
A regular evening schedule is recommended to improve sleep time and quality. Aerobic
exercise may improve sleep quality but should occur at least 6 hours before bedtime. Reading
in bed is discouraged for patients with insomnia. The bedroom temperature should be slightly
cool.

DIF: Cognitive Level: Apply (application) REF: 103

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

3. Which patient statement indicates a need for further teaching about extended-release zolpidem
(Ambien CR)?
a.I will take the medication an hour before bedtime.
b.I should take the medication on an empty stomach.
c.I should not take this medication unless I can sleep for at least 6 hours.
d.I will schedule activities that require mental alertness for later in the day.
ANS: A
Benzodiazepine receptor agonists such as zolpidem work quickly and should be taken
immediately before bedtime. The other patient statements are correct.

DIF: Cognitive Level: Apply (application) REF: 104

 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

4. The nurse cares for a critically ill patient in the intensive care unit (ICU). Which intervention
should the nurse include in the plan of care to improve this patients sleep quality?
a. Ask all visitors to leave the ICU for the night.
b. Lower the level of lights from 8:00 PM until 7:00 AM.
c. Avoid the use of opioids for pain relief during the evening hours.
d. Schedule assessments to allow at least 4 hours of uninterrupted sleep.
ANS: B
Lowering the level of light will help mimic normal day/night patterns and maximize the
opportunity for sleep. Although frequent assessments and opioid use can disturb sleep
patterns, these actions are necessary for the care of critically ill patients. For some patients,
having a family member or friend at the bedside may decrease anxiety and improve sleep.

DIF: Cognitive Level: Apply (application) REF: 106

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

5. What teaching should be included in the plan of care for a patient with narcolepsy?
a. Driving an automobile may be possible with appropriate treatment of narcolepsy.
b. Changes in sleep hygiene are ineffective in improving sleep quality in narcolepsy.
c. Antidepressant drugs are prescribed to treat the depression caused by the disorder.
d. Stimulant drugs should be used for only a short time because of the risk for abuse.
ANS: A
The accident rate for patients with narcolepsy who are receiving appropriate treatment is
similar to the general population. Stimulant medications are used on an ongoing basis for
patients with narcolepsy. The purpose of antidepressant drugs in the treatment of narcolepsy is
the management of cataplexy, not to treat depression. Changes in sleep hygiene are
recommended for patients with narcolepsy to improve sleep quality.

DIF: Cognitive Level: Apply (application) REF: 107

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

6. The nurse manager of a medical/surgical unit wants to improve the alertness of nurses who
work the night shift. Which action will be the most helpful?
a.Arrange for older staff members to work most night shifts.
b.Provide a sleeping area for staff to use for napping at night.
c.Post reminders about the relationship of sleep and alertness.
d.Schedule nursing staff to rotate day and night shifts monthly.
ANS: B
Short on-site naps will improve alertness. Rotating shifts causes the most disruption in sleep
habits. Reminding staff members about the impact of lack of sleep on alertness will not
improve sleep or alertness. It is not feasible to schedule nurses based on their ages.

DIF: Cognitive Level: Apply (application) REF: 110

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

7. Which information regarding a patient's sleep is most important for the nurse to communicate
to the health care provider?
a. 64-year-old nurse who works the night shift reports drinking hot chocolate before
 going to bed in the morning
b. 21-year-old student who takes melatonin to assist in sleeping when traveling from
the United States to Europe
c. 41-year-old librarian who has a body mass index (BMI) of 42 kg/m2 says that the
spouse complains about snoring
d. 32-year-old accountant who is experiencing a stressful week uses
diphenhydramine (Benadryl) for several nights
ANS: C
The patients BMI and snoring suggest possible sleep apnea, which can cause complications
such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe to
use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a
concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to affect this patients
sleep quality.

DIF: Cognitive Level: Analyze (analysis) REF: 107-108

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

8. A patient complains of insomnia and daytime fatigue. What is the first action the nurse should
take in addressing the patients concerns?
a. Question the patient about the use of over-the-counter (OTC) sleep aids.
b. Suggest that the patient decrease intake of caffeine-containing beverages.
c. Advise the patient to get out of bed if unable to fall asleep in 10 to 20 minutes.
d. Recommend that the patient use any prescribed sleep aids for only 2 to 3 weeks.
ANS: A
The nurses first action should be assessment of the patient for factors that may contribute to
poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions
may be appropriate, but assessment is needed first to choose appropriate interventions to
improve the patients sleep.

DIF: Cognitive Level: Apply (application) REF: 105

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

9. A patient with sleep apnea who uses a continuous positive airway pressure (CPAP) device is
preparing to have inpatient surgery. Which instructions should the nurse provide to the
patient?
a. Remind the patient to take the CPAP device to the hospital.
b. Plan to schedule a nighttime polysomnography (PSG) study before surgery.
c. Discourage the patient from requesting pain medication while hospitalized.
d. Call the hospital to ensure that mechanical ventilation will be available for the
patient.
ANS: A
The patient should be told to take the CPAP device to the hospital if an overnight stay is
expected. Many patients will be able to use their own CPAP equipment, but hospital policy
should be checked to make sure it can be used. Patients should be treated for pain and
monitored for respiratory depression. Another PSG is not required before surgery. There is no
need to call the hospital if the patient takes the CPAP device to the hospital.
 DIF: Cognitive Level: Apply (application) REF: 109
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

10. When caring for patients with sleep disorders, which activity can the nurse appropriately
delegate to unlicensed assistive personnel (UAP)?
a. Interview a new patient about risk factors for obstructive sleep disorders.
b. Discuss the benefits of oral appliances in decreasing obstructive sleep apnea.
c. Help a patient choose an appropriate continuous positive airway pressure (CPAP)
mask.
d. Assist a patient to place the CPAP device correctly over the nose and mouth at
bedtime.
ANS: D
Because CPAP mask placement is consistently done in the same way, this is appropriate to
delegate to UAP. The other actions require critical thinking and nursing judgment, and should
be done by the RN.

DIF: Cognitive Level: Apply (application) REF: 111

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Which information obtained by the nurse about an older adult who complains of occasional
insomnia indicates a need for patient teaching (select all that apply)?
a. Drinks a cup of coffee every morning with breakfast
b. Has a snack every evening 1 hour before going to bed
c. Likes to read or watch television in bed on most evenings
d. Usually takes a warm bath just before bedtime every night
e. Occasionally uses diphenhydramine (Benadryl) as a sleep aid
ANS: C, E
Reading and watching television in bed may contribute to insomnia. Older adults should avoid
the use of medications that have anticholinergic effects, such as diphenhydramine. Having a
snack 1 hour before bedtime and/or coffee early in the day should not affect sleep quality.
Rituals such as a warm bath before bedtime can enhance sleep quality.

DIF: Cognitive Level: Apply (application) REF: 104

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity