Chapter 34: Sleep–Wake Disorders: Nursing Care of Persons with Insomnia and Sleep Problems

Format: Multiple Choice

Client Needs: Physiological Integrity: Basic Care and Comfort

Cognitive Level: Understand

Integrated Process: Teaching/Learning

Objective: 2

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1. A nurse is giving a presentation to a community group about sleep and its relationship to health. In explaining the relationship between rapid eye movement (REM) sleep and body temperature, which statement by the nurse would be most appropriate?

A) “There is no observable relationship between REM sleep and body temperature.”

B) “With higher levels of REM sleep, we also experience higher body temperatures.”

C) “Our REM sleep and body temperature cycles are inversely related.”

D) “The extent of our experience of REM sleep is directly proportional to a rise in body temperature.”

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2. The nurse is assessing the sleep patterns of a 70-year-old client whose life partner died 6 months ago. Based on the knowledge of circadian rhythms and the influence of age, which statement would the nurse anticipate that the client would report about a personal sleep pattern?

A) “When I was younger, I didn’t notice any differences in how I felt in the morning or evening.”

B) “Now it seems like I have difficulty falling asleep or staying asleep even when circumstances are adequate for sleep.”

C) “When I worked days, I’d always have trouble feeling sleepy in the morning.”

D) “When I was younger, the amount of sleep I got didn’t seem to matter.”

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3. A student nurse is preparing a nursing care plan for a client who has been diagnosed with insomnia and is experiencing sleep deprivation. Which nursing diagnosis would the nurse most likely identify as reflecting a priority care issue?

A) Risk for Injury

B) Ineffective Coping

C) Deficient Knowledge

D) Anxiety

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4. A client who is receiving counseling at a community health center has reported being unable to sleep during the last three weekly sessions. A nurse interviews the family members to determine the effect of the client’s problem on them. Which response would the nurse most likely expect to hear?

A) “It really hasn’t seemed to be a problem for us.”

B) “There’s been little change in how she gets along with other family members.”

C) “The not sleeping has really had a positive effect on her and us.”

D) “It’s been exhausting living with her these past few weeks.”

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5. A nurse is discussing strategies to enhance sleep with a client who is experiencing insomnia. Which recommendation would be most appropriate for the nurse to suggest?

A) “Eat right before you go to bed, as long as it is something rich that will make you sleepy.”

B) “Try exercising a bit right before your bedtime so you will feel tired and sleepy.”

C) “Drinking a warm cup of tea right before bedtime will help to relax you.”

D) “Establish a regular time for going to bed and getting up in the morning.”

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6. A nurse is working with a psychiatric client who is being discharged from an inpatient facility. The client asks the nurse, “What should I do at home to promote getting adequate sleep?” Which response by the nurse would be most appropriate?

A) “Go to bed at the same time every night and watch a television show that relaxes you.”

B) “Save your bedroom for sleeping; that means no work and no TV in the bedroom.”

C) “Why don’t you ask your psychiatrist for a prescription for a sleeping pill?”

D) “Make sure to keep the bedroom warm and toasty.”

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7. A client diagnosed with a mental disorder is being discharged from an inpatient unit. During the hospital stay, the client eventually was able to get an adequate night’s sleep even though there was a history of chronic insomnia over the years. The client’s spouse asks the nurse what the family can do in the home environment to promote healthy sleep. Which response by the nurse would be most appropriate?

A) “It is basically up to your spouse to focus on promoting personal sleep.”

B) “Consider a glass of wine about 30 minutes before getting ready to go to bed.”

C) “Remember to keep stimulating activities at a minimum before going to bed.”

D) “Give your spouse a spicy snack with a warm cup of tea at night before bedtime.”

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8. A client has been admitted to the psychiatric unit with a diagnosis of narcolepsy. Which client statement would the nurse interpret as reflecting this condition?

A) “Sometimes when I’m falling asleep, I see and hear things that others don’t.”

B) “I often have brief periods of intense excitement when going to sleep, and my legs won’t hold still.”

C) “I lie there and worry all night, and it keeps me awake. I just can’t relax.”

D) “I think my sleep pattern is messed up because I took sleeping pills when I was younger.”

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9. A nurse is preparing a presentation on sleep disorders for a community group. Which statement would the nurse include when explaining the differences between narcolepsy and obstructive sleep apnea syndrome?

A) “Symptoms of both disorders are essentially the same, so it is difficult to differentiate between the two disorders.”

B) “People with narcolepsy awaken from a nap feeling rested and replenished, but those with obstructive sleep apnea do not.”

C) “People with obstructive sleep apnea syndrome can experience temporary paralysis with naps.”

D) “Naps are not recommended for clients with narcolepsy because of their association with severe loss of muscle tone.”

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10. A nurse is working with a client diagnosed with insomnia. When developing an education plan for the client, which sleep promotion intervention would the nurse implement first?

A) Encouraging the client to stop smoking

B) Instructing the client to keep regular bedtimes and rising times

C) Encouraging the client to take frequent naps

D) Administering prescribed sleep medications

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11. A nurse obtaining information about sleep patterns asks the client about the total amount of sleep time, as compared to the amount of time spent in bed. The nurse is assessing which aspect?

A) Sleep latency

B) Sleep architecture

C) Sleep efficiency

D) Sleep–wake cycle

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12. A group of nursing students is reviewing information about factors affecting the pattern and quality of sleep. The students demonstrate a need for additional review when they identify which factor?

A) Sleep patterns are relatively constant across the lifespan.

B) Women report more problems with sleep than men.

C) Working night shifts and sleeping during the day can affect sleep.

D) Environmental influences on sleep can be internal or external.

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13. The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. Which effect of caffeine on sleep would the nurse incorporate into a discussion with the client?

A) Decreased sleep latency

B) Increased total sleep time

C) Decreased REM sleep

D) Increased slow-wave sleep

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14. A client diagnosed with insomnia is taught to avoid watching television, eating, and doing work in the bedroom. Which technique is being used?

A) Sleep restriction

B) Relaxation training

C) Cognitive-behavioral therapy

D) Stimulus control

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15. A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the medication’s effect on which of the following?

A) Gamma-aminobutyric acid (GABA)

B) Serotonin

C) Dopamine

D) Norepinephrine

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16. A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent as a melatonin receptor agonist?

A) Trazodone

B) Estazolam

C) Mirtazapine

D) Ramelteon

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17. After educating a group of nursing students about the physiology of sleep, the instructor determines that the education was successful when the group identifies which of the following as responsible for maintaining wakefulness?

A) Reticular activating system

B) Gamma-aminobutyric acid (GABA)

C) Dopamine

D) Melatonin

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18. A nurse interviewing a client about sleep patterns is told that the client goes to bed about 11 p.m. and usually falls asleep by 11:15 p.m. The nurse identifies this as which time period?

A) Sleep latency

B) Sleep architecture

C) Sleep efficiency

D) Slow-wave sleep

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19. A nursing instructor is describing the prevalence of sleep–wake disorders as being greater among individuals with mental health disorders. Which disorders would the instructor include as being associated with sleep–wake disorders? Select all that apply.

A) Depression

B) Borderline personality disorder

C) Schizophrenia

D) Posttraumatic stress disorder

E) Anxiety

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20. After teaching a class about circadian rhythm disorders, a nursing instructor determines that the education was successful when the class identifies which subtype of this disorder according to the DSM-5? Select all that apply.

A) Delayed sleep phase

B) Nightmare

C) Sleep terror

D) Shift work type

E) Jet lag type