MSN NCLEX Exam for Sleep Disorder

1. To validate the suspicion that a married male client has sleep apnea the nurse first:

  1. asks the client if he experiences apnea in the middle of the night
  2. Questions the spouse if she is awakened by her husband’s snoring
  3. Places the client on a continuous positive airway pressure (CPAP) device
  4. Schedules the client for a sleep test

2. When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about:

  1. Nonsteroidal antiinflammatory drugs (NSAIDs)
  2. Opioids
  3. Anticonvulsants
  4. Antidepressants
  5. Adjuvants

3. The nurse finds a client sleep walking down the unit hallway.  An appropriate intervention the nurse implements is:

  1. Asking the client what he or she is doing and call for help
  2. Quietly approaching the client and then loudly calling his or her name
  3. Lightly tapping the client on the shoulder and leading him or her back to bed
  4. Blocking the hallway with chairs and seating the client

4. The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises.

  1. 1st
  2. 2nd
  3. 3rd
  4. 4th

5. Which of the following medications are the safest to administer to adults needing assistance in falling asleep?

  1. Sedatives
  2. Hypnotics
  3. Benzodiazepines
  4. Anti-anxiety agents

6. To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.)

  1. Drinking a glass of wine just before retiring to bed
  2. Eating a large meal 1 hour before bedtime
  3. Consuming a small glass of warm milk at bedtime
  4. Performing mild exercises 30 minutes before going to bed

7. The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply):

  1. Extended time to fall asleep
  2. Falling asleep at inappropriate times
  3. Difficulty staying asleep
  4. Feeling tired after a night’s sleep

8. The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply):

  1. Prone
  2. Side-lying
  3. Supine
  4. Fowler’s

9. When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is:

  1. Headache
  2. Early awakening
  3. Impaired reasoning
  4. Excessive daytime sleepiness

10. The nurse understands that the most vivid dreaming occurs during:

  1. REM sleep
  2. Stage 1 NREM
  3. Stage 4 NREM
  4. Transition period from NREM to REM sleep

11. A client taking a beta adrenergic blockers for HTN can experience interference with sleep patterns such as:

  1. Nocturia
  2. Increased daytime sleepiness
  3. Increased awakening from sleep
  4. Increased difficulty falling asleep

12. Narcolepsy can be best explained as:

  1. A sudden muscle weakness during exercise
  2. Stopping breathing for short intervals during sleep
  3. Frequent awakenings during the night
  4. An overwhelming wave of sleepiness and falling asleep

13. A nursing measure to promote sleep in school-age children is to:

  1. Make sure the room is dark and quiet
  2. Encourage evening exercise
  3. Encourage television watching
  4. Encourage quiet activities prior to bed time.

14. A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply.

  1. Eat a heavy snack before bedtime
  2. Read in bed before shutting out the light
  3. Leave the bedroom if you are unable to sleep
  4. Drink a cup of warm tea with milk at bedtime
  5. Exercise in the afternoon rather than the evening
  6. Count backwards from 100 to 0 when your mind is racing.

15. A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply:

  1. Chronic stress
  2. Severe anxiety
  3. Generalized pain
  4. Excessive caffeine
  5. Chronic depression
  6. Environmental noise

16. A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care?

  1. Monitor apical heart rate every 2 hours
  2. Monitor blood pressure every 4 hours
  3. Instruct the client to call for ambulation assistance
  4. Clear a path to the bathroom at bedtime.

17.  Select all that apply to the use of barbiturates in treating insomnia:

  1. Barbiturates deprive people of NREM sleep
  2. Barbiturates deprive people of REM sleep
  3. When the barbiturates are discontinued, the NREM sleep increases.
  4. When the barbiturates are discontinued, the REM sleep increases.
  5. Nightmares are often an adverse effect when discontinuing barbiturates.

18.  Select all that apply that is appropriate when there is a benzodiazepine overdose:

  1. Administration of syrup of ipecac
  2. Gastric lavage
  3. Activated charcoal and a saline cathartic
  4. Hemodialysis
  5. Administration of Flumazenil

19. A patient is admitted to the emergency department with an overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart?

  1. naloxone (Narcan)
  2. naltrexone (ReVia)
  3. nalmefene (Revex)
  4. flumazenil (Romazicon)

20. Older adults who take long-acting sedatives or hypnotics are likely to experience:

  1. Hallucinations
  2. Ataxia
  3. Alertness
  4. Dyspnea

21. Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?

  1. Alteration in tissue perfusion
  2. Fluid volume excess
  3. Risk for injury
  4. Risk for infection

22. A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?

  1. naloxone HCl (Narcan
  2. activated charcoal
  3. flumazenil (Romazicon)
  4. ipecac syrup

23. During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating:

  1. “Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.”
  2. “Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis.”
  3. “Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.”
  4. “There really is no difference; the terms are used interchangeably.”

24. The patient’s chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced:

  1. Delirium tremens
  2. Malignant hyperthermia
  3. A tonic-clonic seizure
  4. Respiratory arrest

25.  Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent?

  1. Use IM dosage forms for longer duration
  2. Administer safely with other CNS depressants for insomnia
  3. Monitor geriatric patients for the common occurrence of paradoxical reactions.
  4. Evaluate for physical dependence that occurs within 48 hours of beginning the drug.

26.  Pediatric and geriatric patients often react with more sensitivity to CNS depressants. This type of sensitivity manifests itself in the development of which type of reaction?

  1. Idiopathic
  2. Teratogenic
  3. Paradoxical
  4. Psychogenic

27. Which of the following is an appropriate nursing intervention for patients who are receiving CNS depressants?

  1. Prevent any activity within the hospital setting while on oral muscle relaxants
  2. Make sure that the patient knows that sedation should be minimal with these agents.
  3. Cardiovascular stimulation, a common side effect, would lead to hytertension
  4. Make sure the patient’s call light is close by in case of the need for assistance with activities.

28. Which of the following conditions characterizes rapid eye movement (REM) sleep?

  1. Disorientation and disorganized thinking
  2. Jerky limb movements and position changes
  3. Pulse rate slowed by 5 to 10 beats/minute
  4. Highly active brain and physiological activity levels.

29. Which of the following sleep disorders is the most prevalent?

  1. Hypersomnia
  2. Insomnia
  3. Parasomnia
  4. Sleep-awake schedule disturbance.

30. Which of the following substances is a natural hormone produced by the pineal gland that induces sleep?

  1. Amphetamine
  2. Melatonin
  3. Methylphenidate
  4. Pemoline
Answers and Rationales
  1. D. (Although this is a diagnostic tool, the first thing the nurse would do is question the spouse. This may lead to determining whether more tests are needed).
  2. B. Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.
  3. C. The nurse should not startle the client but should gently awaken the client and lead him or her back to bed.
  4. A. The client is most sensitive to noise in the hospital setting the first night because everything is new. This represents sensory overload, which interferes with sleep and decreases rapid eye movement (REM) as well as total sleep time.
  5. C. The group of drugs that are the safest are the benzodiazepines. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.
  6. C. A small glass of milk relaxes the body and promotes sleep.
  7. A, C, and D. These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia.
  8. B and C. Research demonstrate that the occurrence of SIDS is reduced with these two positions.
  9. D. Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.
  10. A. Although dreams occur during both NREM and REM sleep, the dreams of REM sleep are more vivid and elaborate and are believed to be functionally important to learning, memory processing, and adaptation to stress.
  11. B. Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.
  12. D. Narcolepsy is a dysfunction of mechanisms that regulate the sleep and wake states. Excessive daytime sleepiness is the most common complaint associated with this disorder. During the day a person may suddenly feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur within 15 minutes of falling asleep.
  13. D. The amount of sleep needed during the school years is individualized because of varying states of activities and levels of health. A 6-year old averages 11-12 hours of sleep nightly, whereas an 11-year old sleeps about 9-10 hours. The 6- or 7-year old can usually be persuaded to go to bed by encouraging quiet activities.
  14. C, E, and F. Lying in bed when one is unable to sleep increases frustration and anxiety which further impede sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backwards requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.
  15. A, D, and F. Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.
  16. C. Chloral hydrate is a sedative. This medication does not affect cardiac function. Blood pressure changes are not significant with the use of this medication. A client should call for assistance to the bathroom at night. Additionally, the client may experience residual daytime sedation; therefore, the nurse should instruct the client to call for ambulation assistance during the daytime hours.
  17. B, D, and E. Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares.
  18. B, C, and E. If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation.
  19. D. Flumazenil is the antidote for benzodiazepine overdoses.
  20. B. If longer-acting barbiturates are used in older adults, these clients may experience daytime sedation, ataxia, and memory deficits.
  21. C. Sedative-hypnotics cause CNS depression, putting the patient at risk for injury.
  22. B. There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the GI tract, preventing absorption.
  23. C. Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.
  24. B. Dantrolene is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia (remember intraoperative nursing???)
  25. C.
  26. C.
  27. D.
  28. D.Highly active brain and physiological activity levels characterize REM stage. Stages 3 and 4 of NREM sleep are characterized by disorientation and disorganization, During REM sleep, the body movement ceases except for the eyes. The pulse rate slows by 5-10 beats/minute during NREM sleep, not REM sleep.
  29. B. Approximately 1/3 of American adults have some type of sleep disorder, and insomnia is the most common.
  30. B. Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.