Mental Health NCLEX Sleep Disorders: Dyssomnias and Parasomnias

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 aren’t really there.”

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.

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.

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.

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

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 don’t think I drink any more than my buddies do.”

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

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.

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."

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.”

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.”

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.”

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?”

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

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?”

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.

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

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