NCLEX SLeep Questions

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NCLEX QUESTIONS REST AND SLEE...

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• To validate the suspicion that a married male client has

sleep apnea the nurse first:

• Asks the client if he experiences apnea in the middle of

the night

• Questions the spouse if she is awakened by her

husband's snoring

• Places the client on a continuous positive airway

pressure (CPAP) device

• Schedules the client for a sleep test

Answers and Rationale

• Answer: 4. (2- 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).

• When analgesics are ordered for a client with

obstructive sleep apnea (OSA) following surgery, the

nurse is most concerned about:.

• Nonsteroidal antiinflammatory drugs (NSAIDs)
• Opioids
• Anticonvulsants
• Antidepressants
• Adjuvants
• Answer: 2. 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.

• The nurse finds a client sleep walking down the unit

hallway. An appropriate intervention the nurse

implements is:

• Asking the client what he or she is doing and call for

help

• Quietly approaching the client and then loudly calling

his or her name

• Lightly tapping the client on the shoulder and leading

him or her back to bed

• Blocking the hallway with chairs and seating the client
• Answer: 3. The nurse should not startle the client but should gently awaken the

client and lead him or her back to bed.

• 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.

• 1st
• 2nd
• 3rd
• 4th
• Answer: 1. 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.

• Which of the following medications are the safest to

administer to adults needing assistance in falling asleep?

• Sedatives
• Hypnotics
• Benzodiazepines
• Anti-anxiety agents
• Answer: 3. 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.

• To assist an adult client to sleep better the nurse

recommends which of the following? (Select all that apply.)

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

bed

6. Answer: 3. A small glass of milk relaxes the body and promotes sleep.

• The nurse recognizes that a client is experiencing

insomnia when the client reports (select all that apply):

• Extended time to fall asleep
• Falling asleep at inappropriate times
• Difficulty staying asleep
• Feeling tired after a night's sleep
• Answer: 1, 3, and 4. 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.

• 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):

• Prone
• Side-lying
• Supine
• Fowler's

8. Answer: 2 and 3. Research demonstrate that the occurrence of SIDS is reduced

with these two positions.

• When assessing a client for obstructive sleep apnea

(OSA), the nurse understands the most common

symptom is:

• Headache
• Early awakening
• Impaired reasoning
• Excessive daytime sleepiness

9. Answer: 4. 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.

• The nurse understands that the most vivid dreaming

occurs during:

• REM sleep
• Stage 1 NREM
• Stage 4 NREM
• Transition period from NREM to REM sleep

10. Answer: 1. 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.

• A client taking a beta adrenergic blockers for HTN can

experience interference with sleep patterns such as:

• Nocturia
• Increased daytime sleepiness
• Increased awakening from sleep
• Increased difficulty falling asleep
• Answer: 2. Beta Blockers can cause nightmares, insomnia, and awakenings from

sleep.

12. Narcolepsy can be best explained as:

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

• A nursing measure to promote sleep in school-age

children is to:

• Make sure the room is dark and quiet
• Encourage evening exercise
• Encourage television watching
• Encourage quiet activities prior to bed time.

13. Answer: 4. 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.

• 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.

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

racing.

14. Answer: 3, 5, and 6. 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.

• 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:

• Chronic stress
• Severe anxiety
• Generalized pain
• Excessive caffeine
• Chronic depression
• Environmental noise

15. Answer: 1, 4, and 6. 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.

• A hospitalized client is prescribed chloral hydrate

(Noctec). The nurse includes which action in the plan of care?

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

• Select all that apply to the use of barbiturates in

treating insomnia:

• Barbiturates deprive people of NREM sleep
• Barbiturates deprive people of REM sleep
• When the barbiturates are discontinued, the NREM

sleep increases.

• When the barbiturates are discontinued, the REM sleep

increases.

• Nightmares are often an adverse effect when

discontinuing barbiturates.

17. Answer: 2, 4, and 5. 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.

• Select all that apply that is appropriate when there is a

benzodiazepine overdose:

• Administration of syrup of ipecac
• Gastric lavage
• Activated charcoal and a saline cathartic
• Hemodialysis
• Administration of Flumazenil
• Answer: 2, 3, and 5. 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.