NR 547 MIDTERM EXAM (2025/2026) STUDY GUIDE AND
PRACTICE QUESTIONS WITH VERIFIED ANSWERS
Medications/substances that cause drowsiness:
antihistamines
benzodiazepines
opioids
beta-blockers
muscle relaxants
tricyclic antidepressants
alcohol
Medications/substances that cause wakefulness:
Selective serotonin reuptake inhibitors (SSRI) antidepressants
cocaine
caffeine
amphetamines
corticosteroids
decongestants
alpha-blockers
Sleep Developmental Considerations: Children
Nightmares/night terrors
,-most common among this age group
-arousal occurs during REM sleep
-environmental or psychological stresses & fears
Bedwetting
-common in children ages 3-15
-more common in males
-arouses clients after a deep sleep
-sleepwalking may also be associated
Sleep Developmental Considerations: Adults
major life events
-illness, separation, death, loss of job, etc. can cause anxiety resulting in difficulty sleeping
nightmares
-arousal occurs during REM sleep
-environmental or psychological stresses and fears
Sleep Developmental Considerations: Older Adults
-depression, which is often undiagnosed
-daytime napping, which can impact sleep at night
-arousal from environmental stimuli (noise, temperature, etc.)
-associated medical conditions
,Insomnia tx
Nonpharmacologic
-Cognitive-behavioral therapy (CBT)
• most effective long-term treatment for insomnia and sleep disruptions
• Sleep hygiene is an essential component of CBT
Pharmacologic
-Most OTC & prescription sleep aids are recommended for short-term use only
-Only a few medications are approved for long-term therapy
• zolpidem modified release, eszopiclone, & ramelteon
Sleep hygiene
Schedule
-Be consistent
-at least 7-8 hours
-bedtime routine
-Exercise daily; avoid 4 hours before bedtime
-Avoid napping
-Empty bladder
Environment
-dark, quiet
-cool, comfortable temperature
-designed for rest & sex only
, -Wear comfortable clothing.
-Avoid electronics.
Diet & Medications
-Avoid stimulants late in the day (caffeine, nicotine, alcohol, etc.).
-Schedule stimulant meds for the morning.
-Avoid OTC sleep aids.
-Avoid heavy meals before bed; eat light snack if hungry.
OTC Sleep Aids
-diphenhydramine (Benadryl)
• antihistamines
• commonly used for short-term difficulty sleeping
• FDA-approved for the treatment of insomnia
• reducing sleep latency and increasing sleep time
• has undesirable anticholinergic effects and carryover sedation (esp. in older adults)
-Valerian root
• herbal over-the-counter medication
• sometimes used to promote sleep
• may reduce the amount of time it takes to fall asleep and may improve sleep
• used with caution; may increase the effects of other sleep medication and increase the
sedative effect of depressants, such as alcohol, benzodiazepines, and narcotics
PRACTICE QUESTIONS WITH VERIFIED ANSWERS
Medications/substances that cause drowsiness:
antihistamines
benzodiazepines
opioids
beta-blockers
muscle relaxants
tricyclic antidepressants
alcohol
Medications/substances that cause wakefulness:
Selective serotonin reuptake inhibitors (SSRI) antidepressants
cocaine
caffeine
amphetamines
corticosteroids
decongestants
alpha-blockers
Sleep Developmental Considerations: Children
Nightmares/night terrors
,-most common among this age group
-arousal occurs during REM sleep
-environmental or psychological stresses & fears
Bedwetting
-common in children ages 3-15
-more common in males
-arouses clients after a deep sleep
-sleepwalking may also be associated
Sleep Developmental Considerations: Adults
major life events
-illness, separation, death, loss of job, etc. can cause anxiety resulting in difficulty sleeping
nightmares
-arousal occurs during REM sleep
-environmental or psychological stresses and fears
Sleep Developmental Considerations: Older Adults
-depression, which is often undiagnosed
-daytime napping, which can impact sleep at night
-arousal from environmental stimuli (noise, temperature, etc.)
-associated medical conditions
,Insomnia tx
Nonpharmacologic
-Cognitive-behavioral therapy (CBT)
• most effective long-term treatment for insomnia and sleep disruptions
• Sleep hygiene is an essential component of CBT
Pharmacologic
-Most OTC & prescription sleep aids are recommended for short-term use only
-Only a few medications are approved for long-term therapy
• zolpidem modified release, eszopiclone, & ramelteon
Sleep hygiene
Schedule
-Be consistent
-at least 7-8 hours
-bedtime routine
-Exercise daily; avoid 4 hours before bedtime
-Avoid napping
-Empty bladder
Environment
-dark, quiet
-cool, comfortable temperature
-designed for rest & sex only
, -Wear comfortable clothing.
-Avoid electronics.
Diet & Medications
-Avoid stimulants late in the day (caffeine, nicotine, alcohol, etc.).
-Schedule stimulant meds for the morning.
-Avoid OTC sleep aids.
-Avoid heavy meals before bed; eat light snack if hungry.
OTC Sleep Aids
-diphenhydramine (Benadryl)
• antihistamines
• commonly used for short-term difficulty sleeping
• FDA-approved for the treatment of insomnia
• reducing sleep latency and increasing sleep time
• has undesirable anticholinergic effects and carryover sedation (esp. in older adults)
-Valerian root
• herbal over-the-counter medication
• sometimes used to promote sleep
• may reduce the amount of time it takes to fall asleep and may improve sleep
• used with caution; may increase the effects of other sleep medication and increase the
sedative effect of depressants, such as alcohol, benzodiazepines, and narcotics
