NURS 6630 WEEK 8 ASSIGNMENT 2 2026/2027 |
Assessing & Treating Sleep/Wake Disorders | 31-
Year-Old Male with Insomnia | Complete Solutions |
Pass Guaranteed - A+ Graded
Part I: Initial Assessment & Differential Diagnosis (31-Year-Old Male with
Insomnia) (9 questions)
Q1: A 31-year-old male presents to your PMHNP office with a chief complaint of
insomnia. He reports difficulty falling asleep for the past four months, typically lying
awake for 90–120 minutes before sleep onset. He denies difficulty staying asleep or
early morning awakening. His sleep latency has progressively worsened since starting
a new marketing job with frequent evening client dinners. He drinks 3–4 cups of
coffee daily, with his last cup around 4:00 PM. He denies snoring, witnessed apneas,
or restless legs. What is the most likely insomnia subtype?
A. Sleep maintenance insomnia, characterized by frequent nocturnal awakenings
B. Sleep onset insomnia, characterized by prolonged latency to sleep initiation
[CORRECT]
C. Early morning awakening insomnia, characterized by premature termination of
sleep
D. Paradoxical insomnia, characterized by a marked mismatch between subjective
and objective sleep duration
Correct Answer: B
Rationale: The patient reports prolonged sleep latency (90–120 minutes) with
preserved sleep maintenance and no early awakening — classic sleep onset
insomnia. A describes fragmented sleep, which he denies. C describes terminal
insomnia, typically seen in depression. D requires polysomnographic confirmation of
a subjective-objective discrepancy.
, Q2: During the initial interview, the patient reports feeling "wired" at bedtime,
ruminating about work presentations and client interactions. He rates his daytime
fatigue as 6/10 but denies sleepiness during sedentary activities. His Epworth
Sleepiness Scale score is 6. Which interpretation is most accurate?
A. An ESS score of 6 indicates severe excessive daytime sleepiness requiring
immediate intervention
B. An ESS score ≤ 10 is within normal limits; his primary complaint is insomnia with
associated fatigue rather than hypersomnolence [CORRECT]
C. The ESS is not validated for use in patients with insomnia and should be
disregarded
D. An ESS score of 6 confirms a diagnosis of obstructive sleep apnea
Correct Answer: B
Rationale: ESS scores ≤ 10 are considered normal; scores > 10 suggest excessive
daytime sleepiness. His score supports insomnia-related fatigue rather than a
primary hypersomnia or sleep apnea. A misinterprets the cutoff. C is incorrect — the
ESS is validated across sleep disorders. D is wrong — OSA requires
polysomnography, not ESS alone.
Q3: The patient completes a two-week sleep diary. His average sleep latency is 105
minutes, wake after sleep onset (WASO) is 15 minutes, total sleep time is 5.5 hours,
and time in bed is 8 hours. What is his sleep efficiency?
A. 55%, calculated as total sleep time divided by time in bed
B. 68.75%, calculated as total sleep time (5.5 hours) divided by time in bed (8 hours)
[CORRECT]
C. 82.5%, calculated incorrectly by including only sleep latency in the denominator
D. 45%, calculated by subtracting sleep latency from total sleep time before dividing
Correct Answer: B
Rationale: Sleep efficiency = (total sleep time / time in bed) × 100 = (5.5/8) × 100 =
68.75%. Normal sleep efficiency is > 85%; his is reduced, consistent with insomnia. A
uses the wrong formula. C incorrectly adjusts the denominator. D uses an invalid
calculation.
Assessing & Treating Sleep/Wake Disorders | 31-
Year-Old Male with Insomnia | Complete Solutions |
Pass Guaranteed - A+ Graded
Part I: Initial Assessment & Differential Diagnosis (31-Year-Old Male with
Insomnia) (9 questions)
Q1: A 31-year-old male presents to your PMHNP office with a chief complaint of
insomnia. He reports difficulty falling asleep for the past four months, typically lying
awake for 90–120 minutes before sleep onset. He denies difficulty staying asleep or
early morning awakening. His sleep latency has progressively worsened since starting
a new marketing job with frequent evening client dinners. He drinks 3–4 cups of
coffee daily, with his last cup around 4:00 PM. He denies snoring, witnessed apneas,
or restless legs. What is the most likely insomnia subtype?
A. Sleep maintenance insomnia, characterized by frequent nocturnal awakenings
B. Sleep onset insomnia, characterized by prolonged latency to sleep initiation
[CORRECT]
C. Early morning awakening insomnia, characterized by premature termination of
sleep
D. Paradoxical insomnia, characterized by a marked mismatch between subjective
and objective sleep duration
Correct Answer: B
Rationale: The patient reports prolonged sleep latency (90–120 minutes) with
preserved sleep maintenance and no early awakening — classic sleep onset
insomnia. A describes fragmented sleep, which he denies. C describes terminal
insomnia, typically seen in depression. D requires polysomnographic confirmation of
a subjective-objective discrepancy.
, Q2: During the initial interview, the patient reports feeling "wired" at bedtime,
ruminating about work presentations and client interactions. He rates his daytime
fatigue as 6/10 but denies sleepiness during sedentary activities. His Epworth
Sleepiness Scale score is 6. Which interpretation is most accurate?
A. An ESS score of 6 indicates severe excessive daytime sleepiness requiring
immediate intervention
B. An ESS score ≤ 10 is within normal limits; his primary complaint is insomnia with
associated fatigue rather than hypersomnolence [CORRECT]
C. The ESS is not validated for use in patients with insomnia and should be
disregarded
D. An ESS score of 6 confirms a diagnosis of obstructive sleep apnea
Correct Answer: B
Rationale: ESS scores ≤ 10 are considered normal; scores > 10 suggest excessive
daytime sleepiness. His score supports insomnia-related fatigue rather than a
primary hypersomnia or sleep apnea. A misinterprets the cutoff. C is incorrect — the
ESS is validated across sleep disorders. D is wrong — OSA requires
polysomnography, not ESS alone.
Q3: The patient completes a two-week sleep diary. His average sleep latency is 105
minutes, wake after sleep onset (WASO) is 15 minutes, total sleep time is 5.5 hours,
and time in bed is 8 hours. What is his sleep efficiency?
A. 55%, calculated as total sleep time divided by time in bed
B. 68.75%, calculated as total sleep time (5.5 hours) divided by time in bed (8 hours)
[CORRECT]
C. 82.5%, calculated incorrectly by including only sleep latency in the denominator
D. 45%, calculated by subtracting sleep latency from total sleep time before dividing
Correct Answer: B
Rationale: Sleep efficiency = (total sleep time / time in bed) × 100 = (5.5/8) × 100 =
68.75%. Normal sleep efficiency is > 85%; his is reduced, consistent with insomnia. A
uses the wrong formula. C incorrectly adjusts the denominator. D uses an invalid
calculation.
