NR 226: Adult Health I Comprehensive Final Exam Preparation (2026/2027

A hospitalized patient has slept only two to three hours each night for several days. Which assessment finding is most consistent with the combined emotional and cognitive effects of sleep deprivation? A. Euphoria, increased concentration, and rapid decision-making B. Irritability, anxiety, fatigue, and difficulty concentrating C. Bradycardia, muscle relaxation, and improved memory D. Increased sociability, calmness, and heightened alertness Correct Answer: B. Irritability, anxiety, fatigue, and difficulty concentrating Rationale: Sleep deprivation commonly produces irritability, anxiety, fatigue, forgetfulness, unclear thinking, and difficulty concentrating. These changes may impair judgment and patient safety. Euphoria, improved concentration, heightened alertness, and calmness are not expected. Bradycardia and muscle relaxation are also inconsistent because sleep deprivation may activate the stress response, increasing heart rate and muscle tension. Question 2 During an assessment of a patient suspected of significant sleep deprivation, which cluster of physiological findings should the nurse expect? A. Decreased blood pressure, bradycardia, and flaccid muscles B. Increased heart rate, increased blood pressure, and muscle tension C. Decreased respiratory rate, hypothermia, and absent reflexes D. Increased appetite, reduced sweating, and muscle weakness Correct Answer: B. Increased heart rate, increased blood pressure, and muscle tension Rationale: Sleep deprivation may activate the sympathetic nervous system, resulting in increased heart rate, elevated blood pressure, muscle tension, and sometimes diaphoresis. Bradycardia and hypotension suggest a different physiological process. Hypothermia and absent reflexes are not characteristic findings, while increased appetite and reduced sweating do not represent the typical stress-related response associated with inadequate sleep. Question 3 A nurse observes that a sleep-deprived patient repeatedly avoids conversation, paces in the room, and refuses invitations to participate in group activities. How should these findings be interpreted? A. They are behavioral signs commonly associated with sleep deprivation B. They indicate that the patient has successfully adapted to hospitalization C. They are definitive evidence of a psychotic disorder D. They demonstrate adequate coping and social functioning Correct Answer: A. They are behavioral signs commonly associated with sleep deprivation Rationale: Social isolation, avoidance of conversation, and restlessness may occur when a patient is sleep deprived. These behaviors should prompt further assessment of sleep quality, fatigue, emotional status, and safety. They do not demonstrate effective adaptation or adequate coping. Although similar behaviors may occur in psychiatric disorders, they are not sufficient by themselves to establish a psychiatric diagnosis. Question 4 An older adult who has not slept adequately becomes forgetful and has difficulty following instructions. What is the nurse’s best interpretation of these findings? A. Cognitive changes are expected consequences of sleep deprivation B. The patient is intentionally refusing to cooperate C. The findings confirm irreversible dementia D. The patient is experiencing normal improvement in alertness Correct Answer: A. Cognitive changes are expected consequences of sleep deprivation Rationale: Sleep deprivation can impair attention, memory, concentration, and clarity of thought. In an older adult, these effects may resemble confusion or cognitive decline. The nurse should assess sleep patterns and contributing factors before assuming dementia or noncompliance. Improved alertness would not cause forgetfulness, and a brief period of poor sleep cannot independently confirm an irreversible neurocognitive disorder. Question 5 A fatigued patient reports anxiety and demonstrates diaphoresis, tachycardia, and tense shoulder muscles. Which nursing action is most appropriate initially? A. Document the findings as normal and take no further action B. Assess the patient’s recent sleep pattern and factors interfering with sleep C. Encourage strenuous exercise immediately before bedtime D. Restrict all daytime rest periods regardless of the patient’s condition Correct Answer: B. Assess the patient’s recent sleep pattern and factors interfering with sleep Rationale: The findings may reflect sleep deprivation and sympathetic nervous system activation. The nurse should first assess sleep duration, sleep quality, environmental interruptions, medications, pain, anxiety, and other contributing factors. Strenuous exercise before bedtime may increase arousal. Automatically eliminating rest periods may worsen fatigue, and simply documenting the findings without further assessment fails to address a potentially correctable problem. Question 6 Which outcome best indicates that interventions for sleep deprivation have been effective? A. The patient reports improved concentration and demonstrates reduced irritability B. The patient avoids all social interaction and sleeps throughout the day C. The patient develops increased blood pressure and restlessness D. The patient requires repeated instructions because of forgetfulness Correct Answer: A. The patient reports improved concentration and demonstrates reduced irritability Rationale: Improved concentration, clearer thinking, reduced irritability, decreased anxiety, and restored alertness suggest that adequate sleep is being achieved. Sleeping throughout the day may further disrupt the sleep-wake cycle, particularly if excessive. Increased blood pressure, restlessness, forgetfulness, and the need for repeated instructions indicate continuing physiological, behavioral, or cognitive effects of sleep deprivation. Question 7 During the initial encounter with an older adult, which nursing action is most appropriate? A. Complete a rapid focused assessment without observing general appearance B. Begin with a general survey and systematic head-to-toe observation C. Ask the family to answer all questions for the patient D. Assume that all identified changes are normal consequences of aging Correct Answer: B. Begin with a general survey and systematic head-to-toe observation Rationale: Initial assessment of an older adult should include a general survey and a systematic head-to-toe scan for functional ability, safety risks, illness, and age-related changes. Family input may be helpful, but the patient should remain directly involved whenever possible. The nurse must not automatically attribute abnormalities to aging because treatable illness or injury may otherwise be overlooked. Question 8 An older adult becomes tired midway through a comprehensive nursing assessment. What should the nurse do? A. Continue rapidly to avoid delaying care B. Allow rest periods and resume the assessment when tolerated C. Discontinue the assessment permanently D. Ask the patient to remain standing to maintain alertness Correct Answer: B. Allow rest periods and resume the assessment when tolerated Rationale: Older adults may tire more easily during lengthy assessments. Providing rest periods supports comfort, improves cooperation, and may increase the accuracy of collected information. Rushing can increase fatigue and cause incomplete or unreliable responses. Permanently discontinuing the assessment leaves important information uncollected, while requiring the patient to stand may increase exhaustion and the risk of dizziness or falling.