NSG 3130 — Fundamentals II
Chapter 33: Sleep
Clinical Judgment Practice Test — 28 Questions
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
CHAPTER 33: SLEEP — Questions 1–28
Q1. A nurse explains circadian rhythm physiology to a patient. Which statement correctly describes the timing of cortisol and
melatonin during a normal 24-hour cycle?
Circadian rhythm hormones
A. Cortisol levels rise around 4 a.m. in preparation for waking, while melatonin increases as darkness falls to help induce
sleep
B. Cortisol levels rise at bedtime to induce sleep, while melatonin increases upon waking to promote alertness
C. Cortisol and melatonin remain at constant, unchanging levels throughout the entire 24-hour cycle
D. Cortisol and melatonin are produced by the same gland and consistently rise and fall together in unison
Q2. A nurse compares two stages of a patient's sleep cycle. During Stage A, the patient's heart rate, breathing, and brain waves slow,
and vital signs are stable. During Stage B, the patient's eyes show quick scanning movements, cerebral blood flow increases, and
vital signs fluctuate. Which stages are these, respectively?
NREM vs. REM physiologic effects
A. Rapid eye movement (REM) sleep for Stage A and non-rapid eye movement (NREM) sleep for Stage B
B. Non-rapid eye movement (NREM) sleep for Stage A and rapid eye movement (REM) sleep for Stage B
C. Both stages describe the same physiologic sleep state at different points in the night
D. Neither stage described is a recognized part of the normal sleep cycle
Q3. A nurse notes that a hospitalized patient is very difficult to arouse, shows slow-wave brain activity, has relaxed muscles, and
stable but decreased vital signs. Sleepwalking is more likely to occur during this stage. Which sleep stage is this, and what important
restorative process occurs during it?
NREM stage 3 characteristics
A. NREM stage 1, during which a person is easily aroused and feels drowsy
B. REM sleep, during which vivid, colorful dreaming typically occurs
C. NREM stage 3, during which growth hormone release and other restorative processes occur
D. NREM stage 2, during which snoring may begin and relaxation increases
Q4. A nurse is studying the neurotransmitters involved in regulating sleep stages. Which statement is accurate?
Neurotransmitters and sleep stages
A. Acetylcholine and norepinephrine influence NREM sleep, while serotonin and GABA affect REM sleep
B. A single neurotransmitter, dopamine, is primarily responsible for regulating both REM and NREM sleep
C. Neurotransmitters play no meaningful role in the regulation of REM or NREM sleep stages
D. Acetylcholine and norepinephrine influence REM sleep, while serotonin and GABA affect NREM sleep
, Q5. A patient reports difficulty falling asleep, sleep that is too light, and early-morning awakenings that have persisted for several
weeks following an acute stressful life event. What is the most likely explanation, and what should the nurse understand about
medication treatment?
Insomnia characteristics
A. Insomnia, and medications for insomnia do not address the underlying cause and prolonged use can create drug
dependency
B. Narcolepsy, and medications for this condition cure the underlying disorder within a few weeks of use
C. Sleep apnea, and medications are the definitive first-line treatment recommended for this condition
D. Restless legs syndrome, and medications for this condition eliminate any recurrence permanently
Q6. A patient experiences overwhelming, uncontrollable sleep episodes throughout the day, sometimes with a sudden loss of
voluntary muscle tone triggered by strong emotion. What are these two findings called, and what sleep stage do episodes typically
begin with?
Narcolepsy and cataplexy
A. Hypersomnia with sleep terrors, and sleep episodes typically begin with NREM stage 1 as in normal sleep
B. Narcolepsy with cataplexy, and sleep episodes typically begin with the REM phase rather than the usual NREM-first
sequence
C. Insomnia with bruxism, and sleep episodes typically begin with NREM stage 3 rather than NREM stage 1
D. Sleep apnea with restless legs syndrome, and sleep episodes typically begin with REM sleep as in normal sleep
Q7. A nurse is caring for a patient with obstructive sleep apnea (OSA). What is the underlying mechanism, and which risk factors
increase susceptibility?
Obstructive sleep apnea pathophysiology
A. A central nervous system failure to initiate any respiratory effort, with risk factors limited to female sex and being
underweight
B. A permanent structural loss of lung tissue, with risk factors limited to advanced age alone
C. Collapse of the upper airway despite respiratory effort, with risk factors including male sex, obesity, large neck
circumference, and smoking
D. An autoimmune process affecting the diaphragm, with risk factors limited to a family history of asthma
Q8. A nurse compares two patients with excessive sleepiness. Patient A sleeps 8 to 12 hours a night but still has significant trouble
waking and functioning during the day. Patient B sleeps a normal amount at night but experiences sudden, uncontrollable sleep
episodes lasting seconds to minutes at unpredictable times throughout the day. Which conditions are most consistent with these
presentations, respectively?
Hypersomnia vs. narcolepsy
A. Narcolepsy for Patient A and hypersomnia for Patient B
B. Both patients have the identical sleep disorder with the same underlying cause
C. Neither presentation matches a recognized sleep-related disorder
D. Hypersomnia for Patient A and narcolepsy for Patient B
Q9. A night-shift nurse reports difficulty sleeping during the day and staying alert during overnight shifts. What is this disruption
called, and what is a recommended strategy to help manage it?
Circadian rhythm sleep disorders
A. A circadian rhythm sleep disorder, managed with a regular sleep schedule and an anchor sleep time on days off
B. Narcolepsy, managed exclusively with central nervous system stimulant medications and no lifestyle changes
C. Sleep terrors, managed by avoiding any discussion of the frightening content of the episodes
D. Bruxism, managed with a dental mouth guard as the primary recommended intervention
Q10. [PRIORITY] A nurse is caring for a patient with untreated, severe obstructive sleep apnea. What is the priority concern
regarding potential complications?
OSA complications
A. Sleep apnea carries no risk of any cardiovascular or pulmonary complications if left untreated
B. Prolonged sleep apnea can lead to increased blood pressure, cardiac arrhythmias, pulmonary hypertension, and even
cardiac arrest
C. The main consequence of untreated sleep apnea is mild daytime fatigue with no other health risks
D. Untreated sleep apnea exclusively affects the sleep partner's sleep quality and has no effect on the patient
Chapter 33: Sleep
Clinical Judgment Practice Test — 28 Questions
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
CHAPTER 33: SLEEP — Questions 1–28
Q1. A nurse explains circadian rhythm physiology to a patient. Which statement correctly describes the timing of cortisol and
melatonin during a normal 24-hour cycle?
Circadian rhythm hormones
A. Cortisol levels rise around 4 a.m. in preparation for waking, while melatonin increases as darkness falls to help induce
sleep
B. Cortisol levels rise at bedtime to induce sleep, while melatonin increases upon waking to promote alertness
C. Cortisol and melatonin remain at constant, unchanging levels throughout the entire 24-hour cycle
D. Cortisol and melatonin are produced by the same gland and consistently rise and fall together in unison
Q2. A nurse compares two stages of a patient's sleep cycle. During Stage A, the patient's heart rate, breathing, and brain waves slow,
and vital signs are stable. During Stage B, the patient's eyes show quick scanning movements, cerebral blood flow increases, and
vital signs fluctuate. Which stages are these, respectively?
NREM vs. REM physiologic effects
A. Rapid eye movement (REM) sleep for Stage A and non-rapid eye movement (NREM) sleep for Stage B
B. Non-rapid eye movement (NREM) sleep for Stage A and rapid eye movement (REM) sleep for Stage B
C. Both stages describe the same physiologic sleep state at different points in the night
D. Neither stage described is a recognized part of the normal sleep cycle
Q3. A nurse notes that a hospitalized patient is very difficult to arouse, shows slow-wave brain activity, has relaxed muscles, and
stable but decreased vital signs. Sleepwalking is more likely to occur during this stage. Which sleep stage is this, and what important
restorative process occurs during it?
NREM stage 3 characteristics
A. NREM stage 1, during which a person is easily aroused and feels drowsy
B. REM sleep, during which vivid, colorful dreaming typically occurs
C. NREM stage 3, during which growth hormone release and other restorative processes occur
D. NREM stage 2, during which snoring may begin and relaxation increases
Q4. A nurse is studying the neurotransmitters involved in regulating sleep stages. Which statement is accurate?
Neurotransmitters and sleep stages
A. Acetylcholine and norepinephrine influence NREM sleep, while serotonin and GABA affect REM sleep
B. A single neurotransmitter, dopamine, is primarily responsible for regulating both REM and NREM sleep
C. Neurotransmitters play no meaningful role in the regulation of REM or NREM sleep stages
D. Acetylcholine and norepinephrine influence REM sleep, while serotonin and GABA affect NREM sleep
, Q5. A patient reports difficulty falling asleep, sleep that is too light, and early-morning awakenings that have persisted for several
weeks following an acute stressful life event. What is the most likely explanation, and what should the nurse understand about
medication treatment?
Insomnia characteristics
A. Insomnia, and medications for insomnia do not address the underlying cause and prolonged use can create drug
dependency
B. Narcolepsy, and medications for this condition cure the underlying disorder within a few weeks of use
C. Sleep apnea, and medications are the definitive first-line treatment recommended for this condition
D. Restless legs syndrome, and medications for this condition eliminate any recurrence permanently
Q6. A patient experiences overwhelming, uncontrollable sleep episodes throughout the day, sometimes with a sudden loss of
voluntary muscle tone triggered by strong emotion. What are these two findings called, and what sleep stage do episodes typically
begin with?
Narcolepsy and cataplexy
A. Hypersomnia with sleep terrors, and sleep episodes typically begin with NREM stage 1 as in normal sleep
B. Narcolepsy with cataplexy, and sleep episodes typically begin with the REM phase rather than the usual NREM-first
sequence
C. Insomnia with bruxism, and sleep episodes typically begin with NREM stage 3 rather than NREM stage 1
D. Sleep apnea with restless legs syndrome, and sleep episodes typically begin with REM sleep as in normal sleep
Q7. A nurse is caring for a patient with obstructive sleep apnea (OSA). What is the underlying mechanism, and which risk factors
increase susceptibility?
Obstructive sleep apnea pathophysiology
A. A central nervous system failure to initiate any respiratory effort, with risk factors limited to female sex and being
underweight
B. A permanent structural loss of lung tissue, with risk factors limited to advanced age alone
C. Collapse of the upper airway despite respiratory effort, with risk factors including male sex, obesity, large neck
circumference, and smoking
D. An autoimmune process affecting the diaphragm, with risk factors limited to a family history of asthma
Q8. A nurse compares two patients with excessive sleepiness. Patient A sleeps 8 to 12 hours a night but still has significant trouble
waking and functioning during the day. Patient B sleeps a normal amount at night but experiences sudden, uncontrollable sleep
episodes lasting seconds to minutes at unpredictable times throughout the day. Which conditions are most consistent with these
presentations, respectively?
Hypersomnia vs. narcolepsy
A. Narcolepsy for Patient A and hypersomnia for Patient B
B. Both patients have the identical sleep disorder with the same underlying cause
C. Neither presentation matches a recognized sleep-related disorder
D. Hypersomnia for Patient A and narcolepsy for Patient B
Q9. A night-shift nurse reports difficulty sleeping during the day and staying alert during overnight shifts. What is this disruption
called, and what is a recommended strategy to help manage it?
Circadian rhythm sleep disorders
A. A circadian rhythm sleep disorder, managed with a regular sleep schedule and an anchor sleep time on days off
B. Narcolepsy, managed exclusively with central nervous system stimulant medications and no lifestyle changes
C. Sleep terrors, managed by avoiding any discussion of the frightening content of the episodes
D. Bruxism, managed with a dental mouth guard as the primary recommended intervention
Q10. [PRIORITY] A nurse is caring for a patient with untreated, severe obstructive sleep apnea. What is the priority concern
regarding potential complications?
OSA complications
A. Sleep apnea carries no risk of any cardiovascular or pulmonary complications if left untreated
B. Prolonged sleep apnea can lead to increased blood pressure, cardiac arrhythmias, pulmonary hypertension, and even
cardiac arrest
C. The main consequence of untreated sleep apnea is mild daytime fatigue with no other health risks
D. Untreated sleep apnea exclusively affects the sleep partner's sleep quality and has no effect on the patient
