Sleep Health and Insomnia (Questions 1–10)
Question 1 (Application/Prioritization) A nurse is teaching an older adult patient about healthy
sleep habits to address chronic insomnia. Which instruction should the nurse prioritize?
A. Take melatonin 1 to 2 hours before bedtime.
B. Use the bed only for sleep and sex.
C. Limit fluid intake throughout the day.
D. Avoid strenuous exercise within 1 hour of bedtime.
Correct Answer: B Rationale: Among the healthy sleep habits, setting the expectation that the
bed should be used only for sleep and sex helps establish a positive association between the bed
and sleeping, which is a core intervention for insomnia. Reducing fluid intake is specific to
limiting fluids beforebedtime. Melatonin is a circadian rhythm intervention that may be helpful,
administered 1 to 2 hours before bedtime. Exercise should be avoided in the late afternoon or
evening, but promoting use of the bed only for sleep is a fundamental habit for insomnia
intervention.
Question 2 (Analysis/Risk Factors) An 80-year-old patient who experiences frequent periods of
wakefulness after sleep onset asks the nurse if this is a normal part of aging. The nurse responds
based on the understanding that:
A. Increased wakefulness is expected, and no further investigation is needed.
B. Periods awake after sleep onset, especially exceeding 30 minutes in older adults, require
assessment as poor sleep is an indicator of health status.
C. Daytime napping eliminates the need for concern regarding nocturnal wakefulness.
D. The only changes in sleep architecture seen in older adults are lighter sleep stages (less Stage
4).
Correct Answer: B Rationale: In subjects older than 50, periods of wakefulness are frequent,
and more than 30 minutes of wakefulness after sleep onset occurs in over 50% of older adults.
However, the nurse should recognize that poor sleep is not an inevitable consequence of aging
but an indicator of health status that calls for investigation. Older adults often experience
reduced total sleep time, reduced sleep efficiency, and subjectively lighter sleep with more stage
1 and fewer stage 4 disruptions.
Question 3 (Pharmacology/Safety) The nurse is reviewing medications that might be
contributing to sleep disturbances in an older adult patient. Which medication classes listed in
the chart review are known to potentially affect sleep? (Select all that apply.)
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Diuretics
C. Antihypertensives (e.g., Clonidine)
D. Phenytoin
E. Acetaminophen
Correct Answer: A, B, C, D Rationale: Medications that may affect sleep include Selective
serotonin reuptake inhibitors (SSRIs), Antihypertensives (clonidine, beta-blockers, reserpine,
, methyldopa), Diuretics, and Phenytoin. Acetaminophen is not listed among the medications
specifically affecting sleep.
Question 4 (Prioritization/Safety) A primary care nurse practitioner is considering treatment
options for a 75-year-old patient diagnosed with chronic insomnia. According to best practice
guidelines for older adults, which approach should be pursued initially?
A. Short-term use of zolpidem (a sedative-hypnotic).
B. Initiating nonpharmacological interventions.
C. Prescribing a low-dose benzodiazepine.
D. Starting a trial of an over-the-counter sleep aid.
Correct Answer: B Rationale: Nonpharmacological interventions are the first-line
treatment for sleep problems. Benzodiazepines or other sedative-hypnotics should not be used
in older adults as a first choice of treatment for insomnia.
Question 5 (Assessment/Data Collection) To gather accurate data regarding a patient's sleep
pattern over the past four weeks, the nurse should instruct the patient (or caregiver) to record
which information in a sleep diary? (Select all that apply.)
A. Time when they go to bed
B. Time when they go to sleep
C. Time and type of exercise
D. Amount of caffeine consumed
E. Weight upon waking
Correct Answer: A, B, C, D Rationale: A sleep diary, intended to be kept for 2 to 4 weeks,
requires recording the time the person goes to bed, goes to sleep, wakes up, and gets out of bed.
It also includes recording when they take naps, exercise, consume alcohol, and consume
caffeinated beverages. Weight upon waking is not listed as an instruction for the sleep diary.
Question 6 (Analysis/Risk Factors) Which physical health factor places an older adult at risk
for sleep disturbances?
A. Engagement in meaningful activities.
B. Having chronic dizziness or lower extremity weakness.
C. Taking only one daily oral medication.
D. Living in a quiet environment.
Correct Answer: B Rationale: Comorbidities, such as central nervous system disorders like
Parkinson's disease or dementia, are listed as physical health risk factors for sleep disturbances in
older adults. Chronic dizziness and lower extremity weakness are noted as risk factors for falls,
which are often related to acute or chronic disease states. Active lifestyles and engaging in
meaningful activities are associated with better sleep. Polypharmacy (many medications) is a risk
factor, not just taking one. Environmental noises are a risk factor, not a quiet environment.
Question 7 (Prioritization/Obstructive Sleep Apnea) Which finding related to an older male
patient increases his risk for obstructive sleep apnea (OSA)?
A. Low-intensity aerobic activity.
Question 1 (Application/Prioritization) A nurse is teaching an older adult patient about healthy
sleep habits to address chronic insomnia. Which instruction should the nurse prioritize?
A. Take melatonin 1 to 2 hours before bedtime.
B. Use the bed only for sleep and sex.
C. Limit fluid intake throughout the day.
D. Avoid strenuous exercise within 1 hour of bedtime.
Correct Answer: B Rationale: Among the healthy sleep habits, setting the expectation that the
bed should be used only for sleep and sex helps establish a positive association between the bed
and sleeping, which is a core intervention for insomnia. Reducing fluid intake is specific to
limiting fluids beforebedtime. Melatonin is a circadian rhythm intervention that may be helpful,
administered 1 to 2 hours before bedtime. Exercise should be avoided in the late afternoon or
evening, but promoting use of the bed only for sleep is a fundamental habit for insomnia
intervention.
Question 2 (Analysis/Risk Factors) An 80-year-old patient who experiences frequent periods of
wakefulness after sleep onset asks the nurse if this is a normal part of aging. The nurse responds
based on the understanding that:
A. Increased wakefulness is expected, and no further investigation is needed.
B. Periods awake after sleep onset, especially exceeding 30 minutes in older adults, require
assessment as poor sleep is an indicator of health status.
C. Daytime napping eliminates the need for concern regarding nocturnal wakefulness.
D. The only changes in sleep architecture seen in older adults are lighter sleep stages (less Stage
4).
Correct Answer: B Rationale: In subjects older than 50, periods of wakefulness are frequent,
and more than 30 minutes of wakefulness after sleep onset occurs in over 50% of older adults.
However, the nurse should recognize that poor sleep is not an inevitable consequence of aging
but an indicator of health status that calls for investigation. Older adults often experience
reduced total sleep time, reduced sleep efficiency, and subjectively lighter sleep with more stage
1 and fewer stage 4 disruptions.
Question 3 (Pharmacology/Safety) The nurse is reviewing medications that might be
contributing to sleep disturbances in an older adult patient. Which medication classes listed in
the chart review are known to potentially affect sleep? (Select all that apply.)
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Diuretics
C. Antihypertensives (e.g., Clonidine)
D. Phenytoin
E. Acetaminophen
Correct Answer: A, B, C, D Rationale: Medications that may affect sleep include Selective
serotonin reuptake inhibitors (SSRIs), Antihypertensives (clonidine, beta-blockers, reserpine,
, methyldopa), Diuretics, and Phenytoin. Acetaminophen is not listed among the medications
specifically affecting sleep.
Question 4 (Prioritization/Safety) A primary care nurse practitioner is considering treatment
options for a 75-year-old patient diagnosed with chronic insomnia. According to best practice
guidelines for older adults, which approach should be pursued initially?
A. Short-term use of zolpidem (a sedative-hypnotic).
B. Initiating nonpharmacological interventions.
C. Prescribing a low-dose benzodiazepine.
D. Starting a trial of an over-the-counter sleep aid.
Correct Answer: B Rationale: Nonpharmacological interventions are the first-line
treatment for sleep problems. Benzodiazepines or other sedative-hypnotics should not be used
in older adults as a first choice of treatment for insomnia.
Question 5 (Assessment/Data Collection) To gather accurate data regarding a patient's sleep
pattern over the past four weeks, the nurse should instruct the patient (or caregiver) to record
which information in a sleep diary? (Select all that apply.)
A. Time when they go to bed
B. Time when they go to sleep
C. Time and type of exercise
D. Amount of caffeine consumed
E. Weight upon waking
Correct Answer: A, B, C, D Rationale: A sleep diary, intended to be kept for 2 to 4 weeks,
requires recording the time the person goes to bed, goes to sleep, wakes up, and gets out of bed.
It also includes recording when they take naps, exercise, consume alcohol, and consume
caffeinated beverages. Weight upon waking is not listed as an instruction for the sleep diary.
Question 6 (Analysis/Risk Factors) Which physical health factor places an older adult at risk
for sleep disturbances?
A. Engagement in meaningful activities.
B. Having chronic dizziness or lower extremity weakness.
C. Taking only one daily oral medication.
D. Living in a quiet environment.
Correct Answer: B Rationale: Comorbidities, such as central nervous system disorders like
Parkinson's disease or dementia, are listed as physical health risk factors for sleep disturbances in
older adults. Chronic dizziness and lower extremity weakness are noted as risk factors for falls,
which are often related to acute or chronic disease states. Active lifestyles and engaging in
meaningful activities are associated with better sleep. Polypharmacy (many medications) is a risk
factor, not just taking one. Environmental noises are a risk factor, not a quiet environment.
Question 7 (Prioritization/Obstructive Sleep Apnea) Which finding related to an older male
patient increases his risk for obstructive sleep apnea (OSA)?
A. Low-intensity aerobic activity.
