A 38 y/o male reports excessive daytime sleepiness for the last 2 weeks in the setting of restructuring at his job. He is unable to tell if he is having
... [Show More] more trouble falling asleep or staying asleep. Sometimes he wakes up at 4 am and is unable to fall back asleep. what should the PMHNP do first?
A. Prescribe zolpidem 10 mg at bedtime as needed
B. Prescribe a mirtazapine 15 mg at bedtime
C. Request the patient completes a sleep log
D. Add an extra blanket to his bed covers
C. Request the patient completes a sleep log
A 45 y/o female reports that she has difficulty falling back asleep after she wakes up at 4 am. for the last month. She understand that it is better to get out of bed rather than lying in bed awake. She uses this time to catch up on her reading but as a result is very sleepy during the day. What should the PMHNP recommend?
A. Intermezzo 1.75 mg when she awakes at 4 am
B. Mop the kitchen floor as soon as she wakes up at 4 am
C. Diphenhydramine 25 mg at bedtime
D. Sleep diary for 2 weeks
B. Mop the kitchen floor as soon as she wakes up at 4 am
A 44 y/o male with type 2 diabetes is becoming increasingly irritable, inattentive, forgetful, and frequently falls asleep in front of his computer at work. he is worried he will get fired and lose his benefits which he needs to cover his diabetic supplies. he says, "I am so worried that my blood sugars are a high as 300 and on occasion have wet the bed". What should the PMHNP do during this visit?
A. Provigil 100 mg daily
B. Order a sleep study
C. Mirtazapine 15 mg at bedtime
D. Refer him back to primary care for glycemic control
B. Order a sleep study
A 25 y/o woman reports frequently falling asleep during the day for the last 6 months. This has been affecting her work as a computer help desk agent, noting she sometimes nods off during calls but also during times of high volume hours. When he head hits the back of the chair she wakes up and realizes what happened. She insists she consistently sleeps 8 hours each night. This is most consistent with which of the following?
A. Narcolepsy
B. Circadian rhythm sleep disorder
C. Hypersomnia
D. Night terrors
A. Narcolepsy
John is a 22 y/o RN who has started his first job in the cardiothoracic IVY. After his orientation he began his fulltime position working three 12-hour shifts per week. On his days off he reports excessive fatigue during the day with periods of falling asleep while driving. he also reports difficult staying awake at work his first night back to work. Which of the following is the most likely diagnosis?
A. narcolepsy
B. Circadian rhythm sleep disorder
C. Hypersomnia
D. Night terrors
B. Circadian rhythm sleep disorder
Ella is trying to help her 3 y/o son sleep through the night but reports recently he has had three episodes of waking up within 3 hours of falling asleep with inconsolable screaming and crying. He then falls back asleep on his own and has no memory of what happened. What would be the best intervention?
A. Recommend diphenhydramine 12.5 mg at bedtime
B. Create and maintain bedtime routine and reduce stimuli
C. Order polysomnography and EEG
D. Prescribe desmopressin nasal spray
B. Create and maintain bedtime routine and reduce stimuli
A 45 y/o man reports difficulty falling asleep and early morning awakening. He reports excessive daytime sleepiness as a result of his unrestful sleep. What should the PMHNP do first?
A. Prescribe trazadone 100 mg at bedtime
B. Administer Patient Health Questionnaire (PHQ)-9
C. Order a sleep study
D. Have the patient complete a sleep diary
B. Administer Patient Health Questionnaire (PHQ)-9
A 22 y/o male has been referred by the employee assistance program at his job for poor work performance. The patient reports that no matter how much coffee he drinks he remains sleepy throughout the day and will doze off at meetings. He notes that he will often awake when his head hits the back of his chair when at a meeting. On occasion he has dropped his cup of coffee in front of everyone and now he feels he is under constant scrutiny and thinks people are speculating he is using drugs. What is the most likely diagnosis?
A. Primary hypersomnia
B. Hypnagogic hallucinations
C. Hypnopompic hallucinations
D. Narcolepsy
D. Narcolepsy
A 48 y/o obese woman experiences excessive daytime sleepiness, fatigue, anhedonia, and apathy. Her husband reports that she snores loudly when sleeping, and often will wake up drenched in sweat. the patient has no prior psychiatric history and denies substance abuse. Which of the following is the most likely cause of her symptoms?
A. Airway obstruction
B. Major depression
C. Perimenopause
D. Narcolepsy
A. Airway obstruction
A 52 y/o obese man with type 2 diabetes reports dozing off while driving, watching TV, or reading, with increased apathy and fatigue. The PMHNP orders a sleep study which revealed 10 episodes of apnea lasting 15 to 20 seconds each per hour of sleep. Based on these findings what should the PMHNP prescribe for his condition?
A. Antidepressant medication
B. Referral to otolaryngology for uvuloplasty
C. Referral to otolaryngology for rhinoplasty
D. Continuous positive airway pressure
D. Continuous positive airway pressure
A father brings his 6 y/o son to you because he is worried about him. He states that the son sits up in bed shortly after falling asleep and screams. He says he is consolable and unable to be awakened during these episodes but eventually he falls back asleep. The father states he is not able to fall back asleep after those episodes and is exhausted and falling asleep at work during the day. The child is energetic and playful during the day and has no memory of the episodes. What is the most appropriate response?
A. "Are you worried you are doing something wrong?"
B. "I can see you're upset, but really you are overreacting"
C. "I can see this is upsetting for you"
D. "Tell me why you can't fall back asleep after your son does?"
C. "I can see this is upsetting for you"
The PMHNP is providing psychoeducation and anticipatory guidance to the concerned parent regarding night terrors. At which stage of sleep is this most likely to occur?
A. Any stage of sleep
B. Stage 1
C. Stage 2
D. Stage 3 to 4
D. Stage 3 to 4
Sam is 11 y/o without past psychiatric history. He was born by normal spontaneous vaginal delivery with normal APGAR scores. He has met all of his developmental milestones. He began sixth grade this year and has had increased trouble falling asleep. He has always had bedtime rituals but lately they are extending in complexity and length. Most of his time in the evening is spent checking that the lights are turned off and that the windows are locked. As a result, he is only getting 5 hours of sleep at night and now have excessive daytime sleepiness with decreased interest in socialization and failing grades. which of the following infectious diseases may contribute to this clinical presentation?
A. Treponema
B. Human immunodeficiency virus
C. Streptococcus
D. Congenital herpes simplex virus
B. Human immunodeficiency virus
The PMHNP is covering for the vacationing psychiatrist and is conducting a follow-up visit for a 24 y/o man diagnosed with major depressive disorder. Which type of sleep disturbance is most consistent with this diagnosis?
A. Early morning awakening
B. Sleeping too deeply
C. Easily awakened sleeping to lightly
D. Decreased effect of trazadone
A. Early morning awakening [Show Less]