NR547 DIFFERENTIAL DIAGNOSIS
MIDTERM EXAM GUIDE 200
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE 2026
UPDATE
What criteria must be present to confirm a diagnosis of insomnia
requires complaints occurring at least 3 nights a week for 3 months or more
+ causing clinically significant distress in important areas of functioning
What are some long term effects persistent insomnia is associated with?
Major depressive disorder, HTN, diabetes, stroke, obesity, memory loss,
weakened immune system, and MI
What is hypersomnolence d/o
excessive quantity of sleep, difficulty awakening or staying awake.
vWhat are some signs and symptoms of this disorder?
Signs and symptoms include daytime naps, unintentionally falling sleep
during activities such as reading, confusion and memory impairment upon
,awakening, excessive daytime sleepiness, impairment in occupational
functioning
Factors that affect sleep
- emotional stress
- medication, stimulants and alcohol
- physical illness
-diet
- smoking
-medications
Stages of sleep
1 - drowsy, non-rem
2- light sleep, slowed brain activity
3- moderate to deep sleep, delta waves present
4- deep sleep necessary to feel rested in the morning - sleepwalking
5- REM approx 90 min after sleep begins, decreases with age, most dreaming
occurs
The PMHNP is providing psychoeducation and anticipatory guidance to
concerned parents regarding their child's night terrors. At which stage of
sleep is this most likely to occur?
stage 3-4
What is cataplexy
,the bilateral loss of muscle tone triggered by emotions, particularly laughter
or excitement
What deficiency might be seen in a patient with narcolepsy?
Hypocretin (orexin) deficiency
Which type of diagnostic testing should be performed in order to make a
narcolepsy diagnosis?
Dx testing- cerebrospinal fluid analysis, nocturnal polysomnography (PSG),
and a multiple sleep latency test (MSLT)
vClients with breathing-related sleep disorders typically present with what
signs and symptoms
Excessive daytime sleepiness, trouble concentrating during the day, mood
changes, awakening with a dry mouth or sore throat, morning headaches,
decreased libido, partners endorse snoring, apneic periods, and abrupt
awakenings accompanied by gasping or choking.
What are risk factors of OSA?
Risk factors= ages 40-60, obesity, and family history
, A 48 year old obese woman experiences excessive daytime sleepiness,
fatigue, anhedonia, and apathy. Her husband reports that she snores loudly
when sleeping and often wakes up drenched inn sweat. The patient has no
prior psychiatric history and denies substance abuse. Which of the following
in the most likely cause of her symptoms?
Airway obstruction
3 multiple choice options
What are circadian rhythms?
internall generated rhythms of waking and sleeping. Physical and behavioral
changes related to responses to light and dark
When do Circadian rhythm sleep-wake disorder occur?
Occurs when endogenous, 24-hour cycle is disrupted
Who is at risk for this Circadian rhythm sleep-wake disorder
medical illnesses, those who work night shift, those who are blind
What are parasomnias
MIDTERM EXAM GUIDE 200
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE 2026
UPDATE
What criteria must be present to confirm a diagnosis of insomnia
requires complaints occurring at least 3 nights a week for 3 months or more
+ causing clinically significant distress in important areas of functioning
What are some long term effects persistent insomnia is associated with?
Major depressive disorder, HTN, diabetes, stroke, obesity, memory loss,
weakened immune system, and MI
What is hypersomnolence d/o
excessive quantity of sleep, difficulty awakening or staying awake.
vWhat are some signs and symptoms of this disorder?
Signs and symptoms include daytime naps, unintentionally falling sleep
during activities such as reading, confusion and memory impairment upon
,awakening, excessive daytime sleepiness, impairment in occupational
functioning
Factors that affect sleep
- emotional stress
- medication, stimulants and alcohol
- physical illness
-diet
- smoking
-medications
Stages of sleep
1 - drowsy, non-rem
2- light sleep, slowed brain activity
3- moderate to deep sleep, delta waves present
4- deep sleep necessary to feel rested in the morning - sleepwalking
5- REM approx 90 min after sleep begins, decreases with age, most dreaming
occurs
The PMHNP is providing psychoeducation and anticipatory guidance to
concerned parents regarding their child's night terrors. At which stage of
sleep is this most likely to occur?
stage 3-4
What is cataplexy
,the bilateral loss of muscle tone triggered by emotions, particularly laughter
or excitement
What deficiency might be seen in a patient with narcolepsy?
Hypocretin (orexin) deficiency
Which type of diagnostic testing should be performed in order to make a
narcolepsy diagnosis?
Dx testing- cerebrospinal fluid analysis, nocturnal polysomnography (PSG),
and a multiple sleep latency test (MSLT)
vClients with breathing-related sleep disorders typically present with what
signs and symptoms
Excessive daytime sleepiness, trouble concentrating during the day, mood
changes, awakening with a dry mouth or sore throat, morning headaches,
decreased libido, partners endorse snoring, apneic periods, and abrupt
awakenings accompanied by gasping or choking.
What are risk factors of OSA?
Risk factors= ages 40-60, obesity, and family history
, A 48 year old obese woman experiences excessive daytime sleepiness,
fatigue, anhedonia, and apathy. Her husband reports that she snores loudly
when sleeping and often wakes up drenched inn sweat. The patient has no
prior psychiatric history and denies substance abuse. Which of the following
in the most likely cause of her symptoms?
Airway obstruction
3 multiple choice options
What are circadian rhythms?
internall generated rhythms of waking and sleeping. Physical and behavioral
changes related to responses to light and dark
When do Circadian rhythm sleep-wake disorder occur?
Occurs when endogenous, 24-hour cycle is disrupted
Who is at risk for this Circadian rhythm sleep-wake disorder
medical illnesses, those who work night shift, those who are blind
What are parasomnias
