YTILIBOM & PEELS • 2 MAXE
Nursing Fundamentals
NURS School of Nursing — Exam 2 Review
SLEEP · IMMOBILITY · SAFETY · CLINICAL REASONING
EXAM 2
Nursing Fundamentals — Exam 2
S L E E P D I S O R D E R S , I M M O B I L I TY CO M P L I C AT I O N S , N U R S I N G D I A G N O S I S & S A F E TY
INSTITUTION School of Nursing COURSE CODE NURS-FUND-EXAM2
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Nursing Fundamentals Exam 2 TOTAL QUESTIONS 60+ Comprehensive Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover sleep stages and disorders, immobility complications by body system, nursing diagnosis (NANDA-I/PES format),
patient safety (STEADI, never events, sentinel events), and blood-borne pathogen exposure.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between central sleep apnea and narcolepsy, and between problem-focused and risk
nursing diagnoses.
SLEEP, IMMOBILITY, NURSING PROCESS & PATIENT SAFETY Questions 1 – 60+
1. What is Stage 1 sleep characterized by?
A. Deep, slow-wave brain activity.
B. The state of transition between wakefulness and sleep, with relatively rapid, low-amplitude brain waves.
C. REM sleep with vivid dreaming.
D. Complete muscle atonia.
CORRECT ANSWER B — Transition between wakefulness and sleep with rapid, low-amplitude brain waves
RATIONALE Stage 1 NREM sleep is the lightest sleep stage — the transition from wakefulness to sleep lasting only a few
minutes. EEG shows alpha wave disappearance and emergence of theta waves (low amplitude, mixed
frequency). The person is easily awakened, may experience hypnic jerks (sudden muscle contractions), and if
awakened, may report they were "just drifting off." This stage comprises approximately 5% of total sleep time.
, 2. What is the correct sequence of sleep stages during a normal sleep cycle?
A. REM → Stage 1 → Stage 2 → Stage 3.
B. Stage 1 → Stage 2 → Stage 3, then reverses from Stage 3 → Stage 2, followed by REM.
C. Stage 3 → Stage 2 → Stage 1 → REM.
D. REM occurs only at the beginning of sleep.
CORRECT ANSWER B — Stage 1 → 2 → 3, then reverses 3 → 2, followed by REM
RATIONALE A normal sleep cycle progresses: NREM Stage 1 (light sleep, transition) → Stage 2 (initiation of true sleep) →
Stage 3 (deep slow-wave sleep). The cycle then reverses: Stage 3 → Stage 2, and instead of returning to Stage
1, enters REM (rapid eye movement) sleep. This complete cycle lasts approximately 90-110 minutes and
repeats 4-6 times per night. REM periods lengthen with each cycle, while deep Stage 3 sleep decreases toward
morning.
3. What is the pathophysiological cause of central sleep apnea?
A. Upper airway obstruction from soft tissue collapse.
B. The brain does not send signals to the respiratory muscles to breathe.
C. Excess orexin production.
D. Allergic inflammation of the nasopharynx.
CORRECT ANSWER B — The brain fails to send signals to the respiratory muscles
RATIONALE Central sleep apnea (CSA) is fundamentally different from obstructive sleep apnea (OSA). In CSA, the
brainstem respiratory control centers intermittently fail to transmit signals to the diaphragm and intercostal
muscles, resulting in periods of absent breathing effort. Common causes include heart failure, stroke, opioid
use, and high altitude. In contrast, OSA involves physical airway obstruction with continued respiratory effort.
Symptoms include observed apneas, excessive daytime sleepiness, and impaired cognition. Treatment
includes addressing the underlying cause and may involve adaptive servo-ventilation (ASV) or CPAP with
backup rate.
4. What is narcolepsy and what are its characteristic symptoms?
A. Difficulty falling asleep at night with racing thoughts.
B. Periods of extreme daytime sleepiness with sudden, brief episodes of deep sleep, plus possible cataplexy, sleep
paralysis, and hypnagogic hallucinations.
C. Inability to breathe during sleep due to airway obstruction.
D. Excessive movement during sleep with kicking and thrashing.
CORRECT ANSWER B — Extreme daytime sleepiness with sudden sleep attacks, cataplexy, sleep paralysis, and hypnagogic
hallucinations
RATIONALE Narcolepsy is a chronic neurological disorder of REM sleep dysregulation caused by deficiency of orexin
(hypocretin) — a neuropeptide that regulates wakefulness. Classic tetrad: (1) Excessive daytime sleepiness
with irresistible sleep attacks; (2) Cataplexy — sudden bilateral loss of muscle tone triggered by strong
emotion (laughter, anger) — pathognomonic for type 1 narcolepsy; (3) Sleep paralysis — inability to move
upon waking or falling asleep; (4) Hypnagogic/hypnopompic hallucinations — vivid dreamlike experiences at
sleep onset or awakening. Treatment includes stimulants (modafinil), sodium oxybate for cataplexy, and
scheduled naps.
Nursing Fundamentals
NURS School of Nursing — Exam 2 Review
SLEEP · IMMOBILITY · SAFETY · CLINICAL REASONING
EXAM 2
Nursing Fundamentals — Exam 2
S L E E P D I S O R D E R S , I M M O B I L I TY CO M P L I C AT I O N S , N U R S I N G D I A G N O S I S & S A F E TY
INSTITUTION School of Nursing COURSE CODE NURS-FUND-EXAM2
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Nursing Fundamentals Exam 2 TOTAL QUESTIONS 60+ Comprehensive Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover sleep stages and disorders, immobility complications by body system, nursing diagnosis (NANDA-I/PES format),
patient safety (STEADI, never events, sentinel events), and blood-borne pathogen exposure.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between central sleep apnea and narcolepsy, and between problem-focused and risk
nursing diagnoses.
SLEEP, IMMOBILITY, NURSING PROCESS & PATIENT SAFETY Questions 1 – 60+
1. What is Stage 1 sleep characterized by?
A. Deep, slow-wave brain activity.
B. The state of transition between wakefulness and sleep, with relatively rapid, low-amplitude brain waves.
C. REM sleep with vivid dreaming.
D. Complete muscle atonia.
CORRECT ANSWER B — Transition between wakefulness and sleep with rapid, low-amplitude brain waves
RATIONALE Stage 1 NREM sleep is the lightest sleep stage — the transition from wakefulness to sleep lasting only a few
minutes. EEG shows alpha wave disappearance and emergence of theta waves (low amplitude, mixed
frequency). The person is easily awakened, may experience hypnic jerks (sudden muscle contractions), and if
awakened, may report they were "just drifting off." This stage comprises approximately 5% of total sleep time.
, 2. What is the correct sequence of sleep stages during a normal sleep cycle?
A. REM → Stage 1 → Stage 2 → Stage 3.
B. Stage 1 → Stage 2 → Stage 3, then reverses from Stage 3 → Stage 2, followed by REM.
C. Stage 3 → Stage 2 → Stage 1 → REM.
D. REM occurs only at the beginning of sleep.
CORRECT ANSWER B — Stage 1 → 2 → 3, then reverses 3 → 2, followed by REM
RATIONALE A normal sleep cycle progresses: NREM Stage 1 (light sleep, transition) → Stage 2 (initiation of true sleep) →
Stage 3 (deep slow-wave sleep). The cycle then reverses: Stage 3 → Stage 2, and instead of returning to Stage
1, enters REM (rapid eye movement) sleep. This complete cycle lasts approximately 90-110 minutes and
repeats 4-6 times per night. REM periods lengthen with each cycle, while deep Stage 3 sleep decreases toward
morning.
3. What is the pathophysiological cause of central sleep apnea?
A. Upper airway obstruction from soft tissue collapse.
B. The brain does not send signals to the respiratory muscles to breathe.
C. Excess orexin production.
D. Allergic inflammation of the nasopharynx.
CORRECT ANSWER B — The brain fails to send signals to the respiratory muscles
RATIONALE Central sleep apnea (CSA) is fundamentally different from obstructive sleep apnea (OSA). In CSA, the
brainstem respiratory control centers intermittently fail to transmit signals to the diaphragm and intercostal
muscles, resulting in periods of absent breathing effort. Common causes include heart failure, stroke, opioid
use, and high altitude. In contrast, OSA involves physical airway obstruction with continued respiratory effort.
Symptoms include observed apneas, excessive daytime sleepiness, and impaired cognition. Treatment
includes addressing the underlying cause and may involve adaptive servo-ventilation (ASV) or CPAP with
backup rate.
4. What is narcolepsy and what are its characteristic symptoms?
A. Difficulty falling asleep at night with racing thoughts.
B. Periods of extreme daytime sleepiness with sudden, brief episodes of deep sleep, plus possible cataplexy, sleep
paralysis, and hypnagogic hallucinations.
C. Inability to breathe during sleep due to airway obstruction.
D. Excessive movement during sleep with kicking and thrashing.
CORRECT ANSWER B — Extreme daytime sleepiness with sudden sleep attacks, cataplexy, sleep paralysis, and hypnagogic
hallucinations
RATIONALE Narcolepsy is a chronic neurological disorder of REM sleep dysregulation caused by deficiency of orexin
(hypocretin) — a neuropeptide that regulates wakefulness. Classic tetrad: (1) Excessive daytime sleepiness
with irresistible sleep attacks; (2) Cataplexy — sudden bilateral loss of muscle tone triggered by strong
emotion (laughter, anger) — pathognomonic for type 1 narcolepsy; (3) Sleep paralysis — inability to move
upon waking or falling asleep; (4) Hypnagogic/hypnopompic hallucinations — vivid dreamlike experiences at
sleep onset or awakening. Treatment includes stimulants (modafinil), sodium oxybate for cataplexy, and
scheduled naps.
