Sleep & rest NCLEX-RN Practice Questions

Sleep & Rest NCLEX-RN Practice Questions

Strong sleep and rest practices are essential to patient recovery and overall health, making them a key focus in the NCLEX-RN Basic Care & Comfort domain. This topic-wise set of practice questions targets clinical decision-making around sleep hygiene, insomnia management, sleep-disordered breathing, pharmacologic and nonpharmacologic interventions, and age-specific considerations. You’ll apply evidence-based strategies to prioritize nursing care, teach clients safe sleep habits, and anticipate medication effects that influence sleep quality. Designed for NCLEX-RN preparation and valuable for M. Pharma students seeking deeper clinical-pharmacologic insight, these questions mirror exam-level complexity—integrating assessment, education, safety, and interprofessional collaboration. Use them to refine your reasoning and enhance patient outcomes in both inpatient and community settings.

Q1. Which intervention best promotes sleep for a hospitalized older adult?

• Cluster nursing care to minimize nighttime awakenings
• Keep lights on to prevent falls
• Encourage long evening naps
• Offer caffeinated tea at bedtime

Correct Answer: Cluster nursing care to minimize nighttime awakenings

Q2. A client with chronic insomnia is being taught sleep hygiene. Which statement indicates correct understanding?

• I will use my bed only for sleep and intimacy and get out if I can’t sleep within 20 minutes
• I will drink a small whiskey nightcap to help me fall asleep
• I will scroll on my phone in bed until I feel drowsy
• I will sleep in 3–4 hours on weekends to catch up

Correct Answer: I will use my bed only for sleep and intimacy and get out if I can’t sleep within 20 minutes

Q3. Which client is at highest risk for obstructive sleep apnea (OSA)?

• 52-year-old male with BMI 38, neck circumference 18 inches, loud snoring
• 28-year-old female with BMI 21 and no snoring
• 70-year-old underweight client with COPD who sleeps upright
• 40-year-old male marathon runner with BMI 22

Correct Answer: 52-year-old male with BMI 38, neck circumference 18 inches, loud snoring

Q4. A patient using CPAP for OSA reports nasal dryness and mouth breathing. What is the best nursing action?

• Add heated humidifier to the CPAP circuit
• Increase CPAP pressure settings
• Advise stopping CPAP until dryness resolves
• Apply petroleum jelly inside the mask nightly

Correct Answer: Add heated humidifier to the CPAP circuit

Q5. Which instruction is essential when teaching a patient about zolpidem for insomnia?

• Take immediately before bed when you can allow 7–8 hours of sleep
• Take a second dose if you awaken during the night
• Combine with diphenhydramine for better effect
• Use with alcohol to fall asleep faster

Correct Answer: Take immediately before bed when you can allow 7–8 hours of sleep

Q6. Which prescription should the nurse question for a 78-year-old with insomnia, COPD, and high fall risk?

• Temazepam 30 mg at bedtime as needed for sleep
• Ramelteon 8 mg nightly
• Sleep hygiene education and cognitive behavioral therapy for insomnia
• Low-dose doxepin 3 mg nightly

Correct Answer: Temazepam 30 mg at bedtime as needed for sleep

Q7. Which action is most appropriate to alleviate symptoms of restless legs syndrome (RLS)?

• Check ferritin and supplement iron if low
• Restrict all movement in the evening
• Increase caffeine intake after dinner
• Use sedating antihistamines nightly

Correct Answer: Check ferritin and supplement iron if low

Q8. Which instruction aligns with stimulus control therapy for insomnia?

• Go to bed only when sleepy and leave the bed if unable to sleep after about 20 minutes
• Spend the day in bed to catch up on sleep
• Watch TV in bed to distract the mind
• Nap for 2–3 hours daily to reduce fatigue

Correct Answer: Go to bed only when sleepy and leave the bed if unable to sleep after about 20 minutes

Q9. A postoperative client reports poor sleep due to pain. What is the priority intervention?

• Administer the prescribed analgesic before bedtime and reassess comfort
• Turn on the television for distraction
• Encourage hallway ambulation at 0200
• Offer coffee with dinner to prevent headaches

Correct Answer: Administer the prescribed analgesic before bedtime and reassess comfort

Q10. Which teaching supports safe sleep for a 2-month-old infant?

• Place infant supine on a firm mattress with no loose bedding
• Place infant prone to prevent aspiration after feeds
• Bed-share with parents to monitor breathing
• Use sleep positioners and pillows to reduce rolling

Correct Answer: Place infant supine on a firm mattress with no loose bedding

Q11. A pregnant client in the third trimester reports difficulty sleeping. What is the best advice?

• Sleep in left lateral position with pillows for support
• Sleep flat on the back to reduce hip strain
• Take hot tubs late at night to relax
• Start temazepam 15 mg at bedtime

Correct Answer: Sleep in left lateral position with pillows for support

Q12. Which strategy best promotes sleep and reduces delirium risk in ICU patients?

• Cluster care, reduce nighttime noise/light, provide earplugs/eye masks
• Perform hourly neuro checks overnight in stable patients
• Keep overhead lights on all night for visibility
• Schedule non-urgent labs between 0100–0400

Correct Answer: Cluster care, reduce nighttime noise/light, provide earplugs/eye masks

Q13. Which client statement indicates correct understanding about narcolepsy?

• Strong emotions can trigger sudden loss of muscle tone called cataplexy
• I should drive long distances even if sleep attacks persist
• Nighttime alcohol will improve my daytime alertness
• Modafinil is taken at bedtime to help me sleep

Correct Answer: Strong emotions can trigger sudden loss of muscle tone called cataplexy

Q14. Which is the best initial method to assess sleep patterns in chronic insomnia?

• Two-week sleep diary tracking bedtimes, awakenings, naps, and substance use
• Immediate overnight polysomnography for all patients
• Fasting cortisol measurement
• Daytime EEG only

Correct Answer: Two-week sleep diary tracking bedtimes, awakenings, naps, and substance use

Q15. A client with GERD reports nocturnal heartburn disrupting sleep. What is the best bedtime advice?

• Elevate the head of the bed and avoid meals within 3 hours of bedtime
• Drink peppermint tea at bedtime
• Eat a large chocolate snack before sleeping
• Lie flat immediately after dinner

Correct Answer: Elevate the head of the bed and avoid meals within 3 hours of bedtime

Q16. What is the recommended sleep duration for school-age children (6–12 years)?

• 9–12 hours per 24 hours
• 6–7 hours per 24 hours
• 13–16 hours per 24 hours
• 4–5 hours per 24 hours

Correct Answer: 9–12 hours per 24 hours

Q17. A client with OSA is receiving IV opioids via PCA. What is the priority nighttime monitoring?

• Continuous pulse oximetry with capnography if available during sleep
• Check pain scores every 6 hours only
• Place the client supine for comfort
• Offer alcohol to relax before bed

Correct Answer: Continuous pulse oximetry with capnography if available during sleep

Q18. An older adult started trazodone for sleep. Which finding requires urgent follow-up?

• Dizziness and near-falls upon standing in the morning
• Mild dry mouth relieved with water
• Vivid dreams without impairment
• Slight morning grogginess resolving with movement

Correct Answer: Dizziness and near-falls upon standing in the morning

Q19. A business traveler will fly east across six time zones next week. Which strategy best reduces jet lag?

• Gradually advance bedtime and wake time by 30–60 minutes each day for several days
• Stay awake all night before the flight
• Plan long daytime naps on arrival
• Expose to bright light late at night on arrival

Correct Answer: Gradually advance bedtime and wake time by 30–60 minutes each day for several days

Q20. Which client should avoid diphenhydramine as a sleep aid?

• Older adult with benign prostatic hyperplasia and glaucoma
• Healthy 20-year-old without medical conditions
• Postpartum, breastfeeding mother considering a single dose
• Athlete with seasonal allergies controlled on nasal steroids

Correct Answer: Older adult with benign prostatic hyperplasia and glaucoma

Q21. Which change in sleep architecture is expected with normal aging?

• Decreased slow-wave sleep with more nighttime awakenings
• Increased percentage of REM sleep
• Longer total sleep time without daytime naps
• Minimal effect of evening caffeine on sleep

Correct Answer: Decreased slow-wave sleep with more nighttime awakenings

Q22. Which findings most strongly suggest high OSA risk using STOP-Bang criteria?

• Neck circumference 44 cm and BMI 37 with loud snoring
• BMI 22 and neck 32 cm without snoring
• Age 25, female, long-distance runner
• Blood pressure 110/70 and no observed apneas

Correct Answer: Neck circumference 44 cm and BMI 37 with loud snoring

Q23. Which is the best bedtime snack to support sleep onset?

• Small carbohydrate-protein snack like warm milk and whole-grain crackers
• Spicy nachos and soda
• Energy drink and protein bar
• Large, greasy meal

Correct Answer: Small carbohydrate-protein snack like warm milk and whole-grain crackers

Q24. A patient is nonadherent to CPAP due to claustrophobia. What is the best intervention?

• Trial of nasal pillows mask with gradual desensitization sessions
• Discontinue CPAP indefinitely
• Prescribe nightly benzodiazepines to tolerate the mask
• Tighten headgear straps to prevent leaks

Correct Answer: Trial of nasal pillows mask with gradual desensitization sessions

Q25. A client on an SSRI reports new-onset insomnia. What should the nurse suggest?

• Take the SSRI dose in the morning to minimize insomnia
• Add caffeine in the evening to counter fatigue
• Double the bedtime dose for faster adjustment
• Stop the SSRI abruptly

Correct Answer: Take the SSRI dose in the morning to minimize insomnia

Q26. What is the priority safety measure for an adult with sleepwalking (somnambulism)?

• Secure the environment by locking doors/windows and removing tripping hazards
• Wake the client abruptly during episodes
• Restrain the client in bed at night
• Encourage alcohol at bedtime to suppress episodes

Correct Answer: Secure the environment by locking doors/windows and removing tripping hazards

Q27. A client using a nicotine patch reports insomnia and vivid dreams. What is the best advice?

• Remove the patch at bedtime or switch to a lower-dose, 16-hour patch
• Add an energy drink in the evening to compensate
• Continue the patch unchanged; symptoms will not improve
• Apply two patches to build tolerance

Correct Answer: Remove the patch at bedtime or switch to a lower-dose, 16-hour patch

Q28. Which statement about melatonin supplements is accurate?

• It may potentiate anticoagulation; monitor INR if on warfarin
• It is free of any drug interactions
• It cures OSA, allowing discontinuation of CPAP
• It causes addiction with severe withdrawal

Correct Answer: It may potentiate anticoagulation; monitor INR if on warfarin

Q29. Which medication is most likely to disturb sleep if taken at night?

• Prednisone taken in the evening
• Mirtazapine 15 mg at bedtime
• Melatonin 3 mg at bedtime
• Hydroxyzine 25 mg at bedtime

Correct Answer: Prednisone taken in the evening

Q30. A client has taken clonazepam nightly for months and wants to stop. What is the best nursing advice?

• Taper dose gradually under provider supervision to prevent withdrawal and rebound insomnia
• Stop abruptly to reset natural sleep
• Substitute with alcohol at bedtime
• Switch immediately to a higher-potency benzodiazepine

Correct Answer: Taper dose gradually under provider supervision to prevent withdrawal and rebound insomnia

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