# Situation: The school nurse of a public school that serves Grades 1 to 10 provides health appraisal, screening, and health education for the learners. A 15-year-old girl in Grade 10 often falls asleep in class. Her sleep diary for one week shows: Nights | Bedtime | Wake time Sunday to Thursday (5 nights) | 12:00 midnight | 5:30 a.m. Friday and Saturday (2 nights) | 1:00 a.m. | 11:00 a.m. Her hemoglobin is 12.8 g/dL (128 g/L). Which interpretation is correct? Round off to one decimal place.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629439  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The school nurse of a public school that serves Grades 1 to 10 provides health appraisal, screening, and health education for the learners.

A 15-year-old girl in Grade 10 often falls asleep in class. Her sleep diary for one week shows:
Nights | Bedtime | Wake time
Sunday to Thursday (5 nights) | 12:00 midnight | 5:30 a.m.
Friday and Saturday (2 nights) | 1:00 a.m. | 11:00 a.m.
Her hemoglobin is 12.8 g/dL (128 g/L). Which interpretation is correct? Round off to one decimal place.

## 보기

1. Her sleepiness is better explained by her hemoglobin than her sleep
2. Her average of about 7.8 hours a night is close to what she needs
3. Her weekend sleep of 10 hours makes up for her school-night shortfall
4. Her average of about 6.8 hours a night is below what she needs **✔ 정답**

**정답: 4**

## 해설

She sleeps 5.5 hours on each of 5 nights (27.5 hours) and 10 hours on each of 2 nights (20 hours), a total of 47.5 hours, or 47.5 ÷ 7 = 6.8 hours a night. Adolescents need about 8 to 10 hours, so she is chronically sleep-deprived, and long weekend sleep does not repay the weekday debt. A hemoglobin of 12.8 g/dL (128 g/L) is not anemia.

## 심화 해설

When a 15-year-old student presents with frequent daytime sleepiness, the first step is to quantify her actual sleep and compare it against age-appropriate requirements. Her weekday routine of sleeping from midnight to 5:30 a.m. yields 5.5 hours per night. Over five school nights, that totals 27.5 hours. On Friday and Saturday, she sleeps from 1:00 a.m. to 11:00 a.m., giving 10 hours each night, or 20 hours across the weekend. The weekly total is 47.5 hours, and dividing by 7 gives an average of 6.8 hours per night.

Adolescents aged 14 to 17 years require approximately 8 to 10 hours of sleep per night for optimal alertness, learning, and emotional regulation. A sustained average of 6.8 hours places her well below the lower limit of the recommended range, indicating chronic sleep restriction. The weekend extension to 10 hours does not erase the weekday deficit. Sleep debt is not repaid hour-for-hour by sleeping longer on weekends; circadian misalignment and accumulated sleep pressure persist. Key point! Recovery sleep on weekends can reduce subjective sleepiness temporarily, but it does not restore the cognitive and behavioral performance lost during the school week.

The hemoglobin level of 12.8 g/dL (128 g/L) is within normal limits for an adolescent female. Anemia is typically defined as hemoglobin below 12.0 g/dL (120 g/L) for nonpregnant women aged 15 and older. Because her hemoglobin is normal, anemia cannot explain her classroom sleepiness; the sleep diary provides the more plausible explanation. The differential should therefore focus on sleep quantity and quality rather than hematologic causes.

Experimental evidence supports this interpretation. In a laboratory study of adolescents aged 15 to 17 years, restricting time in bed to 5 hours for five consecutive nights produced measurable declines in daytime functioning, including increased sleepiness, even when a two-night weekend recovery of 10 hours in bed was allowed [3]. The recovery period did not fully restore baseline performance, reinforcing that weekend catch-up sleep is insufficient to offset a school-week deficit. Similarly, a multi-night crossover study in 14- to 16-year-olds found that 6.5 hours in bed over five nights led to more inattentive and sleepy behaviors in a simulated classroom compared with 10 hours in bed . These findings align with the student’s pattern: her school-night sleep of 5.5 hours is even shorter than the restricted condition in that study, making daytime sleepiness highly predictable.

The distinction between average sleep and nightly consistency matters clinically. A student who averages 6.8 hours but oscillates between 5.5 hours on weekdays and 10 hours on weekends experiences two problems: chronic weekday sleep restriction and circadian rhythm disruption from shifting bedtimes and wake times. Watch out! Averaging sleep across a week can mask the severity of school-night deprivation. The school nurse should assess weekday sleep separately from weekend sleep when evaluating daytime sleepiness.

Population-based data also connect short sleep duration to poorer academic outcomes. In a large Norwegian study of 16- to 19-year-olds, shorter sleep duration and larger weekday-weekend bedtime differences were associated with lower grade point averages . The student’s 1-hour bedtime difference between weekdays and weekends, combined with a 5.5-hour weekday sleep duration, places her in a high-risk pattern for both sleepiness and academic difficulty.

From a nursing process perspective, the correct interpretation guides the next step. The priority is not to investigate anemia further but to address sleep hygiene and schedule regularity. The school nurse can use the sleep diary to show the student and family the gap between her current average (6.8 hours) and the recommended range (8 to 10 hours). Interventions should target earlier and more consistent bedtimes on school nights rather than relying on weekend recovery sleep. Even a modest shift—moving bedtime from midnight to 10:30 p.m. on school nights—would add 1.5 hours per night and bring her average closer to the recommended range.

| Interpretation | Assessment | Rationale |
| --- | --- | --- |
| Average nightly sleep | 6.8 hours | Below the 8–10 hour adolescent requirement |
| Weekday sleep | 5.5 hours | Severe restriction on school nights |
| Weekend sleep | 10 hours | Does not repay weekday sleep debt |
| Hemoglobin | 12.8 g/dL (128 g/L) | Normal; anemia is not the cause of sleepiness |

The correct answer is therefore that her average of about 6.8 hours a night is below what she needs. The sleep diary, not the hemoglobin value, explains the classroom sleepiness. Chronic sleep restriction during the school week, with insufficient weekend recovery, is the most clinically relevant finding.References (research sources)

- [3]An experimental study of adolescent sleep restriction during a simulated school week: changes in phase, sleep staging, performance and sleepiness.Research articleAgostini A, Carskadon MA, Dorrian J, Coussens S, Short MA (2017) · DOI: 10.1111/jsr.12473

## 임상 시나리오

Adolescent Sleep Deprivation ScreeningInterpreting a school-night sleep diary in a sleepy student
Calculate the weekly average sleep: 5 school nights at 5.5 hours plus 2 weekend nights at 10 hours equals 47.5 hours, or 6.8 hours per night.

Compare against the adolescent sleep requirement of 8-10 hours per night. A sustained average of 6.8 hours indicates chronic sleep restriction.

A hemoglobin of 12.8 g/dL (128 g/L) is normal for an adolescent female, so anemia does not explain the sleepiness.

CautionWeekend recovery sleep of 10 hours does not repay weekday sleep debt or restore lost cognitive and behavioral performance.

## 핵심 개념

- **Sleep debt** — The cumulative effect of not getting enough sleep, which is not fully repaid by sleeping longer on weekends.
- **Adolescent sleep requirement** — Adolescents aged 14-17 years need approximately 8-10 hours of sleep per night for optimal alertness and learning.
- **Anemia threshold** — Hemoglobin below 12.0 g/dL (120 g/L) in nonpregnant women aged 15 and older; 12.8 g/dL is normal.
- **Sleep diary** — A self-reported record of bedtime, wake time, and sleep duration used to assess sleep patterns.
- **Circadian misalignment** — A mismatch between the body's internal clock and the external sleep-wake schedule, common in adolescents with late bedtimes.

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