A nurse is assessing a client who thinks they have sleep apnea. Which of the following questions should the nurse ask?
"Do you snore loudly?"
"What time do you go to bed?"
"How often do you have trouble sleeping?"
"Do you fall asleep unexpectedly?"
The Correct Answer is A
A. "Do you snore loudly?": Loud snoring is a common symptom of sleep apnea, particularly obstructive sleep apnea. The nurse should inquire about snoring, as it may indicate airway obstruction during sleep, a key feature of the condition.
B. "What time do you go to bed?": While bedtime habits are relevant to sleep hygiene, the specific timing of going to bed is not as directly related to diagnosing sleep apnea. Other questions, such as snoring or breathing patterns, are more relevant for this assessment.
C. "How often do you have trouble sleeping?": Trouble sleeping can be a symptom of various sleep disorders, but it is not specific to sleep apnea. The nurse should focus on symptoms like snoring, choking, or stopping breathing during sleep, which are more indicative of sleep apnea.
D. "Do you fall asleep unexpectedly?": Falling asleep unexpectedly may suggest excessive daytime sleepiness, which can be a result of sleep apnea. However, snoring is a more direct and common symptom of sleep apnea that should be prioritized in the initial assessment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Discuss the client's condition with a nurse on another unit: Sharing a client’s condition with a nurse on another unit without a need-to-know basis violates confidentiality rules. Discussions about client conditions should be limited to personnel involved in care.
B. Fax client information with a cover sheet: A fax cover sheet protects the confidentiality of client information by identifying the contents and indicating that it is confidential. This ensures that the information is not exposed to unauthorized individuals during transmission.
C. List the client's name and condition on board at the nurses station: Displaying client information in public or semi-public areas, violates confidentiality. Client information should be kept private and only accessed by those who are involved in the client’s care.
D. Post client diagnosis on message board in their room: Posting the client’s diagnosis in their room is a violation of confidentiality, as other individuals (like visitors or hospital staff) may have access to that information without a need to know.
Correct Answer is D
Explanation
A. Speech therapy referral: A speech therapy referral is appropriate for a client with dysphagia following a stroke. Speech therapists can assess the severity of swallowing difficulties and provide strategies to improve swallowing function. This is standard care.
B. Dietitian consult: A dietitian consult is essential to ensure proper nutritional intake and modify the client's diet for safe swallowing. A dietitian can help adjust the texture of foods and recommend alternatives to reduce the risk of aspiration.
C. Oral suction at the bedside: Oral suctioning is a precautionary measure for clients with dysphagia to clear any potential obstructions from the airway. It’s essential to have suction equipment available at the bedside in case of choking or aspiration.
D. Clear liquids: Clear liquids are not recommended for clients with dysphagia because they pose a higher risk for aspiration. Clear liquids can be difficult for individuals with swallowing difficulties to control and may lead to choking or aspiration pneumonia.
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