A nurse is teaching a class about sleep disorders. The nurse should include that which of the following conditions can cause obstructive sleep apnea (OSA)
Heart failure
Brainstem injury
Recent weight loss
Enlarged tonsils
The Correct Answer is D
A) Heart failure:
While heart failure can cause a variety of symptoms, including shortness of breath, fatigue, and nocturnal respiratory disturbances, it is not a direct cause of obstructive sleep apnea (OSA). However, heart failure can exacerbate the effects of sleep apnea, particularly in individuals who already have OSA, leading to a condition known as "central sleep apnea with Cheyne-Stokes respiration.
B) Brainstem injury:
Brainstem injury can affect the regulation of breathing and may lead to central sleep apnea, where the brain fails to send the proper signals to the muscles that control breathing. However, brainstem injury does not directly cause obstructive sleep apnea, which is typically caused by physical blockages or obstructions in the upper airway.
C) Recent weight loss:
Recent weight loss is generally not associated with the development of obstructive sleep apnea. In fact, weight loss can sometimes reduce the severity of OSA in overweight or obese individuals. OSA is more commonly associated with excess weight and fat deposits around the neck and throat, which can contribute to airway obstruction during sleep.
D) Enlarged tonsils:
Enlarged tonsils, especially in children, are a well-known cause of obstructive sleep apnea (OSA). The enlarged tonsils can block the upper airway during sleep, leading to periods of apnea or hypopnea (reduced airflow). This obstruction can result in snoring, choking, and interrupted sleep.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Safety needs:
In Maslow's hierarchy of needs, safety needs are the second level, after physiological needs, and include the need for security and protection from harm. In this scenario, the client’s concern about where to hide their cellphone during the procedure reflects anxiety related to the potential loss or theft of personal property, which relates to safety and security. By offering to lock the cellphone in a secure area, the nurse is addressing the client's need for safety and reassurance about their belongings while undergoing a medical procedure.
B) Esteem needs:
Esteem needs are related to feelings of self-worth, accomplishment, and respect from others. While a person’s sense of esteem can be affected by how others treat their belongings, this particular situation does not relate to the client seeking recognition or respect. The client’s anxiety about where to place the cellphone is more about feeling secure and protected, rather than about esteem or recognition from others.
C) Love and belonging needs:
Love and belonging needs are associated with the need for interpersonal relationships, affection, and social connections. While the nurse’s interaction with the client may help foster a sense of comfort and connection, the concern about the cellphone does not stem from a need for social support or relationships. Instead, it is related to safety and security.
D) Physiological needs:
Physiological needs represent the most basic level of Maslow's hierarchy and include things like air, food, water, and shelter. Although the client is preparing for a medical procedure, their concern about the cellphone does not fall under this category. The focus here is on the safety of the client’s belongings, which is a higher-level need than basic physiological survival.
Correct Answer is B
Explanation
A) Assist the client into a standing position:
While assisting the client into a standing position is necessary for assessing orthostatic hypotension, it should not be the first action. The nurse needs baseline measurements of the client's blood pressure before making any position changes. This ensures that the changes in blood pressure can be accurately attributed to the positional changes, rather than being affected by the initial standing position.
B) Check the blood pressure with the client in a supine position:
The first step in assessing for orthostatic hypotension is to take a baseline blood pressure while the client is lying flat in the supine position. This provides a reference point for comparison when the client changes positions (to sitting and then standing). This helps to detect significant drops in blood pressure when transitioning to an upright position.
C) Determine the client's blood pressure 1 minute after each position change:
While it is important to measure blood pressure after each position change, this action should occur after baseline blood pressure has been taken while the client is in the supine position. Orthostatic hypotension is assessed by measuring blood pressure in three positions: supine, sitting, and standing.
D) Place the client in a sitting position:
Placing the client in a sitting position is a necessary part of the orthostatic hypotension assessment, but it is not the first step. The nurse must first measure the blood pressure while the client is lying down (supine) to establish a baseline for comparison with the blood pressure readings taken after sitting and standing.
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