A 31-year-old male client presents to the PMHNP with a chief complaint of fatigue. He reports that sometimes he falls asleep at work, which is causing issues with his employment. These episodes occur at least four times a week and started approximately 5 months ago. He says he spends most of his weekends in bed or on the couch, sleeping and napping. Which of the following scales distinguishes reports of dozing behavior from feelings of fatigue and drowsiness/sleepiness?
Polysomnography
Multiple Sleep Latency Test (MSLT)
Epworth Sleepiness Scale
Cerebrospinal fluid (CSF) hypocretin measurement
The Correct Answer is C
Choice A reason: Polysomnography is a comprehensive overnight sleep study used to diagnose sleep disorders such as obstructive sleep apnea, parasomnias, and periodic limb movement disorder. While it provides objective data on sleep architecture and disturbances, it does not specifically distinguish between subjective feelings of fatigue and actual dozing behavior during the day.
Choice B reason: The Multiple Sleep Latency Test (MSLT) is an objective test that measures how quickly a person falls asleep in a quiet environment during the day. It is used to assess excessive daytime sleepiness and diagnose conditions like narcolepsy. However, it does not capture subjective experiences or differentiate between fatigue and sleepiness based on self-report.
Choice C reason: The Epworth Sleepiness Scale is a validated self-administered questionnaire that evaluates the likelihood of dozing off in various daily situations. It is specifically designed to distinguish between general fatigue and actual sleepiness by assessing the propensity to fall asleep, making it the most appropriate tool in this scenario.
Choice D reason: CSF hypocretin measurement is used in the diagnosis of narcolepsy type 1, where hypocretin levels are typically low. While it is a biomarker for a specific sleep disorder, it does not help differentiate between fatigue and sleepiness in broader clinical contexts and is not a practical screening tool for general sleep complaints.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Carcinomas are typically hard, irregular, immobile, and may be associated with skin changes or nipple retraction. While breast cancer must always be ruled out, the described mass lacks the suspicious features of malignancy.
Choice B reason: A clogged duct is usually painful and associated with lactation. It presents as a tender, localized area of swelling and is not typically rubbery or mobile. This patient is nulligravid and not lactating, making this diagnosis unlikely.
Choice C reason: Fibroadenomas are common benign breast tumors in young women. They are typically smooth, round, rubbery, mobile, and nontender. The location in the upper outer quadrant and the described characteristics strongly suggest a fibroadenoma.
Choice D reason: Duct ectasia involves dilation of the milk ducts and may present with nipple discharge, tenderness, or inflammation. It is more common in older women and does not typically present as a discrete, mobile mass.
Correct Answer is D
Explanation
Choice A reason: Sickle cell anemia is indeed inherited in an autosomal recessive pattern. Individuals must inherit two copies of the mutated beta globin gene (one from each parent) to manifest the disease. Carriers with one copy are typically asymptomatic but may pass the gene to offspring.
Choice B reason: The condition results from a point mutation in the beta globin gene, specifically a substitution of valine for glutamic acid at the sixth position. This leads to the production of hemoglobin S, which polymerizes under low oxygen conditions, causing red blood cells to assume a sickle shape.
Choice C reason: The sickled red blood cells can obstruct small blood vessels, leading to ischemia and infarction in various tissues, including bones. This can predispose patients to osteomyelitis and bone necrosis, particularly in long bones. Thus, this statement is accurate.
Choice D reason: This statement is false and stigmatizing. Patients with sickle cell anemia experience real and often severe pain due to vaso-occlusive crises. Labeling them as drug-seeking undermines their legitimate need for pain management and contributes to healthcare disparities.
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