A nurse caring for a patient with obstructive sleep apnea received an order for CPAP while hospitalized and to use at home.
The machine was delivered to the patient's room about 8 p.m. Which of these actions should the nurse implement next?
Educate the patient to sleep on her side instead of her back.
Discuss strategies to lose weight and a keto diet.
Notify the healthcare provider about an order for modafinil to begin in the morning.
Instruct the patient on how to set up the CPAP machine.
The Correct Answer is D
Choice A rationale
While lateral positioning can help maintain airway patency by preventing the tongue and soft tissues from collapsing into the posterior pharynx, it is not the immediate priority when a new medical device has arrived. Positional therapy is a secondary behavioral intervention for obstructive sleep apnea. The primary prescribed treatment is Continuous Positive Airway Pressure, and ensuring the patient can use the equipment correctly is more impactful for managing the apnea-hypopnea index during sleep.
Choice B rationale
Weight loss and dietary changes are important long-term strategies for reducing the severity of obstructive sleep apnea by decreasing parapharyngeal fat deposits. However, discussing a keto diet or long-term weight goals is not the most urgent action at 8 p.m. when the patient is preparing for sleep. The immediate clinical need is to stabilize the airway during the upcoming night of rest, which requires the functional application of the newly delivered CPAP machine.
Choice C rationale
Modafinil is a wake-promoting agent sometimes used to treat residual daytime sleepiness in sleep apnea patients, but it does not treat the underlying airway obstruction. Notifying the provider for a new medication is not as urgent as ensuring the patient can safely use the mechanical ventilation support already ordered and delivered. Furthermore, the nurse should prioritize non-pharmacological airway management and patient education on the prescribed CPAP therapy before seeking additional stimulant medications.
Choice D rationale
The nurse's immediate priority is to ensure the patient knows how to safely and effectively use the CPAP machine before they go to sleep. Proper education includes fitting the mask to prevent air leaks, understanding how to turn the device on, and managing the humidification settings. Continuous Positive Airway Pressure works by creating a pneumatic splint for the upper airway. Without proper instruction, the patient may have poor compliance or ineffective therapy during the night.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While a cough is a common symptom of pulmonary tuberculosis, it is typically productive rather than non-productive as the disease progresses. The inflammatory response to the Mycobacterium tuberculosis bacteria in the lung tissue leads to the production of purulent sputum, which may also contain blood, a condition known as hemoptysis. A completely dry, non-productive cough is less characteristic of the cavitary lesions and tissue necrosis that usually occur in active pulmonary tuberculosis cases.
Choice B rationale
Skin discoloration is not a classic or primary diagnostic finding associated with the initial evaluation of pulmonary tuberculosis. While chronic illness can eventually lead to pallor due to anemia or cyanosis if oxygenation is severely impaired, these are non-specific signs. Tuberculosis primarily affects the respiratory system and causes systemic constitutional symptoms rather than specific dermatological changes. Diagnostic focus remains on respiratory secretions, chest imaging, and systemic inflammatory responses like fevers and weight loss.
Choice C rationale
Leg cramps are generally unrelated to the pathophysiology of Mycobacterium tuberculosis infection. Cramping is more commonly associated with electrolyte imbalances, such as low potassium or magnesium, or peripheral vascular issues. While a patient with advanced tuberculosis may experience generalized muscle wasting or weakness due to cachexia, localized leg cramps do not help rule in or rule out a diagnosis of tuberculosis during a clinical evaluation of a suspected respiratory infection.
Choice D rationale
Night sweats are one of the hallmark constitutional symptoms of active pulmonary tuberculosis. This occurs due to the body's cytokine response to the chronic infection, which alters the hypothalamic thermoregulatory set point. These sweats are often profuse and occur specifically during the night, frequently soaking the patient's clothes or bed linens. Along with a low-grade afternoon fever, weight loss, and a persistent cough, night sweats strongly suggest the presence of a chronic mycobacterial infection.
Correct Answer is B
Explanation
Choice A rationale
Using a humidifier might assist with airway moisture or comfort, but it does not address the underlying pathophysiology of obstructive sleep apnea. Sleep apnea in obese clients is primarily caused by the physical collapse of the upper airway due to excess adipose tissue in the neck and pharyngeal area. Humidification does nothing to reduce this mechanical obstruction or the resulting apneic episodes. Therefore, this statement indicates a misunderstanding of the structural nature of the sleep disorder.
Choice B rationale
This statement shows an understanding of the treatment for obstructive sleep apnea because weight loss is a primary intervention for obese clients. Excess fat deposits in the soft tissues of the neck narrow the airway and increase the likelihood of collapse during muscle relaxation in sleep. Reducing body mass decreases the pressure on the pharynx, thereby increasing the airway diameter and reducing the frequency of apneic events. Weight loss can significantly improve the apnea-hypopnea index scores.
Choice C rationale
Taking a sleeping pill is dangerous for a client with obstructive sleep apnea and indicates a severe lack of understanding. Sedatives and hypnotics further relax the muscles of the upper airway and suppress the central nervous system's drive to wake up when oxygen levels drop or carbon dioxide levels rise. Normal arterial carbon dioxide is 35 to 45 mmHg. Suppressing the arousal response can lead to prolonged periods of hypoxia and potentially fatal respiratory arrest during sleep.
Choice D rationale
Consuming alcohol before bedtime is contraindicated for clients with sleep apnea. Alcohol acts as a potent central nervous system depressant and a muscle relaxant. Similar to sleeping pills, it causes the muscles of the throat to relax excessively, which worsens the mechanical obstruction of the airway. Alcohol also interferes with the various stages of the sleep cycle and blunts the body's natural protective reflexes that trigger gasping or waking when the airway is blocked.
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