An obese 56-year-old married man complains of daytime sleepiness, and his wife states that he snores, snorts, and gasps during nighttime sleep. What polysomnographic finding is needed to confirm the diagnosis of obstructive sleep apnea hypopnea?
Polysomnographic evidence of at least 5 apnea or hypopnea episodes per hour of sleep
Polysomnographic evidence of at least 15 episodes per hour of sleep
No polysomnography is necessary
Polysomnographic evidence of resolution of apneas/hypopneas with application of continuous positive airway pressure
The Correct Answer is A
Choice A reason: A diagnosis of obstructive sleep apnea (OSA) is confirmed when polysomnography reveals at least 5 episodes of apnea or hypopnea per hour of sleep in the presence of symptoms such as snoring, gasping, or daytime sleepiness. This threshold is consistent with clinical guidelines and reflects mild OSA.
Choice B reason: While 15 or more episodes per hour indicate moderate to severe OSA, the minimum diagnostic threshold is 5 events per hour with associated symptoms. Therefore, this choice is overly restrictive and not the best initial diagnostic criterion.
Choice C reason: Polysomnography is the gold standard for diagnosing OSA. Clinical symptoms alone are insufficient for a definitive diagnosis, especially when treatment decisions depend on severity classification.
Choice D reason: Resolution of apneas/hypopneas with CPAP confirms treatment efficacy but does not establish the initial diagnosis. This finding is relevant after diagnosis and during titration studies, not for confirming OSA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Bupropion is an antidepressant that may improve energy and libido, but the PHQ-9 score of 4 indicates minimal depressive symptoms. The primary concern here is reduced libido and weight gain, which may be better addressed by evaluating testosterone levels.
Choice B reason: Testosterone deficiency is common in men with type 2 diabetes and can contribute to reduced libido, weight gain, and mood changes. Given the low PHQ-9 score and symptoms suggestive of hypogonadism, testosterone replacement therapy is the most appropriate next step after confirming low serum testosterone levels.
Choice C reason: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for depression. However, SSRIs can further reduce libido and are not indicated for mild depressive symptoms. This choice does not address the patient's primary concerns.
Choice D reason: Dulaglutide is a GLP-1 receptor agonist used to improve glycemic control and promote weight loss. While it may help with weight, it does not address libido or mood directly and is not the most targeted intervention for the current symptoms.
Correct Answer is B
Explanation
Choice A reason: This describes the pathophysiology of macular degeneration, not diabetic retinopathy. Macular degeneration involves the breakdown of photoreceptor cells in the macula, leading to central vision loss, but is not directly caused by diabetes.
Choice B reason: Diabetic retinopathy is caused by chronic hyperglycemia leading to microvascular damage in the retina. This includes capillary leakage, microaneurysms, and neovascularization, which can result in retinal edema, hemorrhage, and ultimately vision loss. It is a leading cause of blindness in adults with diabetes.
Choice C reason: This describes the pathophysiology of cataracts, where lens proteins become denatured and coagulated, leading to opacity. While cataracts are more common in diabetics, this is not the mechanism of diabetic retinopathy.
Choice D reason: This describes the pathophysiology of glaucoma, which involves increased intraocular pressure due to impaired aqueous humor drainage. Although glaucoma can co-occur with diabetes, it is not the primary mechanism of diabetic retinopathy.
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