Sleep Apnea Nclex
The client with sleep apnea asks her nurse how her new prescription for Xyrem (sodium oxybate) can help this problem. What is the nurse's best response? A. "The drug depresses your nervous system and allows you to have a deeper night's sleep." B. "Xyrem stimulates daytime wakefulness so that you are less likely to have narco-lepsy with your sleep apnea." C. "The drug reduces the water content of your oral mucous membranes, increasing the diameter of your throat so that your tongue does not obstruct your airway." D. "Xyrem constantly elevates the carbon dioxide content of your blood, which then triggers the respiratory centers of the brain so that you breathe more rapidly and more deeply."
A One problem with sleep apnea is that clients get so little restful sleep at night that they develop excessive daytime sleepiness (narcolepsy), often falling asleep while at work, driving, or per-forming other tasks. Xyrem does not help the apnea but does promote a deeper sleep, so that the client is less likely to fall asleep at inappropriate places or times during the day.
What is the rationale for using CPAP to treat sleep apnea? A) positive air pressure holds the airway open B) negative air pressure holds the airway closed C) delivery of oxygen facilitates respiratory effort D) alternating waves of air stimulate breathing
A) positive air pressure holds the airway open
A patient with sleep apnea is given a noninvasive method of monitoring rest and activity cycles. The patient is required to wear a small watch device on the wrist. What is the name of this method? A Actigraphy IncorrectB Electromyogram C Polysomnography D Electrooculogram
A. Actigraphy is a noninvasive method of monitoring rest and activity cycles. In this method, a small actigraph watch is worn on the wrist to measure gross motor activity. An electromyogram records muscle tone. Polysomnography is also used to measure sleep apnea but through electrodes that record the main stages of sleep and wakefulness. Eye movements are recorded with an electrooculogram.
The spouse of a patient tells the nurse that, during sleep, the patient's respiration ceases for 10 seconds. This happens repeatedly during the night. As a result, the patient feels sleepy throughout the day. What is this condition known as? A Apnea B Insomnia C Hypopnea D Hypercapnia
A. Apnea is a medical condition in which there is a cessation of spontaneous respirations for 10 seconds or more. It can prevent the patient from sleeping soundly and cause daytime sleepiness. Insomnia is a lack of sleep. Hypopnea is a condition characterized by shallow respirations. Hypercapnia is a condition characterized by an increased concentration of carbon dioxide in the body.
Which assessment question is most appropriate when the nurse is assessing a patient who is receiving care for suspected obstructive sleep apnea (OSA)? A. "Do you smoke?" B "Do you tend to awaken early in the morning?" C "Are you under a lot of stress at work or at home right now?" D "Do you have a history of chronic obstructive pulmonary disease (COPD)?"
A. Smoking is a major etiologic factor in OSA. Early wakening and stress are associated with insomnia, not OSA in particular. COPD exacerbates the hypoxemia associated with OSA, but does not precipitate the onset of OSA itself.
A patient has obstructive sleep apnea (OSA). What should the nurse include in the teaching related to ways the patient can minimize the negative effects of OSA? Select all that apply. A Raise the head end of the bed slightly. B Use an oral appliance that prevents the airway from collapsing. C Sleep in a side-lying position. D Avoid consuming alcoholic beverages several hours before going to sleep. E Take sleeping pills before going to bed.
A.B.C.D Raising the head end of the bed keeps the airway open and prevents blockage to the airway. An oral appliance serves as special mouth guard to prevent the airway from collapsing. Sleeping on the side may help the patient to breathe easily. Alcoholic beverages may worsen OSA by decreasing the muscle tone and causing airway collapse. Use of sedatives will exacerbate OSA due to respiratory depression.
A patient has undergone an uvulopalatopharyngoplasty. Which instructions should the nurse give this patient at the time of discharge? Select all that apply. A "The throat may feel sore. It is normal." B "Snoring may persist until inflammation subsides." C "If you feel soreness in the throat, it is a sign of complication." D "If snoring doesn't stop immediately, you may need another surgery." E "There may be foul breath. You can reduce it by using a diluted mouthwash."
A.B.E The nurse has to inform the patient that a sore throat after surgery is normal. Snoring may also be present until the inflammation after surgery has subsided. The patient may have a foul breath odor that may be reduced by rinsing with diluted mouthwash and then salt water. Snoring and sore throat are commonly seen after surgery.
A patient's partner informs the nurse that the patient wakes up with a startle and gasps for breath several times at night. The nurse understands the patient is experiencing sleep apnea. What are the common risk factors in this patient for sleep apnea? Select all that apply. A Body mass index (BMI) 30 kg/m2 B Age 44 years C Habit of smoking D.Neck circumference 18 inches E .Occasional consumption of alcohol
A.C.D. The common risk factors for sleep apnea include BMI greater than 28 kg/m2, smoking habit, and neck circumference greater than 17 inches. Sleep apnea is often observed in patients older than 65 years. Occasional consumption of alcohol is not a risk factor by itself.
Which problem is associated with obesity, heavy snoring, and shallow breathing? A) Sleep apnea B) Narcolepsy C) Hypersomnia D) Hyperpnea
A.Sleep apnea refers to recurrent periods of absence of breathing for 10 seconds or longer, occurring at least 5 times per hour.
A 32-year-old morbidly obese male complains of excessive fatigue, snoring, and awakening in the middle of the night, which prevents restorative sleep. He is sluggish during the day due to the lack of sleep and feels like he is going "fall asleep at the wheel" when driving to work. Occupation: dishwasher. Medical history includes hypertension and type 2 diabetes. Current medications include ACE inhibitor and metformin. Denies use of alcohol, tobacco, or drugs. On physical examination, the patient is afebrile, pulse 88, resps 20/min, BP 178/95. BMI is 45. These are signs and symptoms of: A. Obstructive sleep apnea B. Primary insomnia C. Heart failure D. All of the above
ANS: A With the obesity epidemic, the incidence of obstructive sleep apnea (OSA) is also increasing. Besides obesity, other predisposing and risk factors include narrowed upper airways, macroglossia, tonsillar hypertrophy, sleep medicines, alcohol, smoking, nasal obstruction, and hypothyroidism. It occurs more in middle-aged men. A thorough medication history, respiratory history, neurologic history, and mental health assessment should be performed. One of the more common symptoms of OSA is snoring, usually reported by the spouse. The patient may complain of frequent nighttime awakening, morning drowsiness, headache (caused by carbon dioxide buildup in the brain), cognitive impairment, as well as impotence and weight gain, which can be both a cause and an effect. Systemic hypertension is a complication of OSA but often resolves when the cause of the apnea is corrected.
A nurse is caring for a client who has sleep apnea and is prescribed modafinil (Provigil). The client asks, "How will this medication help me?" How should the nurse respond? a. "This medication will treat your sleep apnea." b. "This sedative will help you to sleep at night." c. "This medication will promote daytime wakefulness." d. "This analgesic will increase comfort while you sleep."
ANS: C Modafinil is helpful for clients who have narcolepsy (uncontrollable daytime sleep) related to sleep apnea. This medication promotes daytime wakefulness.
A nurse assesses a client who reports waking up feeling very tired, even after 8 hours of good sleep. Which action should the nurse take first? a. Contact the provider for a prescription for sleep medication. b. Tell the client not to drink beverages with caffeine before bed. c. Educate the client to sleep upright in a reclining chair. d. Ask the client if he or she has ever been evaluated for sleep apnea.
ANS: D Clients are usually unaware that they have sleep apnea, but it should be suspected in people who have persistent daytime sleepiness and report waking up tired. Causes of the problem should be assessed before the client is offered suggestions for treatment.
A 64-year-old obese man is admitted to the hospital for treatment of heart failure secondary to alcoholism. For which of the following negative consequences should the nurse assess? A) Chronic pain B) Obstructive sleep apnea C) Parkinson disease D) RLS
Ans: B Factors associated with increased risk for obstructive sleep apnea include obesity, diabetes, stroke, Parkinson disease, congestive heart failure, genetic predisposition, craniofacial anatomic features, and the use of alcohol or medications that depress the respiratory center
A 45-year-old obese man arrives in a clinic with complaints of daytime sleepiness, difficulty going to sleep at night, and snoring. What is the patient exhibiting manifestation of? A) Angina B) Diabetes C) Obstructive sleep apnea D) Depression
Ans: C Feedback: Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of angina or diabetes. Snoring is not an indication of depression.
A 45-year-old obese man arrives in a clinic with complaints of daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem? A) Adenoiditis B) Chronic tonsillitis C) Obstructive sleep apnea D) Laryngeal cancer
Ans: C Feedback: Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This patient's symptoms are not suggestive of laryngeal cancer.
The nurse is caring for a middle-aged man who complains of excessive daytime sleepiness. The nurse's examination reveals that the patient has large tonsils. He jokingly tells the nurse that his wife complains that he snores. The nurse hypothesizes that the patient has which of the following disorders? a. deviated septum b. obstructive sleep apnea c. occlusion of the nostrils d. upper respiratory infection
B Obstructive sleep apnea occurs when muscles in the nasopharynx and pharynx relax during sleep, resulting in pauses in breathing. Typically patients are overweight, middle-aged men who complain of excessive daytime sleepiness. Logged
A patient with obstructive sleep apnea tells the nurse, "I just hate using this continuous positive airway pressure (CPAP) thing, but I know I need it. Is there anything I can do so that I don't need to use it?" Which of these would be an appropriate suggestion from the nurse? A Taking a nap during the day. B Referral to a weight loss program. C Trying a mild sedative at bedtime. D Drinking a glass of wine just before bedtime.
B. Because excessive weight worsens obstructive sleep apnea (OSA), referral to a weight loss program may be indicated. Weight loss and bariatric surgery reduce OSA. Daytime napping does not help this condition. Instruct the patient to avoid taking sedatives or consuming alcoholic beverages for three to four hours before sleep. Sleep medications often make OSA worse.
A patient with sleep apnea asks the nurse, "What can I do to get better sleep?" What is an appropriate nursing response? A "Taking one to two sleeping pills at night will prevent sleep apneic episodes." B "Keeping your hypertension under control is beneficial for general health." C "Being overweight is a contributing factor; losing weight can often resolve apnea." D "High blood glucose levels contribute to the apnea; monitor your sugar carefully."
C. Being overweight is an important risk factor for sleep apnea. Reducing weight often helps in resolving this condition. Taking sleeping pills may habituate a person, and taking it on a regular basis should be avoided. Keeping hypertension and blood glucose in control is beneficial for general health, but is not related to sleep apnea specifically.
The patient is scheduled for a sleep study test to see if the patient has mild sleep apnea. What should the nurse teach the patient to do until the test can be completed? IncorrectA Take sleep medications B Use the spouse's continuous positive airway pressure (CPAP) mask C Sleep in a side-lying position D Do not use pillows when sleeping
C. Conservative treatment for mild obstructive sleep apnea (OSA) begins with sleeping on one's side. Sleep medication often makes OSA worse. CPAP is adjusted for the patient and used with more severe symptoms after diagnosis. Elevating the head of the bed may eliminate OSA.
A patient with severe sleep apnea has been prescribed continuous positive airway pressure (CPAP). A nurse adjusts the blower to maintain adequate positive pressure during inspiration and expiration. The nurse should maintain the pressure in what range? A.1-5 cm of H2O B.5-10 cm of H2O C.5-25 cm of H2O D.1-25 cm of H2O
C. The pressure required to maintain an adequate positive pressure is 5-25 cm of H2O. This range of pressure is essential to avoid collapse of the airway.
A patient with sleep apnea is scheduled for surgery that involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove the obstructing tissue. What is this surgery called? A Mastectomy B Tonsillectomy C Uvulopalatopharyngoplasty D Genioglossal advancement and hyoid myotomy
C. Uvulopalatopharyngoplasty is a surgery for resolving sleep apnea. This surgery involves excision of the tonsillar pillars, uvula, and posterior soft palate to remove the obstructing tissue. Mastectomy is surgery for the excision of breast cancer. Tonsillectomy is surgery for the excision of the tonsils. Genioglossal advancement and hyoid myotomy is another surgery for sleep apnea. It involves advancing the attachment of the muscular part of the tongue on the mandible.
The nurse observes a patient's respirations during sleep and notes the absence of respirations that lasts from 15 to 45 seconds. What should the nurse consider this patient is experiencing? 1. laryngeal spasm 2. sleep apnea 3. respiratory acidosis 4. renal failure
Correct Answer: 2 Manifestations of obstructive sleep apnea include periods of apnea that last 15 to 120 seconds. No symptoms of laryngeal spasm or renal failure are noted. Respiratory acidosis would be diagnosed from arterial blood gases.
Sleep apnea would be diagnosed in a patient who has which of these findings? 1. More than 15 apnea episodes per hour of sleep 2. More than 5 apnea episodes per hour over an 8-hour period 3. More than 75% of the apneas are obstructive. 4. More than 75% of the apneas and hypopneas are obstructive. a. 1, 4 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4
D During a sleep study, obstructive sleep apnea (OSA) is confirmed when either of the following two conditions exists: 15 or more apneas, hypopneas, or RERAs per hour of sleep (i.e., the AHI or RDI >15 events/hour) in an asymptomatic patient. More than 75% of the apneas and hypopneas must be obstructive. Or, 5 or more apneas, hypopneas, or RERAs per hour of sleep (i.e., the AHI or RDI >5/hour events/hour) in patients with symptoms (e.g., sleepiness, fatigue, and inattention) or signs of disturbed sleep (e.g., snoring, restless sleep, and respiratory pauses). More than 75% of the apneas and hypopneas must be obstructive.
Signs and symptoms of sleep apnea include which of the following? a. Loud snoring b. Difficulty falling asleep c. Headache in the evening d. Nighttime sleepiness
a. Loud snoring
The most effective treatments for sleep apnea include all of the following EXCEPT a. weight loss. b. the use of stimulant drugs. c. the use of a continuous positive airway pressure (CPAP) mask. d. surgery for breathing obstructions.
b. the use of stimulant drugs.