A clinical polysomnography (PSG) may be performed on a patient with signs and symptoms of a sleep disorder. What measures and observations does this study include (select all that apply)?

Correct Answer: A

Rationale: In the context of pharmacology and medical-surgical care, understanding the rationale behind conducting a clinical polysomnography (PSG) is crucial. In this scenario, the correct answer is A) Heart rate monitoring. Rationale for Heart Rate Monitoring (Correct Answer): Heart rate monitoring is essential during a PSG because it helps assess the patient's autonomic nervous system activity, which can provide valuable insights into sleep disorders such as sleep apnea. Changes in heart rate can indicate disruptions in normal sleep patterns and assist in diagnosing specific sleep disorders. Rationale for Incorrect Options: B) Noninvasive oxygen saturation (SpO2): While monitoring oxygen saturation is important in sleep studies to detect conditions like sleep apnea, it is not specifically part of a PSG. SpO2 monitoring is typically performed through a pulse oximeter and is a common practice in sleep studies, but it is not a direct measure included in a PSG. C) Surface body temperature fluctuations: Monitoring body temperature is not a standard component of a PSG. While body temperature can fluctuate during sleep, it is not a primary measure used to diagnose sleep disorders. D) Blood pressure monitoring (noninvasive): Although blood pressure monitoring is relevant in assessing overall health and potential cardiovascular issues related to sleep disorders, it is not a standard measure included in a PSG study. Blood pressure monitoring may be done separately but is not typically part of PSG procedures. Educational Context: Understanding the components of a PSG is vital for healthcare providers involved in diagnosing and managing sleep disorders. By recognizing the specific measures included in a PSG, clinicians can accurately interpret the results and make informed decisions regarding patient care and treatment options. This knowledge is essential in pharmacology to ensure appropriate medication management for patients with sleep disorders based on PSG findings.

Correct Answer: C

Rationale: The correct answer is C) Contributes to unnecessary suffering and physical and psychosocial dysfunction. In this scenario, the nurse's decision to delay giving pain medication to a patient experiencing severe pain rated at 9 out of 10 can lead to increased suffering for the patient. Acute pain management is crucial in postoperative care to promote comfort, aid in recovery, and prevent complications such as delayed mobilization and respiratory complications. Option A is incorrect because withholding pain medication based on fear of addiction or toxic effects can compromise effective pain management, leading to increased suffering and potential complications for the patient. Option B is incorrect because appropriate pain management, including timely administration of analgesics, is essential in preventing respiratory dysfunction related to inadequate pain control. Delaying pain medication can actually increase the risk of respiratory complications due to uncontrolled pain. Option D is incorrect as it does not address the immediate need for effective pain management in this situation. While it is important to start with the lowest effective dose of analgesics and titrate as needed, it is equally crucial to ensure timely pain relief for patients experiencing severe pain. In an educational context, this scenario highlights the importance of prompt pain assessment and management in postoperative care. Nurses should prioritize adequate pain relief to enhance patient comfort, facilitate recovery, and improve overall outcomes. Delaying pain medication in the presence of severe pain can lead to unnecessary suffering and hinder the patient's physical and psychosocial well-being.

Correct Answer: D

Rationale: In this question on pain types, the correct answer is D) Pain arising from muscles and bones; localized or diffuse and radiating. This type of pain corresponds to musculoskeletal pain, which can be caused by various conditions affecting the muscles or bones, such as strains, sprains, fractures, or arthritis. Option A) Pain from loss of afferent input does not match the example of musculoskeletal pain as it typically refers to neuropathic pain resulting from nerve damage or dysfunction, where there is a disruption in the transmission of sensory signals. Option B) Pain persisting from sympathetic nervous system (SNS) activity is more associated with complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy, which involves abnormal sympathetic nervous system responses, rather than direct musculoskeletal issues. Option C) Pain caused by dysfunction in the central nervous system (CNS) is related to conditions like fibromyalgia or central sensitization, where there is an amplification of pain signals in the CNS, but it does not specifically align with the example of musculoskeletal pain. Educationally, understanding different categories of pain is crucial for healthcare professionals to accurately assess and manage pain in patients. Recognizing the source and characteristics of pain helps in selecting appropriate treatment strategies and promoting patient comfort and well-being.

Correct Answer: C

Rationale: In the context of pharmacology, particularly in postoperative pain management, the rationale for not initiating PCA analgesic with a basal dose lies in the risk of adverse respiratory outcomes. Providing a basal dose along with patient-controlled analgesia can increase the total opioid dose received by the patient, potentially leading to respiratory depression, especially in opioid-naive individuals like the 68-year-old patient in this scenario. Option A, opioid overdose, is not the primary concern in this scenario as the focus is on preventing adverse respiratory outcomes. Option B, nausea and itching, are common side effects of opioids but are not as critical as respiratory depression. Option D, lack of pain control, can be addressed by appropriate titration of the PCA dose based on the patient's needs without the need for a basal dose. Educationally, this scenario highlights the importance of individualizing pain management strategies and carefully monitoring for potential complications when using opioids, especially in vulnerable populations like postoperative patients. Understanding the rationale behind not initiating a basal dose with PCA can help healthcare providers optimize pain management while minimizing risks associated with opioid use.

Correct Answer: B

Rationale: In this scenario, the nurse's priority should be to address the family members' behavior as it pertains to the patient's well-being. Option B, taking the family members aside and explaining that the patient may be able to hear them, is the correct choice because it focuses on the immediate emotional and psychological needs of the patient. This action promotes a therapeutic environment for the patient by ensuring that the family communicates appropriately in the presence of the terminally ill individual. Option A is incorrect as simply asking the family members to leave the room does not address the underlying issue of their behavior impacting the patient. Option C is also incorrect because it dismisses the family's concerns without providing emotional support or guidance. Option D, while emphasizing the importance of the patient's autonomy, does not address the current situation of the family arguing at the bedside. Educationally, this scenario highlights the importance of holistic care in nursing practice, especially in end-of-life situations. Nurses must not only attend to the physical needs of the patient but also address the emotional and psychological aspects of care, including family dynamics and communication. By choosing option B, the nurse demonstrates empathy, communication skills, and the ability to advocate for the patient's emotional well-being during a critical time.