A 48-Year-Old Woman Comes to the Clinic with Her Husband

question 79

Multiple Choice

A 48-year-old woman comes to the clinic with her husband due to snoring.  Her husband mentions that she snores sometimes and gets up to urinate 2 or 3 times during the night.  The patient reports no daytime sleepiness, morning headaches, lack of concentration, or fatigue.  She drinks a glass of wine every evening and does not smoke cigarettes.  The patient works as a railroad operator, controlling the traffic of passenger trains through a large city.  She last saw a physician 3 years ago and has no chronic medical conditions.
Blood pressure is 158/95 mm Hg, pulse is 76/min, and respirations are 14/min.  BMI is 31 kg/m².  The nasal septum is midline.  Examination shows a neck circumference of 17 inches.  The lungs are clear to auscultation.  There is no peripheral edema.
Complete blood count, serum chemistries, and TSH are within normal limits.  ECG shows left ventricular hypertrophy.
The patient agrees to take antihypertensive medication.  Which of the following is the most appropriate recommendation for addressing this patient's snoring?

• A)Alcohol avoidance and sleeping in the lateral position
• B)Continuous nocturnal pulse oximetry
• C)External nasal dilator strips at bedtime
• D)In-laboratory, supervised polysomnography
• E)Trial of intranasal decongestant spray

Understand the concepts of motivation, including its key characteristics such as activation, persistence, and intensity.

Recognize the historical and contemporary theories of motivation, including but not limited to instinct, drive, incentive, arousal, and humanistic theories.

Explain the influence of biological factors (such as instincts, drives, and arousal) on motivation.

Discuss the role of environmental and psychological factors in shaping motivation.

---

Definitions:

Potash Inc.

A company or entity involved in the production or supply of potash, a potassium-containing salt used in agriculture, industry, and other sectors.

Operating Synergy

The cost reductions achieved by economies of scales produced by a merger or acquisition.

Economy-of-Scope Advantage

Benefits derived from the ability of a company to produce a variety of products together more efficiently than producing each one of them on its own.

Anticipated Synergies

The expected benefits, efficiencies, or savings generated through the combination or collaboration of different entities, projects, or processes.