RPSGT Risk Management & Assessment 2 — Questions and Answers
Question 1: A patient with severe obstructive sleep apnea is scheduled for a split-night study. Which condition would most contraindicate proceeding with CPAP titration in the second half of the night?
- AHI of 20 during the diagnostic portion
- Patient reports chest pain during the diagnostic portion (Correct answer)
- Oxygen nadir of 85% during the diagnostic portion
- Patient is a mouth breather
Correct answer: Patient reports chest pain during the diagnostic portion
New-onset chest pain during sleep testing is a medical emergency that requires stopping the study and contacting emergency services.
Question 2: During a polysomnography study, the technologist notices the patient's SpO2 has dropped to 78% for over 2 minutes without any associated EEG arousal. What is the FIRST action the technologist should take?
- Increase the sensitivity on the SpO2 channel
- Visually check the patient via camera and verify probe placement (Correct answer)
- Immediately wake the patient and apply supplemental oxygen
- Document the event and continue monitoring
Correct answer: Visually check the patient via camera and verify probe placement
Before intervening, the technologist must verify the reading is accurate by checking probe placement and observing the patient, as artifact is a common cause of spurious desaturations.
Question 3: A patient informs the RPSGT that they took an extra dose of their prescribed opioid pain medication before arriving for their sleep study. What is the most appropriate action?
- Proceed with the study and note the extra dose in the medical record
- Notify the supervising physician or medical director before starting the study (Correct answer)
- Cancel the study immediately without consulting anyone
- Administer naloxone as a precaution
Correct answer: Notify the supervising physician or medical director before starting the study
Altered medication dosing, especially with opioids, requires physician notification before proceeding because of significant risks to respiratory drive during sleep.
Question 4: Which of the following is the most significant fall risk factor specific to the sleep laboratory environment?
- Patient age under 30
- Darkened room with multiple electrode wires attached to the patient (Correct answer)
- High ambient temperature in the sleep room
- Use of a standard hospital bed
Correct answer: Darkened room with multiple electrode wires attached to the patient
The combination of low lighting for sleep and tethering wires from electrodes creates a unique tripping and falling hazard in the sleep lab environment.
Question 5: A sleep technologist witnesses a patient have a generalized tonic-clonic seizure during a study. After calling for help, which action is the NEXT priority?
- Restrain the patient's limbs to prevent injury
- Position the patient on their side to protect the airway (Correct answer)
- Apply a bite block between the patient's teeth
- Increase the paper speed on the EEG to capture the event
Correct answer: Position the patient on their side to protect the airway
Positioning the patient laterally (recovery position) protects the airway from aspiration and is the primary safety intervention during a seizure.
Question 6: Which documentation element is MOST critical from a risk management perspective when a patient refuses a recommended intervention during a sleep study?
- The technologist's personal opinion about the refusal
- A statement that the patient refused, the risks explained, and that the physician was notified (Correct answer)
- Only the time the refusal occurred
- The brand name of the equipment that was refused
Correct answer: A statement that the patient refused, the risks explained, and that the physician was notified
Informed refusal documentation must include that the patient was educated on risks, their decision, and that the supervising physician was informed to protect both the patient and the facility.
Question 7: A CPAP-titration patient complains of significant aerophagia (air swallowing) causing abdominal bloating at a pressure of 12 cmH2O. What is the most appropriate risk-mitigation response?
- Increase pressure to 16 cmH2O to reduce apneas faster
- Notify the interpreting physician and document the complaint; consider lowering pressure or switching to BiPAP (Correct answer)
- Ignore the complaint as it is not life-threatening
- Administer an antacid from the lab supply cabinet
Correct answer: Notify the interpreting physician and document the complaint; consider lowering pressure or switching to BiPAP
Aerophagia is a known CPAP complication; the physician must be informed so a clinical decision can be made about pressure adjustment or modality change.
RPSGT Risk Management & Assessment 2
A patient with severe obstructive sleep apnea is scheduled for a split-night study.
Which condition would most contraindicate proceeding with CPAP titration in the second half of the night?