Neurological Disorders and Nursing Care, Exams of Nursing

Download Neurological Disorders and Nursing Care and more Exams Nursing in PDF only on Docsity! NUR 340 Final Comprehensive Exam1 Questions and Answers- Graded A+ Cerebrum function of all lobes - Correct Answer higher level thinking (speech memory movement) frontal-higher cognitive function, memory retention, voluntary eye movements, voluntary motor movement, and speech in Broca's area. temporal-somatic, visual, and auditory data and contains Wernicke's speech area parietal-spatial information and contains the sensory cortex. occipital-Processing of sight Brainstem function - Correct Answer vitals- heart & lung function, sneezing, coughing, hiccupping, vomiting, sucking, and swallowing. Cerebellum function - Correct Answer coordinates voluntary movement and maintains trunk stability and equilibrium gout - Correct Answer pain in big toe is biggest clinical manifestation can be primary or secondary urate crystals deposit into joints & subQ tissues usually on bedrest from extreme pain What should be included in the nursing plan for prevention of skin breakdown in a stroke patient? Select all that apply. 1 Good skin hygiene 2 Minimizing the frequency of position changes 3 Massaging the damaged area 4 Applying emollients to dry skin 5 Administering back rubs with alcohol for a cooling effect - Correct Answer 1, 4 The skin of a patient with stroke is particularly susceptible to breakdown related to loss of sensation, decreased circulation, and immobility. Therefore the nursing prevention plan for skin breakdown should include pressure relief interventions such as position changes, application of emollients to dry skin, good skin hygiene, and early mobility. Massage to the damaged area may cause additional damage and should be avoided. Back rubs can be very relaxing, but should be done with lotion or oil, not alcohol, which is very drying to the skin. Text Reference - p. 1405 A patient presenting with pneumonia scores 5 on the CURB-65 scale. What action should the nurse take? 1 Advise no treatment. 2 Advise treating at home. 3 Consider hospital admission. 4 Consider admission to an intensive care unit. - Correct Answer 4 Bisphosphonate drugs should be administered correctly to facilitate absorption into the body. The drug should be consumed with a full glass of water. The patient may experience flu-like symptoms such as fever and headache without any loss of appetite or vomiting. After eating, the patient should remain upright for 30 minutes and should not lie down. The medicine should be taken 30 minutes before having food. Text Reference - p. 1556 Which similarity is seen in patients with rheumatoid arthritis and those with systemic lupus erythematosus? 1 Both may show symptoms of Reiter's syndrome. 2 Both may show symptoms of Sjogren's syndrome. 3 Both may show symptoms of restless leg syndrome. 4 Both may show symptoms of carpal tunnel syndrome. - Correct Answer Sjogren's syndrome may be seen in both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Patients with Sjogren's syndrome have decreased lacrimal and salivary secretion leading to dry eyes and mouth. Reiter's syndrome is seen in reactive arthritis. Restless leg syndrome is a clinical manifestation of fibromyalgia. Carpal tunnel syndrome is present in rheumatoid arthritis but absent in SLE. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. Text Reference - p. 1571 A patient has been given spinal anesthesia for knee replacement surgery. The nurse should monitor the patient for which indicators of autonomic nervous system blockade? Select all that apply. 1 Nausea 2 Bradycardia 3 Hypotension 4 Vomiting 5 Hyperglycemia - Correct Answer 1,2, 3, 4 Spinal anesthesia involves administration of an anesthetic agent into the cerebrospinal fluid. It may produce an autonomic, sensory, or motor blockade. The signs of autonomic blockade include nausea, bradycardia, hypotension, and vomiting. Hyperglycemia is not a sign of autonomic blockade. Text Reference - p. 345 While evaluating a patient the nurse suspects primary open-angle glaucoma if which classic symptom is present? 1 Vacillating pupil 2 Constant tearing 3 Decreased peripheral vision 4 Colored halos around lights - Correct Answer 3 Primary open-angle glaucoma develops slowly and without symptoms. The gradual loss of peripheral vision is one of the diagnostic criteria for primary open-angle glaucoma, which manifests as tunnel vision late in POAG. Vacillating pupils and constant tearing are not directly associated with any form of glaucoma. Colored halos around lights are seen in acute-angle closure glaucoma, which is less common than POAG. Acute-angle closure glaucoma is an ocular emergency requiring immediate intervention, because intraocular pressure increases rapidly and may cause optic nerve damage and blindness. Text Reference - p. 399 The registered nurse is teaching a student nurse about the proper way to communicate with a patient who has aphasia due to a stroke. Which statement made by the student nurse indicates a need for further learning? 1 "I will speak in a normal tone with the patient." 2 "I will frame questions in a "Yes" or "No" format." 3 "I will not pretend to understand the patient, if I do not." 4 "I will try to force communication with the patient if the patient is upset." - Correct Answer 4 Communication should not be forced if the patient is upset because anxiety worsens aphasia. Communication with the patient should be in a normal tone of voice because the patient should not feel as if they are spoken to like a child. Questions should be framed in a "Yes" or "No" format, to make communication easier for the patient. The nurse should not pretend to understand the patient. Instead, the patient should be encouraged to use nonverbal modes of communication. Test-Taking Tip: Be alert with the stem of the question. Recollect the concepts and apply the appropriate ones, reread the options until you are strong enough to conclude the option to be the suitable one. Text Reference - p. 1407 The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia care unit (PACU). What should the nurse's initial action be upon the patient's arrival? 1 Assess the patient's pain 2 Empty the urine bag whenever it is 25 percent filled. 4 Maintain the urine drainage bag above the level of the bladder. 5 Cleanse the patient's genitalia using antiseptic before placing the catheter. - Correct Answer 1, 2, 5 UTIs are a common problem in patients with spinal cord injuries. The best method for preventing UTIs is regular and complete bladder drainage. After the patient is stabilized, the best means of managing long-term urinary function should be assessed. Usually the patient is started on an intermittent catheterization program. The other common yet important intervention that a nurse could utilize is to use aseptic methods while inserting the catheter, like cleaning the genitalia using antiseptic. The urine bag should be drained every eight hours or when filled about two thirds. When catheterized for a long period, the urine bag should be kept below the level of the bladder; this will prevent backflow of urine and guard against infections. Text Reference - p. 1481 A patient is scheduled for a gastrectomy. During the preoperative evaluation, the patient reports taking ginseng regularly. What should the nurse do? 1 Inform the surgeon. 2 Advise the patient to take vitamin E in addition to the ginseng. 3 Advise the patient to decrease the dose of ginseng. 4 Advise the patient to replace the ginseng with another herbal drug. - Correct Answer 1 The priority intervention is to inform the surgeon. The gastrectomy needs to be rescheduled. The next priority is to suggest that the patient discontinue the use of ginseng, because ginseng increases blood pressure before and during surgery. Vitamin E should not be taken, because it can increase bleeding. Decreasing the dose of ginseng will not remove the risk. Use of any herbal product should be discontinued 2 to 3 weeks before surgery, because such medicines may increase the risk of postoperative bleeding. Text Reference - p. 320 A patient with pneumonia has a fever of over 103° F. What should the nurse do to manage the patient's fever? 1 Administer aspirin (ASA) on a scheduled basis around the clock. 2 Provide acetaminophen every four hours to maintain consistent blood levels. 3 Administer acetaminophen when the patient's oral temperature exceeds 103.5° F. 4 Provide drug interventions if complementary and alternative therapies have failed. - Correct Answer Antipyretics should be given around the clock to prevent acute swings in temperature. ASA would not be the drug of choice because of its antiplatelet action and accompanying risk of bleeding. 103.5° F is already a high fever and antipyretics should be given sooner. When treating fever, drug interventions normally are not withheld in lieu of complementary therapies. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax. Text Reference - p. 176 A patient with a stroke develops aphasia. What does the nurse suspect to be the reason for the patient's condition? 1 A defect in the vertebral artery 2 A defect in the middle cerebral artery 3 A defect in the anterior cerebral artery 4 A defect in the posterior cerebral artery - Correct Answer 2 Aphasia is caused by a defect in the middle cerebral artery. A defect in the vertebral artery may lead to cranial nerve deficits, or coma. Defects in the anterior cerebral artery may cause motor or sensory deficits. A defect in the posterior cerebral artery may result in visual hallucinations or motor deficits. Text Reference - p. 1393 A nurse is caring for an older adult postoperatively. For which symptoms should a nurse be observant to distinguish delirium from dementia? Select all that apply. 1 Rapid onset of symptoms, often at night 2 Abrupt progression of disease 3 Difficulty in finding proper words 4 Sleeping during the day 5 Accelerated, incoherent speech - Correct Answer 1, 2, 5 Delirium is a temporary state of mental confusion caused by reversible impairment of cerebral oxidative metabolism and multiple neurotransmitter abnormalities. The onset is usually rapid, mostly at night, and with abrupt progression. Decreased oxygen supply to the brain may cause the patient's speech to become accelerated and incoherent. In contrast, dementia has a slow onset and progression. The changes are subtle and progress over many years. As the cognitive decline progresses, and more brain areas are affected, the patient may have difficulty in finding proper words. A patient with dementia system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. A Foley catheter is not indicated at this time, and it is not reasonable to ask the patient to wait until the surgery is underway. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. Text Reference - p. 327 A patient with a family history of malignant hyperthermia is being taken into the operating room. While this patient is under general anesthesia, which sign would indicate that the patient is experiencing malignant hyperthermia? 1 Muscle contracture 2 Hypotension 3 Tachycardia 4 Bronchospasm - Correct Answer 1 Malignant hyperthermia causes hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium. The early manifestations may include muscle contracture, hyperthermia, hypoxemia, lactic acidosis, and hemodynamic and cardiac alterations. Tachycardia may be seen but is not specific to malignant hyperthermia. Hypotension and bronchospasms are seen in anaphylactic reactions. Text Reference - p. 346 The nurse provides postoperative care one day after a patient undergoes colostomy surgery. The patient's stoma is moist and dark pink, with no obvious drainage. Which action should the nurse take? 1 Document the normal findings 2 Consult the enterostomal therapist 3 Irrigate the ostomy with normal saline 4 Palpate the abdomen around the stoma - Correct Answer 1 A colostomy stoma that is moist and dark pink without any drainage on the first postoperative day is normal. These findings should be documented in the patient's medical record. Consulting the enterostomal therapist, irrigating the ostomy, and palpating the abdomen are not necessary, because the colostomy stoma is normal. Text Reference - p. 992 A patient has undergone cholecystectomy. What postoperative care should the nurse perform for this patient? Select all that apply. 1 Maintain a low-fat diet. 2 Monitor for any bleeding. 3 Instruct not to do deep breathing. 4 Place patient in shock position. 5 Place the patient in Sims' position. - Correct Answer 1, 2, 5 After cholecystectomy, it is important to follow dietary restrictions. A diet low in fat decreases the workload of the liver. Bleeding is a complication after the procedure; hence the nurse should monitor it. It is important to position the patient in Sims' position to facilitate gas pockets moving away from the diaphragm. Encourage deep breathing along with movement and ambulation to help expand the lungs and promote ventilation. The patient need not be put in shock position; it does not contribute to recovery. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 1040 A registered nurse is teaching a student nurse about tissue plasminogen activator (tPA) administration in a patient with ischemic stroke. Which statement made by the student nurse indicates a need for further teaching? 1 "tPA is administered intravenously (IV)." 2 "tPA is administered by intraarterial infusion." 3 "tPA should be administered within 12 hours of the onset of a stroke." 4 "tPA requires blood pressure monitoring during and 24 hours after the treatment." - Correct Answer 3 When tPA is administered to patients with an acute onset of ischemic stroke, it is administered intravenously (IV) and should be provided 3 to 4.5 hours from the onset of a stroke, not 12 hours. When administered by intraarterial infusion, tPA is delivered directly to the clot and can be administered up to 6 hours after the onset of stroke symptoms. It is important to monitor blood pressure during the treatment and for 24 hours after the fibrinolytic treatment. If blood pressure is not controlled, it can alter the fibrinolytic treatment. Text Reference - p. 1398 Prevention of vision loss resulting from chronic open angle glaucoma is accomplished best by which intervention? 1 Tobacco smoking cessation Text Reference - p. 1407 The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. The nurse discusses several risk factors for osteoporosis, including which of the following? Select all that apply. 1 Obesity 2 Asian descent 3 Smoking 4 Hyperlipidemia 5 Sedentary lifestyle - Correct Answer 2, 4, 5 A small frame, Asian descent, smoking, and a sedentary lifestyle all contribute to the development of osteoporosis. Obesity and hyperlipidemia are not risk factors for osteoporosis. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in one to two minutes. Text Reference - p. 1554 A patient receiving long-term corticosteroid therapy for rheumatoid arthritis is admitted to the hospital with a wound of the left upper extremity. What should the nurse expect while assessing this patient? Select all that apply. 1 The patient is at risk of hyperglycemia. 2 The wound of this patient will heal slowly. 3 There will be reduced bleeding from the wound. 4 The patient is at a risk of developing bone infection. 5 The symptom of fever may be blunted in this patient. - Correct Answer 1, 2, 5 Persistent hyperglycemia (steroid diabetes) can occur because of altered glucose metabolism. Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of patients receiving long-term corticosteroid therapy tend to heal slowly. Because of the depressed immune system, fever may be blunted in this patient. Corticosteroid therapy does not affect the risk of bleeding from the wound or the risk of bone infection. Text Reference - p. 181 The nurse is examining a patient suspected of having fibromyalgia. Which sites should the nurse assess for tenderness? Select all that apply. 1 Knee 2 First rib 3 Low cervical area 4 Lesser trochanter 5 Medial epicondyle - Correct Answer 1, 3 In order to identify a patient with fibromyalgia, the nurse should examine 18 identified sites for tenderness. Tenderness in 11 or more of these sites indicates fibromyalgia. These 18 identified tender points include the knee and the low cervical area. Other identified tender points include the second rib, the greater trochanter, and the lateral epicondyle. Text Reference - p. 1591 The new patient has a diagnosis of frontal lobe dementia. What functional difficulties should the nurse expect in this patient? 1 The lack of reflexes 2 Endocrine problems 3 Higher cognitive function abnormalities 4 Respiratory, vasomotor, and cardiac dysfunction - Correct Answer 3 Because the frontal lobe is responsible for higher cognitive function, this patient may have difficulty with memory retention, voluntary eye movements, voluntary motor movement, and expressive speech. The lack of reflexes would occur if the patient had problems with the reflex arcs in the spinal cord. Endocrine problems would be evident if the hypothalamus or pituitary gland were affected. Respiratory, vasomotor, and cardiac dysfunction would occur if there were a problem in the medulla. Text Reference - p. 1338 The nurse is caring for a patient in the initial postoperative period after having an ileostomy. What is a priority nursing action for this patient? 1 Using opaque pouches for the patient 2 Limiting sodium in the patient's diet 3 Offering high-fiber food to the patient 4 Using transparent pouches for the patient - Correct Answer 4 3 Carotid duplex scan 4 Evoked response testing 5 Cerebrospinal fluid analysis - Correct Answer 2, 4, 5 There is no definitive diagnostic test for MS. CT scan, evoked response testing, cerebrospinal fluid analysis, and magnetic resonance imaging (MRI) along with the patient's history and physical examination, are used to establish a diagnosis for MS. EEG and carotid duplex scan are not used for diagnosing MS. Test-Taking Tip: When using this program, be sure to note if you guess at an answer. This will permit you to identify areas that need further review. Also it will help you to see how correct your guessing can be. Text Reference - p. 1430 A nurse is caring for a patient who has undergone a knee joint replacement. What measures should a nurse take to prevent constipation of the patient in the postoperative period? Select all that apply. 1 Advise the patient to drink more than 2500 mL/day of fluids. 2 Instruct the patient to drink cold fluids. 3 Advise the patient to eat more fruits and vegetables. 4 Advise the patient to maintain complete bed rest until recovery. 5 Use stool softeners and laxatives as advised. - Correct Answer 1, 3, 5 Patients often have reduced mobility after a fracture, which may result in constipation. The nurse should implement appropriate measures, such as high fluid intake (more than 2500 mL/day unless contraindicated) and a diet high in bulk and roughage (fruits and vegetables) to prevent constipation. If these measures fail to maintain normal bowel pattern, then laxatives and stool softeners can be used. Constipation can be relieved by drinking warm fluids, not cold ones. Physical activity also helps in bowel activity, so the patient should ambulate as early as the indications and provider prescriptions allow. Text Reference - p. 1519 The patient in the intensive care unit is receiving gentamicin for pneumonia from Pseudomonas. What assessment results should the nurse report to the health care provider? 1 Decreased weight 2 Increased appetite 3 Increased urinary output 4 Elevated creatinine level - Correct Answer 4 Gentamicin can be toxic to the kidneys and the auditory system. The elevated creatinine level must be reported to the health care provider, because it probably indicates renal damage. Other factors that may occur with renal damage would include increased weight and decreased urinary output. Many medications have the side effect of anorexia. Text Reference - p. 1057 Which dietary instructions should the nurse provide the caregiver of a postoperative patient with dumping syndrome? Select all that apply. 1 "Avoid giving cheese." 2 "Give the patient eggs and meat." 3 "Avoid giving jelly and jam." 4 "Avoid giving fluids with meals." 5 "Divide the meals into three feedings." - Correct Answer 2, 3, 4 Eggs and meat contain proteins and fat, which help to rebuild body tissues and meet energy demands. Distention and fullness of the stomach can occur if fluids are consumed along with meals. Jelly and jam cause diarrhea and dizziness; these foods should be avoided. Cheese contains proteins and fats and should be provided to the patient. The meals of the patient should be divided into six small feedings to avoid overloading the stomach and intestine during meal times. Text Reference - p. 950 An 82-year-old woman is brought to her health care provider by her daughter with complaints of some confusion. What testing should the nurse suggest for this patient? 1 Urinalysis 2 Sputum culture 3 Red blood cell count 4 White blood cell count - Correct Answer 4 The developments of urinary tract infections commonly contribute to atypical manifestations, such as cognitive and behavior changes in older adults. Sputum culture, red blood cell count, and white blood cell count may be done, but the first step would be to assess for a possible urinary tract infection. A diabetic patient is waiting in the preoperative holding area for a hernia operation. The patient asks the nurse if the daily insulin dose should be taken. Which response is the most appropriate? 1 "I will check with the surgeon and let you know." 2 "Take half of the dose of insulin because you are fasting." 3 "Replace the insulin with an oral drug." 4 "Avoid taking insulin, because it may cause hypoglycemia." - Correct Answer 1 If a diabetic patient on insulin is due for surgery, it is important to get clear instructions from the surgeon regarding the insulin administration. The surgeon may choose to avoid the dose or give an adjusted dose based on the blood sugar levels. The nurse should not suggest taking a reduced dose, because it may cause a fluctuation in blood sugar levels. The insulin should not be replaced with oral drugs unless advised by the surgeon. The insulin dose may be skipped if the surgeon advises that. Text Reference - p. 322 A nurse is updating the health history of a patient who has been admitted to the hospital with a stroke. What question should the nurse ask the patient's support person? 1 What was the time of onset of symptoms? 2 How much food did the patient eat the previous night? 3 What was the position of the patient when the symptoms arose? 4 Was the patient wearing tight clothes at the time of the stroke? - Correct Answer 1 The time of onset of stroke is important for all types of stroke since it can affect the treatment decisions. Other questions are not relevant. The quantity of food that the person had in the previous night does not contribute to diagnosis or treatment of stroke. Strokes do not happen in a particular position; therefore, questions about the patient's position are not relevant. Wearing tight clothes does not increase the risk of stroke; therefore, the question is not relevant. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 1400 A patient with behavioral changes is scheduled for neurologic testing. Which findings does the nurse identify as supporting a diagnosis of dementia? Select all that apply. 1 Loss of memory 2 Early awakening from sleep 3 Hyperactive body movements 4 Difficulty with normal conversation 5 Changes developing over the last few days - Correct Answer 1, 4 Dementia is often diagnosed when two or more brain functions, such as memory loss or language skills, are significantly impaired. Early awakening from sleep is associated with depression. Hyperactive body movements are associated with either dementia or delirium. Behavior changes that developed over the last few days are manifestations of delirium. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 1443 Topics The nurse is providing care to a postoperative patient on a medical-surgical unit. The patient is experiencing tachypnea and becomes disoriented at times. Which is the priority action by the nurse in this situation? 1 Assessing the current level of pain 2 Activating the rapid response team 3 Documenting the data in the medical record 4 Administering the prescribed antihypertensive medication - Correct Answer 2 Tachypnea and disorientation are early and subtle signs of deterioration. The rapid response team (RRT) brings rapid and immediate care to unstable patients in non-critical care units. While assessing pain, documenting the data in the medical record, and administering prescribed medications such as antihypertensive medications are all appropriate actions, they are not the priority nursing actions in this situation. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. Text Reference - p. 1599 An older adult patient is receiving corticosteroid therapy for rheumatoid arthritis. What is the major concern in adopting this line of treatment? 1 Osteopenia 2 Drug-drug interaction 3 Moon face and weight gain 4 3 Draw a blood specimen to evaluate the white blood cell count 4 Administer the antibiotic over at least 60 minutes - Correct Answer 2 The nurse should ensure that the sputum for culture and sensitivity has been sent to the laboratory before administering the antibiotic. It is important that the organisms be correctly identified (in the culture) before their numbers are affected by the antibiotic; the test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Vital signs and white blood cell count measurement can be assessed following the obtainment of sputum cultures. Timing of antibiotic administration should be based upon the institution's policy. Text Reference - p. 525 What action is most beneficial to a patient with a right-brain stroke? 1 Wear shoes when out of bed 2 Arrange food on the left side 3 Remove clutter and obstacles 4 Give directions non-verbally - Correct Answer 3 A right-brain stroke survivor is at a higher risk for injury due to mobility issues. Therefore, all clutter and obstacles should be removed and proper lighting should be provided. Patients should wear nonslip and skid-resistant socks when out of bed to prevent falls. A right-brain stroke patient will tend to neglect the left side of the body; food should not be placed on the left side. All directions for activities should be given verbally to facilitate comprehension. Text Reference - p. 1406 The nurse is aware that which type of anesthesia can be administered without the presence of an anesthesia care provider? 1 Moderate sedation 2 General anesthesia 3 Regional anesthesia 4 Monitored anesthesia care - Correct Answer 1 An anesthesia care provider (ACP) is responsible for administering anesthesia. An ACP can be an anesthesiologist, nurse anesthetist, or anesthesiologist assistant. Moderate sedation involves administering sedatives, anxiolytics, or analgesics. It is used for procedures performed outside the operating room and does not require the presence of an ACP. A registered nurse who is educated in moderate sedation and is permitted by institution protocols and state nurse acts can perform this. However, general anesthesia, regional anesthesia, and monitored anesthesia care require the presence of an ACP. Text Reference - p. 341 Which measure is a priority for a nurse to include in the plan of care for a patient who has multiple sclerosis? 1 Referring the patient for genetic counseling 2 Teaching the patient about medications used during acute exacerbations 3 Assisting the patient in identifying the factors that precipitate exacerbations 4 Instructing the patient in the proper technique for self-administration of an enema - Correct Answer 3 The cause of multiple sclerosis is unknown, although fatigue, stress, or events such as pregnancy or acute illness can bring on an exacerbation. Identifying and avoiding such activities or factors may prevent exacerbations. Multiple sclerosis does not have a genetic link. Teaching the patient about medications and the proper technique for the self- administration of an enema is important but not as high of a priority as preventing exacerbations of the disease and complications. Text Reference - p. 1429 A patient with ulcerative colitis has been prescribed sulfasalazine. What instructions should the nurse give to the patient regarding the medication? 1 The function of the patient's liver enzymes will be monitored. 2 This medication should not be used, if patient is pregnant. 3 The medication may cause irregular values on a complete blood count (CBC). 4 The medication may cause a yellowish orange discoloration of skin and urine. - Correct Answer 4 When the patient is treated with sulfasalazine, the patient should be informed that this medication may cause the skin and urine to become yellowish orange in color. This medication does not require monitoring of liver enzymes, may be prescribed for pregnant women, and will not significantly alter a CBC. Text Reference - p. 978 When reviewing the preoperative forms, the nurse notices that the informed consent form is not signed. What is the best action for the nurse to take? 1 Have the patient sign a consent form. 2 Have the family sign the form for the patient. 3 Notify the health care provider to obtain consent for surgery. 4 Teach the patient about the surgery and get verbal permission. - Correct Answer 3 The informed consent for the surgery must be obtained by the health care provider. The nurse can witness the signature on the consent form and verify that the patient (or caregiver if patient is a minor, unconscious, or mentally incompetent to sign) understands A nurse is providing immediate postoperative care for a patient who has undergone a thymectomy. An anesthesia care provider has prescribed Naloxone. What is the primary reason the medication is being given? 1 To reverse opioid-induced respiratory depression 2 To decrease postoperative pain 3 To reduce the incidence of postoperative infection 4 To maintain normal blood pressures - Correct Answer 1 Narcan is the antidote of opioids. It contains naloxone. Opioid overdose induces respiratory depression. Narcan is prescribed to reverse this. Narcan is not useful in reducing postoperative pain or postoperative infection, or in maintaining blood pressure. Text Reference - p. 344 A nurse assesses the blood pressure (BP) of a patient who had a stroke and finds it to be 166/96 mm Hg. What is the priority action by the nurse? Select all that apply. 1 Call the health care provider immediately. 2 Start intravenous antihypertensive drugs. 3 Start oral antihypertensive drugs. 4 Ensure adequate fluid intake. 5 Consider this as a protective response. - Correct Answer 4, 5 Elevated BP is common immediately after a stroke. It is important to provide adequate fluid intake during acute care to maintain hydration. Elevation of BP is a protective response to maintain cerebral perfusion. Therefore, it is not necessary to call the health care provider. Antihypertensives should be started only if there is a marked increase in BP (systolic greater than 220 mm Hg or diastolic greater than 120 mm Hg). Text Reference - p. 1397 A female patient is one-day postoperative following an abdominal hysterectomy. Which intervention should the nurse perform to prevent deep vein thrombosis (DVT)? 1 Place the patient in a high-Fowler's position 2 Provide pillows to place under the patient's knees 3 Encourage the patient to change positions frequently - Correct Answer 3 The patient should be encouraged to change positions frequently and ambulate to prevent venous stasis. The high-Fowler's position and pressure under the knees should be avoided to prevent DVT. Deep breathing and coughing are therapeutic exercises but do not address directly the risk of DVT. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors. Text Reference - p. 1298 A patient is admitted to the hospital for elective surgery. The patient is taking nonsteroidal antiinflammatory drugs (NSAIDs) for knee pain. The nurse recognizes that NSAID use will have what effect on a postoperative patient? 1 It may increase the risk of infections. 2 It may cause atelectasis postoperatively. 3 It may cause clotting of blood in the deep veins of legs. 4 It may increase risk of postoperative bleeding. - Correct Answer 4 Although pain killers are required for surgical patients, the use of NSAIDS should be stopped before surgery, because these drugs are associated with increased postoperative bleeding. NSAIDS do not increase the risk of infections. NSAIDS do not cause atelectasis postoperatively. NSAIDS do not increase blood clotting. Text Reference - p. 320 Topics Which postoperative care, given by the nurse to the patient after a total hip replacement surgery, indicates an effective intervention? 1 Allowing the patient to sit on chairs without arms 2 Allowing the patient to cross legs at the knees or ankles 3 Allowing the patient to use a pillow between the legs for the first six weeks after surgery 4 Allowing the patient to perform daily activities such as putting on shoes and socks - Correct Answer 3 The nurse should allow the patient to use a pillow between the legs for the first six weeks after surgery. It should be used when lying on the nonoperative side or when in a supine position to maintain the joint in abduction and prevent dislocation of the new joint. Sitting on chairs without arms will lead to a sudden flexing of the body more than 90°, resulting in destabilization of the prosthesis. Crossing of the legs at the knees or ankles affects healing of the soft tissue of the hip joint, leading to predisposition of the joint. Performing daily activities such as putting on shoes and socks that require flexing the body more than 90°, will lead to damage of the soft tissue. Therefore, it should be avoided till at least six weeks after the surgery. Text Reference - p. 1526 A patient with significant right-sided pneumonia is receiving respiratory therapy. Which position is best suited for this patient? 1 Assisting the patient with the grieving process 2 Preventing the complication of pressure ulcers 3 Preventing the complication of urinary tract infections 4 Teaching the patient to build a general resistance to illness 5 Teaching the patient to maintain a good balance between exercise and rest - Correct Answer 2, 3 A patient experiencing an acute exacerbation of multiple sclerosis may be immobile and confined to bed. The first nursing interventions in this phase are aimed at preventing major complications associated with immobility. Pressure ulcers may occur due to the immobility of the patient while confined to the bed. Immediate care should be taken to prevent this. Urinary tract infections are also common due to the stagnation of urine. Assisting the patient with the grieving process is an important intervention during the diagnostic phase of multiple sclerosis. It is not applicable to a patient with an acute exacerbation of the disease. Teaching the patient to build general resistance to illness is a general intervention for a patient suffering from multiple sclerosis. Teaching the patient to maintain a good balance between exercise and rest is a general intervention for a patient with multiple sclerosis. It is not applicable for patients who are immobile. Text Reference - p. 1432 The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention? 1 Pain at the surgical site 2 Sudden shortness of breath 3 Serosanguineous wound drainage 4 Limited range of motion of the affected leg - Correct Answer 2 The sudden onset of shortness of breath could be an indication of fat embolism syndrome, a potentially fatal complication of long bone fractures. Pain at the surgical site, serosanguineous wound drainage, and limited range of motion of the affected leg are all expected findings in a patient who has just undergone repair of a fractured hip. Text Reference - p. 1523 A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? 1 Escherichia coli bacteria in the urine 2 A very tender prostate gland 3 Complaints of chills and rectal pain 4 Complaints of urgency and frequency - Correct Answer 2 A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem, because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in the urine, chills, rectal pain, urgency, and frequency are all present with a UTI and not specifically indicative of prostatitis. Text Reference - p. 1322 For which complication does the nurse monitor a postoperative patient for based solely on the postoperative status? 1 Atelectasis 2 Bronchoconstriction 3 Increased compliance 4 Chronic productive cough - Correct Answer 1 Atelectasis is the condition in which the alveoli collapse due to insufficient surfactant. The postoperative patient is at risk for atelectasis due to the effects of anesthesia and shallow breathing that often accompanies pain. Bronchoconstriction, increased compliance, and a chronic productive cough are not complications associated with surgery. Text Reference - p. 477 What nursing diagnostic statement would be assigned the highest priority in the plan of care for a patient who has ulcerative colitis? 1 Activity intolerance 2 Deficient fluid volume 3 Impaired tissue integrity 4 Risk for impaired skin integrity - Correct Answer 2 In ulcerative colitis, fluid is not absorbed from the distal large intestine because of ulceration, bleeding, and, later, scarring and narrowing of the lumen of the bowel. Fluid and electrolytes are also lost in the stool; therefore deficient fluid volume is the priority nursing diagnostic statement. Activity intolerance, impaired tissue integrity, and risk for impaired skin integrity are all possibilities related to ulcerative colitis, but they are not as high of a risk as deficient fluid volume. Text Reference - p. 978 The nurse is administering allopurinol (Zyloprim) to a patient who has been diagnosed with chronic tophaceous gout. Which of the following laboratory test results should be immediately reported to the health care provider? The community health nurse is teaching a class on osteoporosis to a group of postmenopausal women. The nurse determines that the group understands the information if they select _____________ as the only drug that increases bone formation in osteoporotic bones. ibandronate (Boniva) risedronate (Actonel) alendronate (Fosamax) teriparatide (Forteo) - Correct Answer teriparatide (Forteo) Teriparatide, a form of parathyroid hormone (PTH) produced by recombinant DNA technology, promotes bone formation by increasing the activity of osteoblasts. Bisphosphonates, such as ibandronate, risedronate, and alendronate, suppress resorption of bone through inhibition of osteoclasts. See Lehne p. 946, 952 A patient with gout is starting a long-term medication regimen. The nurse anticipates the need to provide teaching about which of the following drugs? febuxostat (Uloric) indomethacin (Indocin) prednisone naproxyn (Naprosyn) - Correct Answer febuxostat (Uloric) A nurse prepares to administer a highly protein bound drug to an elderly patient. Based on knowledge of pharmacokinetics in the elderly, the nurse would be most concerned about increased drug effects when the laboratory report reveals a low serum albumin level. high serum albumin level. high serum creatinine level. increased gastric pH. - Correct Answer low serum albumin level. The nurse is providing education to a patient diagnosed with gastroesophageal reflux disease (GERD). In addition to teaching about proton pump inhibitors, the nurse will also recommend that the patient avoid alcohol and late-night meals. avoid strenuous physical exercise. maintain a strictly bland diet. include dairy products with each meal. - Correct Answer avoid alcohol and late-night meals. A patient has been prescribed both clopidogrel (Plavix) and esomeprazole (Nexium) and also takes an NSAID for osteoarthritis. The patient found information on the web that esomeprazole reduces the anti-platelet effect of clopidogrel and wants to discontinue the PPI. The nurse"s response is based on a consensus guideline that states PPI drugs and antiplatelet drugs should not be used concurrently in any patients. the benefit of taking both drugs outweighs the risk for patients who have GI bleeding risk factors. there is no protective benefit to taking a PPI drug concurrently with clopidogrel. NSAIDs increase the risk of GI bleeding and should not be used with PPI or antiplatelet drugs. - Correct Answer the benefit of taking both drugs outweighs the risk for patients who have GI bleeding risk factors. An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist. The patient is to begin taking omeprazole (Prilosec). The nurse will teach the patient that a complete cure is expected with this medication. lifestyle changes can be as effective as medication therapy. long-term therapy may be needed. the medication is used until surgery can be performed. - Correct Answer long-term therapy may be needed. A patient will begin taking a cholinesterase inhibitor for early Alzheimer"s disease (AD). The nurse is teaching the patient"s spouse about the medication. Which statement by the spouse indicates a need for further teaching? vitamin E - Correct Answer memantine (Namenda) A patient is ordered to receive colchicine for an acute gout episode. Colchicine is thought to act by inhibiting uric acid synthesis. the migration of leukocytes to the inflamed site. excretion of uric acid. synthesis of white and red blood cells. - Correct Answer the migration of leukocytes to the inflamed site. The nurse explains to a patient beginning drug therapy with alendronate (Fosamax) that the drug should be taken 1 hour before bedtime with any beverage of choice. with an evening meal that includes a protein source. one-half hour before breakfast with 8 oz water. 1 hour after any meal. - Correct Answer one-half hour before breakfast with 8 oz water. Alendronate should be administered first thing in the morning with 8 oz water 30 minutes before meals or other medications to prevent esophagitis and to facilitate absorption. See Lehne pg 943; Lewis pg. 1637 Which statement, if made by a patient who has been prescribed low-dose aspirin therapy, would indicate a need for further teaching? "I should inform my pharmacist that I am taking aspirin therapy." follow-up on that referral to the smoking cessation clinic." take the aspirin with food or a full glass of water." take a buffered formulation of aspirin to reduce the risk of bleeding." - Correct Answer take a buffered formulation of aspirin to reduce the risk of bleeding." When administering risedronate (Actonel) to a patient, the nurse will first administer the ordered calcium carbonate. be sure the patient has recently eaten. assist the patient to sit up at the bedside. ask about any leg cramps or hot flashes. - Correct Answer assist the patient to sit up at the bedside. To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Actonel, as well as other drugs of this class, should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates. See Lehne pg. 943, 956, Lewis p. 1637 A patient with osteoporosis will be taking alendronate (Fosamax). The nurse teaches the patient to do which of the following after taking the drug? Consume a full cup of water or juice Wait 30 minutes to eat any food Lie on the left side for 15 minutes Immediately follow the dose with an antacid - Correct Answer Wait 30 minutes to eat any food Waiting 30 minutes before eating improves absorption. It is also important to have the patient sit or stand upright for 30 minutes after ingesting alendronate to minimize esophageal irritation. See Lehne pg. 943; Lewis 1637 The nurse is reviewing laboratory results of a patient who has been prescribed ticlopidine (Ticlid) for the last week. The WBC count is 3000/mm3 and the neutrophil count is 30%. A nursing priority for this patient is prevent the degeneration of cortical neurons. - Correct Answer enhance transmission by intact central cholinergic neurons. To assess for adverse drug reactions in an older adult, the nurse will place highest priority on which of the following laboratory results? serum creatinine levels creatinine clearance serum albumin levels liver function tests - Correct Answer creatinine clearance A patient with an acute attack of gout in the left great toe has a new prescription for probenecid (Benemid). Which information about the patient"s home routine indicates a need for teaching regarding gout management? takes one aspirin a day to prevent angina. sleeps about 8 to 10 hours every night. drinks about 3 quarts of juice and water daily. usually eats beef once or twice a week. - Correct Answer takes one aspirin a day to prevent angina. The nurse is providing education to a patient who is to be discharged home on alendronate (Fosamax). The nurse will instruct the patient to immediately report which of the following complications? Rash Arthralgia Diarrhea Difficulty swallowing - Correct Answer Difficulty swallowing Esophagitis is the most serious adverse effect of alendronate, sometimes resulting in ulceration. The nurse should instruct the patient immediately to report difficulty swallowing, which can be a sign of esophageal injury. Rash, arthralgia, and diarrhea may occur in patients taking bisphosphonates, but are not of the same priority level as esophagitis. See Lehne p. 943, 956 open angle intra-occular pressure glaucoma - Correct Answer IOP between 22 and 32 optic disk cupping - wider and deeper, first sign of chronic open angle glaucoma B-blockers (topical), anhidrase inhibitors, cholinergic, and Alpha adrenergic blockers Drugs control, do not treat! When meds do not work, outpatient procedure ALT uses only topical anesthetic, uses laser to decrease pressure. Uses topical corticosteroids 3-5 days to prevent acute rise in IOP. traceculostomy last, open surgery. IOP closed angle glaucoma - Correct Answer 50 +; normal is 10-21, emergency, immediate intervention give hyperosmotic agents to lower IOP. Psoriasis - Correct Answer Risk for cardiovascular disease r/t weakened immune system Goal is to reduce inflammation, no cure (autoimmune) Topical corticosteroids, tar, calcipotriene, anthralin, intralesional inj. corticosteroids for chronic plaques systemic: natural or artificial UVB; PUVA (UVA w/ topical or systemic photosensitizer) immunosuppresants photosensitivity treatments 2-4x a week side effects include: N/V, sunburn, persistent pruritis, erythmea psoralen should be used in caution w/ pt's w/ liver or renal disease, slower metabolism & excretion, can lead to prolonged photosensitivity long term use of corticosteroids can lead to: atrophy of skin from impaired cell mitosis, capillary fragility, susceptibility to bruising Fibromyalgia - Correct Answer chronic. Physiologic abnormalities: increased level of substance P in CSF, low levels of blood flow to the thalamus, dysfunction of the HPA access, low levels of serotonin (depression) and tryptophan, abnormalities in cytokine function, changes in HPA for physical and mental health, decreased response to stress. MMSE, what is it for? - Correct Answer dementia NIHSS, what is it for? - Correct Answer severity of stroke, 11 items score 0-4, 0 is normal function & as you up up impairment is increased Sodium normal value - Correct Answer 135-145 Potassium normal value - Correct Answer 3.5-5.0 RBC normal value - Correct Answer men: 4.3-5.7 women: 3.8-5.1 Hgb normal value - Correct Answer men: 13.2-17.2 women: 11.7-16.0 Hct normal value - Correct Answer men: 39-50% women: 35-47% WBC normal value - Correct Answer 4000-11000 Platelet normal value - Correct Answer 150,000-400,000 Serum Creatinine normal value - Correct Answer 0.6-1.3 BUN normal value - Correct Answer 6-20 aPTT normal value, therapeutic range-heparin - Correct Answer 25-35 heparin therapy: 60-80 PT normal value - Correct Answer 11-16 INR normal value - Correct Answer 0.8-1.2 Warfarin therapy: 2-3 Glucose normal value - Correct Answer 70-120 pH normal value - Correct Answer 7.35-7.45 CO2 normal value - Correct Answer 35-45 HCO3 normal value - Correct Answer 22-26 PaO2 normal value - Correct Answer 80-100 SaO2 normal value - Correct Answer >95% CRP normal range - Correct Answer 6.8-820 ESR normal range - Correct Answer <30 What is most specific test for SLE? - Correct Answer Anti-DNA osteoporosis - Correct Answer chronic deterioration of bone tissue leading to bone fragility more common in women from low estrogen (menopause) and lower calcium intake women should get an initial bone scan before the age of 65, men should be screened before age 70 BONE RESORPTION EXCEEDS BONE DEPOSITION osteoporosis risk factors - Correct Answer advancing age (65+) female low body weight white or Asian ethnicity current cigarette smoking nontraumatic fracture sedentary lifestyle postmenopausal (lack of estrogen) family hx diet low in calcium or vit D deficiency excessive alcohol consumption low testosterone in men long-term use of corticosteroids, thyroid replacement, heparin, anti-seizure drugs osteoporosis and specific diseases - Correct Answer IBD intestinal malabsorption (Crohn's) renal disease RA hyperthyroidism chronic alcoholism cirrhosis of liver DM drugs that interfere with bone metabolism - Correct Answer corticosteroids (long-time use major contributor!!) anti-seizure drugs aluminum-containing antacids heparin