NUR 2755 / NUR2755: Multidimensional Care IV / MDC 4 Exam 1 Study Guide Q&As 2024/25, Exams of Nursing

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NUR 2755 / NUR2755: Multidimensional Care IV / MDC 4

Exam 1 Study Guide Questions and Correct Answers (2024 /

2025) (Verified Answers)

1. What is the most common type of dementia?: Alzheimer's disease
2. IS ALZHEIMER'S REVERSIBLE?: NO
3. What is the etiology of Alzheimer's?: Unknown
4. Alzheimer's is the result of?: changes in personality, memory, and/or judgement
5. What are risk factors for Alzheimer's?: * 65+ years

• female
• head injury
• APOE gene

6. what is the patho of Alzheimer's: plaques, tangles, degeneration of neurons
7. How is Alzheimer's diagnosed?: biopsy at autopsy is the only definitive way but dementia can be ruled out with CT, labs, UA, and MRI
8. Early s/s of Alzheimer's Disease: - decreased short term memory

• decreased sense of smell

• misplaced items

9. MIDDLE S/S OF ALZHEIMER'S DISEASE: - WANDER

• agitated
• incontinent
• money issues

10. late s/s of Alzheimer's disease: - bed ridden

• agnosia (inability to recognize objects, people, or sounds)

11. Medications used for Alzheimer's: Cholinesterase inhibitors

• slow breakdown of Ach
• Donepezil and Rivastigimine NMDA receptor antagonists
• block excess amounts of glutamate
• Memantine

12. Nursing care for Alzheimer's: - safe environment (#1) good lighting, no clutter

• stick with a routine
• offer walks, exercise
• reduce distractions

• avoid use of restraints

13. What is Parkinson's Disease: Movement disorder caused by the death of cells that generate dopamine in the basal ganglia and substantial nigra. Low levels of dopamine and high levels of Ach
14. How does Parkinson's progress?: slowly, but will eventually lead to disability
15. How is parkinson's diagnosed: history and s/s

16. s/s of parkinsons: - tremors

• muscle rigidity
• mak like facial expression
• bradykinesia
• shuffling gait
• cogwheel rigidity in limbs
• propulsive gait (head and neck forward, back is slouched)

17. nursing care for parkinson's: - safe environment

• sit up when eating, thick liquids
• encourage ROM and exercise

18. Medication for Parkinson's: - Sinemet

• Levodopa (increases dopamine levels in CNS) and Carbidopa (prevents levodpa breakdown)
• take at same time every day
• know that increased protein can alter effectiveness
• Benztropine
• decreases Ach levels

19. What are headaches?: vasodilation of blood vessels in the brain
20. What causes headaches: genetics, stress, hormones
21. What can trigger a headache?: coffee, yogurt, alcohol, MSG, marinated foods
22. s/s of headache: head pain for 4 - 72 hours, N/V, unilateral pain, may come with aura
23. what are cluster headaches?: happen at night, stuffy nose
24. treatment of headache: Prophylactic = propranolol Mild = NSAID Severe = sumatriptan

• ergotamine tartrate
• 6 tabs in 1 day
• take as soon as pain starts
• MOA = constricts cerebral blood vessels

25. What is increased ICP made of?: CSF, blood, brain
26. what causes increased ICP: infection, trauma, increased CSF, hemorrhage, tumors
27. s/s of increased ICP: MIND CRUSH

M: mental status change (early sign) = decreased LOC, irritable, confusion I: irregular breathing (late sighn) = Cheyene Stokes N: nerve damage to eye = pupil changes D: decerebrate (limbs out) and decorticate (limbs to core) posturing

C: cushing's triad (late) = HTN + brady + wide pule pressure R: reflux - N/V U: unconscious S: seizures H: headaches

28. NURSING CARE FOR INCREASED ICP: PRESS P: position HOB @ 30 degrees and make sure body's midline (no flexion of neck or hips) R: respiratory we want to prevent hypercapnia by hyperventilating (limit suctioning) E: elevated temp - prevent it! S: system checks = neuro checks S: straining things - avoid it (no lifting, blowing nose, cough/sneeze)
29. Additional Nursing care measures for ICP: - turn down the lights

• no TV or noise
• put sign on door telling visitors to see nurse first

30. What do you NOT do when someone has increased ICP?: Lumbar Puncture

31. What is the Glasgow Coma Scale?: - A brain injury severity scale that assesses depth and duration of impaired consciousness and coma.
32. what 3 areas make up the Glasgow coma scale?: - eyes score 1 - 4

• verbal score 1 - 5
• motor score 1- 6 Total score 3 - 15 **lower the score = more severe injury/status

33. EYES FOR GLASGOW COMA SCALE: ESPN E - eyes open spontaneously (4) S - sound (3) P - pain (2) N - not open (1)
34. Verbal for Glasgow coma scale: Our Country WIN O: oriented (5) C: confusion (4)

W: words are inappropriate (3) I: incomprehensible sounds (2) N: nothing (1)

35. Motor for Glasgow coma scale: Can't Live Without FANs C: commands followed (6) L: localize to pain (5) W: withdrawal from pain (4) F: flexion - decorticate posturing (3) A: abnormal extension-decerebrate (2) N: nothing (1)
36. what are seizure: abnormal and increase in firing of neurons
37. what is epilepsy: chronic seizures
38. what triggers seizures: stress, fatigue, coffee
39. what are risk factors for seizures: infection, trauma, fever, withdrawal, imbal- ances
40. How do you diagnose siezures: EEG (wash hair prior)
41. Seizure Precautions: - padded bed rails

• O2 and suction at bedside
• IV access

• lowest bed setting

42. Types of siezures: absence, atonic, tonic clonic, status epilepticus
43. Absence Seizures: - day dreaming

• LOC for a few seconds
• s/s = pick at clothes, lip smack, blank stare

44. Atonic Seizures: loss of muscle tone - fall
45. Tonic Clonic seizure: - tonic = stiffening

• clonic = rhythmic jerking
• postictal phase = coming back to - confused/sleepy

46. Status Epilepticus: - medical emergency!

• 1 seizure that lasts > 5 mins
• repeat of seizure w/in 30 min

47. nursing care during siezure: - turn patient on left side (#1)

• loosen restrictive clothing
• note onset and duration
• do NOT insert anything by mouth

48. Nursing care after seizure: - take vitals

• perform neuro checks

• determine what trigger was
• maintain left lying position

49. Treatment of seizures: Phenytoin

• narrow range (10-20), s/s= gingival hyperplasia

Valproic acid

• s/s = hepatotoxic Carbamazepine
• can cause a rash (Steven Johnson syndrome)

50. Education for Seizures and Seizure treatment: - medication compliance (abrupt withdrawal = rebound seizures)

• do not drive
• wear medical alert bracelet

51. surgical treatment of seizure: - vagal nerve stimulator

• craniotomy

52. What is encephalitis?: infection & inflammation of the brain tissue ***life threatening
53. How is encephalitis diagnosed?: CSF analysis or EEG
54. What are the s/s of encephalitis?: stiff neck, n/v, fever
55. What can encephalitis increase risk of?: increased ICP

56. Nursing care for encephalitis: - turn down lights and noise

• keep midline and HOB @ 30 degrees
• avoid straining activities

57. What is meningitis: inflammation of meninges (around brain and spinal cord)
58. what are the two main types of meningitis: 1. viral - more common
59. bacterial - cause is step
60. Prevention of meningitis: vaccination

• Hib for baby
• MCV4 for teens

60. Diagnosis of meningitis: CSF analysis
61. What does CSF analysis look like for viral meningitis?: clear, increased wbc and protein
62. what does CSF analysis look like for bacterial meningitis: cloudy, decreased glucose, increased wbc, and protein
63. s/s of meningitis: nuchal rigidity, n/v, photophobia, Brudzinski's sign, Kernig's sign
64. What is Brudzinski's sign?: After forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg.

65. What is Kernig's sign?: After flexing the hip and knee at 90 degree angles, pain and resistance are noted.
66. Nursing care for Meningitis: - bacterial = antibiotics

• viral = acyclovir
• steroids (decrease inflammation, increased infection)
• prophylaxis treatment for anyone in contact/exposed
• implement droplet precautions for first 24 hours of treatment
• Decrease ICP risk by elevating HOB, keep body midline, avoid straining activities, turn everything down

67. What is MS?: Autoimmune disease with chronic inflammation and no cure; just periods of relapse and remition
68. what is patho of MS: - body attacking its own myelin sheath
69. what causes MS: genetic, autoimmune, infection
70. what are risk factors of MS: female, white, 20 - 50 y/o
71. diagnosis of MS: no 100% way

• MRI
• CSF analysis (increased WBC, proteins, IgG)

72. S/S of MS: - muscle weakness

• intention tremors
• tinnitus
• vision (diplopia, nystagmus)

73. Nursing care for MS: - protect from injury

• allow for periods of rest
• help manage stress b/c this can lead to relapse/remit

74. Meds for MS: - Immunomodulators, immunosuppressants (decreased inflam- mation, increase infection)

• muscle relaxant = baclofen

75. what is Autonomic dysreflexia: Firing of SNS with no PNS response
76. what injury causes autonomic dysreflexia?: injury above T
77. what causes autonomic dysreflexia?: - bowel, bladder, breakdown of skin
78. s/s of autonomic dysreflexia: - severe htn

• bradycardia
• headache
• diaphoresis
• blurry vision

• facial flush above injury
• pale below injury

79. NURSING CARE FOR AUTONOMIC DYSREFLEXIA: PREVENT:

• bladder distention (empy it, check tubing for kinks, use bladder scanner)

• bowel - check for impactation
• skin breakdown - remove tight clothing Detect: at risk above T6 injury, report of headache, check BP Action: elevate HOB, Remove restrictive clothing, schedule bowel and bladder maintenance

80. What is true for spinal cord injury: the higher the injury, the more system affected and shorter the lifespan
81. diagnosis of spinal cord injury: X-ray, CT scan, MRI
82. prevention of spinal cord injury: stop drugs and alcohol
83. causes of spinal cord injury: traumatic: falls, MVA, violence Non-traumatic: tumors, RA Direct: fracture, hyperflexion (diving), hyperextension, penetration (GSW), axial load
84. types of spinal cord injuries: Complete: complete severed spinal cord, com- plete loss of function below injury Incomplete: spinal cord is partially severed, partial loss of function Quadriplegia

• at C
• Unable to move all 4 extremeties

• MVA, fall Paraplegia
• below T1, paralysis of lower extremities, can be result of GSW

85. what is the main cause of death for people with spinal cord injuries: sepsis, pneumonia, PE
86. Acute management of spinal cord injury: - airway and breathing

• immobilize head and neck (c-collar)
• determine LOC by using GCS

87. Medications for spinal cord injuries: - corticosteroid = methylprednisolone

• first given as IV bolus - then IV continuous drip for 24 hours
• needs to be given w/in 8 hrs of injury
• s/s hyperglycemia, poor wound healing, infection
• education: increae Ca intake, ROM, deep breathing

88. what is the number 1 thing to keep in mind with a spinal cord injury?: AIR- WAY and BREATHING
89. Complications of Spinal cord injury: - autonomic dysreflexia

• neurogenic shock (hypo, bready, edema, temp)

90. what is a stroke?: alteration in blood flow to the brain
91. TIA: transient ischemic attack = mini stroke, warning sign
92. diagnosis of stroke: CT without contrast
93. Etiology of stroke: - nonmodifiable = age, sex, history

• modifiable = HTN, BC user, high cholesterol, smoker

94. s/s of stroke: FAST facial droop, arm drift, speech is slurred, time how much as passed
95. General Left vs Right side stroke: Left = language Right = impulse & judgement
96. Left-sided stroke s/s: - receptive aphasia (unable to verbally communicate back)

• right sided hemiparesis (weakness)

• agraphia (unable to right)
• Aware of their deficits - anxiety and depression

97. Right-sided stroke s/s: - poor impulse control and judgement

• 1 sided neglect syndrome (unaware of deficits on left side of body, big safety concern)
• short attention span
• proprioception (depth) issues

98. Broca's area: expressive aphasia: unable to communicate/express back in speech
99. Wernikies aphasia: receptive aphasia: unable to receive/understand what is being said
100. nursing care for both broca's and wernikies: - be patient

• use short phrases
• use gestures/point
• limit distractions around

101. Treatment of stroke: General - anticoagulants, stool softeners, benzo's Ischemic stroke aka clot - tPa = thrombolytics (must be w/in 3 hours, BP needs to be in range, neuro checks every 15 mins. NOT for bleeding, htn, >3hrs

Hemorrhagic stroke - only treatment is surgery (BP must be in range, NOT for

someone on blood thinners (coumadin), if blood is too thin, admin fresh plasma or Vit K)

102. Nursing care for stroke: - safe environment (teach patient to scan before ambulating)

• lots of eating concerns:
• sit up
• tuck chin
• thick liquids
• use dentures
• no straws
• take small bites
• use mechanical soft diet Complications of stroke: increased ICP, seizures, HTN, headach

103. Who is at risk for TBI: infants, teens, older adults
104. how does TBI occur: falls, mva, gsw, sports
105. levels of tbi: mild - concussion moderate - decreased loc

severe - prolonged LOC

106. types of TBI: - subdural hematoma - bleeding below dura and above arachnoid

• primary: open (directly to brain) closed (fracture)
• secondary - result of primary

107. Nursing care for TBI: #1 determine what caused injury

• monitor LOC by GCS
• watch for CSF - clear drainage, shows halo with test
• wiping = ok
• blowing/inserting = NO
• prevent increased ICP

108. Complications of ICP: hydrocephalus, infection, stroke, increased ICP
109. meds for icp: antiseizure, mannitol, corticosteroids