NUR2571 Exam 3 Study Guide, Exams of Nursing

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NUR2571 Exam 3 Study Guide

Professional Nursing II PN 2

NUR2571 Exam 3 Study Guide : Professional Nursing II / PN 2

PN2 Exam 3 Neuro

• S/s, causes of autonomic dysreflexia o s/s: hypertensive crisis, bradycardia, severe headache, stroke or seizure activity o Cause: noxious stimuli such as a full bladder, fecal impaction, wrinkle in clothing, menstrual cramps, erection, ingrown toenail, bladder infection, sitting on catheter tubing o High blood pressure and spinal cord injury- check their bladder o Hypertensive crisis (elevated systolic pressures of 260 to 300)
• Gillian Barre, s/s, complications o s/s: starts in the legs and works its way up, motor weakness, areflexia (absence of reflexes), respiratory failure, face muscle deficit ▪ causes paresthesia and pain in hands and feet - this is reversible o Complications: respiratory distress
• Multiple Sclerosis – s/s, what to avoid o s/s: NYSTAGMUS fatigue in lower extremities, pain or paresthesia, diplopia (changes in peripheral vision), tinnitus, vertigo, dysphagia, o avoid: avoid extreme temperatures, stress, smoking
• Parkinson’s – What tx and meds are supposed to help o Levodopa/Carbidopa (Sinemet)- provides dopamine replacement to treat motor symptoms o Watch their swallowing- speech therapist o Provide finger foods o Encourage activity
• Myasthenia Gravis – Testing for o Tensilon Test: baseline measurement of the cranial muscle strength

▪ Have atropine available (antidote)

• ALS – patient and family teaching (SATA), late s/s o Teaching: emotional support, teaching about signs/prevent respiratory distress, speech therapy (how

to communicate), physical therapy, talk about choices for end of life care o Late s/s: respiratory distress

• Alzheimer’s – pt. and family teaching, what meds are used for, safety measures o Safety measures: remove scatter rugs, lock doors/alarms, good lighting, install handrails, place mattress on the floor, remove clutter, secure electrical cords to baseboards, keep cleaning supplies locked, wear identification bracelet o Meds: doesn’t cure but helps with behavior/emotional problems o Teaching: encourage AD support groups, safe environment, keep on a sleeping schedule, provide verbal and nonverbal communication, offer snacks and finger food, be consistent and repetitive, give memory training o promote self-care for as long as possible
• Migraines – what helps, patient teaching, s/s of common migraine (SATA) o s/s: photophobia, pulsating sensation (throb), pain that gets worse with activities o patient teaching/what helps: dark environment
• SCI (Spinal Cord Injury) – what to assess first, pt. teaching for respiratory o If blood pressure is high assess bladder first o Use of incentive spirometer to prevent pneumonia or ARDS Eyes
• What is Strabismus o Commonly known as cross eyed; a vision condition in which a person cant align both eyes simultaneously under normal conditions. One or both of the eyes may turn in, out, up, or down
• S/s, tx of cataracts o s/s: decreased visual acuity (reduced night vision)

blurred vision, diplopia (double vision), glare and light sensitivity, halo around lights, absent red reflex, visible opacity, progressive and painless loss of vision o Treatment: surgical removal of the lens

• What is macular degeneration o The gradual central loss of vision that affects the macula of the eye o Often called age-related macular degeneration
• Glaucoma, cause and tx o Leading cause of blindness o Cause: decreased fluid drainage or increased fluid secretion increases intraocular pressure and causes atrophic changes of the optic nerve and visual defects. o Treatment: ▪ prescribed eye medication (Pilocarpine, timolol , beta blockers ▪ check pulse and blood pressure before taking timolol Ears
• What ototoxicity causes o Sensorineural hearing loss
• Causes of sensorineural and conductive hearing loss o Conductive (something is physically stopping the sound): otosclerosis, ear wax, infection o Sensorineural: ototoxicity (mycin, flagel, NSAIDS, aspirin overdose)
• Treatment and patient teaching for acute otitis media o At risk for loss of balance o Bacterial: treated with antibiotics o (SATA) Teaching: finish all antibiotics, take analgesics, apply a warm cloth, if pain gets uncontrollable then seek help Diabetes/Thyroid
• Graves – pt. teaching, diet o Patient must discontinue any iodine containing medication 1 week prior to a thyroid scan o Radioactive Iodine teaching: not if pregnant, don’t kiss anyone or have sex for 5 days, don’t sit next to someone in a car for more than an hour, stay away from babies for 24 hours o Teaching: Monitor pulse, eat meals frequently o Diet: higher calories

• Type 1 – Cause o Auto-immune response or idiopathic o Diagnosed in childhood, little or no insulin, first sign is DKA

o Metabolic acidosis (Kussmauls respirations)

• Type 2 – Pt. teaching (SATA), testing for o Testing for metabolic syndrome (Syndrome X) o Teaching: ▪ High fiber diet ▪ Exercise
• Insulin – Pt. teaching about overall administration, which one goes IV o IV: regular (Humalin R) o Teaching: always clear before cloudy, monitor for hypoglycemia ▪ Rotate sites (wait 3-6 weeks to use that site again) ▪ Check sugar before giving insulin
• Lispro and NPH – onset, peak times o Lispro: onset 2-4 hours; no peak o NPH: onset 1.5 hours; peak 4-12 hours
• How to prevent lipodystrophy o insulin
• Foot care teaching o Don’t clip toe nails o Don’t wear open toed shoes
• Thyroid post-op complications and what to assess o Assess for signs of hypocalcemia: positive Chvostek’s and trousseaus o Assess for bleeding behind the neck o Vocal cord paralysis or damage: sounding hoarse
• Hypothyroid – s/s, meds for, will take meds forever o s/s: no energy, GI slows, weight gain, cold, no circulation, slurred speech ▪ tend to have cardiac disease o Meds: Levothyroxine (Synthroid) o Yes, they take them forever o Patient can become depressed because they are very tired
• How often to get eyes checked o Annual – due to retinopathy
• Pts. At greatest risk for Diabetes o Obese, family history, 45 and older, hypertension,

American Indians

• Good exercises for diabetics
• DKA s/s

o Polyuria, polydipsia, polyphagia, Kussmauls respirations, fruity breath

• Reducing diabetes vascular complications (SATA): o Check blood sugar, low carb low sugar low fat diet, exercise, stop smoking, watch BP A 24-year-old woman who uses injectable illegal drugs asks the nurse about preventing AIDS. The nurse informs the pt that the best way to reduce the risk of HIV infection from drug use it to Participate in a needle-exchange program An adolescent with IDDM is learning about a diabetic diet. He asks the nurse if he will ever be able to go out to eat with his friends again. What is the most appropriate answer for the nurse to give? Yes, you will learn what foods are allowed so you can eat with your friends An adult with myxedema is started on thyroid replacement therapy and is discharged. The client returns to the doctor’s office one week later. Which statement that the client makes is the most indicative of an adverse reaction to the medication? My chest hurts when I was sweeping the floor this morning After teaching the wife of a client who has Parkinson disease, then nurse assess the wife’s understanding. Which statement by the client indicates that she correctly understands changes associated with this disease? He may have trouble chewing, so I will off bite- sized portions Which treatment is used to manage hyperthyroidism? Select all that apply. Irradiation of the thyroid and Thyroidectomy

Which problem is most likely to develop if hyperthyroidism remains untreated? Heart failure A client who has just had a thyroidectomy returns to the unit in stable condition. What equipment is it essential for the nurse to

have readily available? Tracheostomy set Which finding would be the greatest cause for concern to the nurse during the early postoperative period following a thyroidectomy? Carpal spasm when the blood pressure is taken An adult with myxedema is started on thyroid replacement therapy and is discharged. The client returns to the doctor's office one week later. which statement that the client makes is most indicative of an adverse reaction to the medication? "My chest hurt when I was sweeping the floor this morning." Which diet does the nurse expect will be ordered for the client with hypothyroidism? High roughage, low calorie A client develops hypoparathyroidism after a total thyroidectomy. What treatment should the nurse anticipate? Administration of calcium A nurse is caring for an older adult client who has diabetes mellitus. The client reports loss of peripheral vision. For which of the following is the client at risk? Open-angle glaucoma A nurse is reinforcing selfcare instructions with a client following a trabeculectomy. Which of the following statements should the nurse include? "You need to limit your housekeeping activities." A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with this disease? (Select all that apply.) Genetic predisposition, Hypertension, and Age

A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following clinical manifestations should the nurse expect to find? (Select all that apply.) Blurred vision and White pupils

A nurse is collecting data from a client who has Parkinson's disease. Which of the following are expected findings? (Select all that apply.) Pill-rolling tremor of the fingers, Shuffling gait, and Lack of facial expressions A nurse is assisting with a plan of care for the nutritional needs of a client who has stage 4 Parkinson's disease. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) Record diet and fluid intake daily, Add thickener to liquids, and Offer nutritional supplements between meals. A nurse is caring for a client who is to start therapy with bromocriptine (Parlodel). For which of the following should the nurse monitor? (Select all that apply.) Dyskinesias, Orthostatic hypotension, and Constipation A nurse is caring for a client who has Parkinson's disease and displays manifestations of bradykinesia. Which of the following is an appropriate action by the nurse? Assist with hygiene as needed A client is diagnosed as having insulindependent diabetes mellitus (IDDM). She received regular insulin at 7:30 A.M. When is she most apt to develop a hypoglycemic reaction? Mid-morning An adolescent with IDDM is learning about a diabetic diet. He asks the nurse if he will ever be able to go out to eat with his friends again. What is the most appropriate answer for the nurse to give? "Yes. You will learn what foods are allowed so you can eat with your friends." At 10 A.M., a client with Type 1 diabetes becomes very irritable and starts to yell at the nurse. Which initial nursing assessment should take priority?

Color and temperature of skin An elderly woman has been recently diagnosed as having Type 2 diabetes. Which of the following complaints that she has is most likely to be related to the diagnosis of diabetes mellitus?

Pruritus vulvae A client is admitted to the hospital with recently diagnosed Type I diabetes mellitus and is to have fasting blood work drawn this morning. At 7:00 A.M., the lab has not arrived to draw the blood. The client's dose of regular insulin is scheduled for 7: A.M. What is the best action for the nurse to take? Withhold the insulin until the lab comes and the client will be eating within 15 to 30 minutes An elderly client with Type 2 diabetes mellitus develops an ingrown toenail. What is the best action for the nurse to take? Notify the physician Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. Which laboratory result will the nurse monitor to determine whether the medication has been effective? C-reactive protein level Which information will the nurse include when teaching range of motion exercises to a patient with an exacerbation of rheumatoid arthritis Application of cold packs before exercise may decrease joint pain Which of these laboratory values, noted by the nurse when reviewing the chart of a hospitalized diabetic patient, indicates the need for rapid assessment of the patient? Noon blood glucose of 52 mg/dL A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first? Place the patient on a cardiac monitor The nurse obtains the following information about a patient before administration of metformin (Glucophage). Which

finding indicates a need to contact the health care provider before giving the metformin? The patient's blood urea nitrogen (BUN) level is 60 mg/dL Which nursing action will the nurse include in the plan of care

when admitting a patient with an exacerbation of inflammatory bowel disease (IBD)? Monitor stools for blood A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to place the patient on NPO status A 24 year old woman who uses injectable illegal drugs asks the nurse about preventing AIDS. The nurse informs the patient that the best way to reduce the risk of HIV infection from drug use is to participate in a needle-exchange program When the nurse is caring for a patient whose HIV status in unknown, which of these patient exposures is most likely to require postexposure prophylaxis? Needle stick with a needle and syringe used to draw blood A pregnant woman with a history of early chronic HIV infection is seen at the clinic. Which information will the nurse include when teaching the patient? Most infants born to HIV-positive mothers are not infected with the virus A nurse is teaching a client who experiences migraine headaches and is prescribed a beta-blocker. Which statement would the nurse include in this client's teaching? "Take this drug as prescribed, even when feeling well, to prevent vascular changes associated with migraine headaches." A nurse assesses a client who has a history of migraines. Which clinical manifestation would the nurse identify as an early sign of a migraine with aura? Visual disturbances

A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex) for migraine headaches. Which condition would alert the nurse to hold the medication and contact the healthcare provider?

Prinzmetal's angina After teaching the wife of a client who has Parkinson disease, the nurse assesses the wife's understanding. Which statement by the client's wife indicates that she correctly understands changes associated with this disease? "He may have trouble chewing, so I will offer bite-sized portions." A nurse plans care for a client with Parkinson disease. Which intervention would the nurse include in this client's plan of care? Keep the head of the bed at 30 degrees or greater A nurse is teaching the daughter of a client who has Alzheimer's disease. The daughter asks, "Will the medication my mother is taking improve her dementia?" How would the nurse respond? "It will not improve her dementia but can help control emotional responses." A nurse assesses a client with Alzheimer's disease who is recently admitted to the hospital. Which psychosocial assessment would the nurse complete? Evaluate the client's reaction to a change of environment A nurse witnesses a client with late-stage Alzheimer's disease eat breakfast. Afterward the client states, "I am hungry and want breakfast." How would the nurse respond? "I see you are still hungry. I will get you some toast." A nurse cares for a client with advanced Alzheimer's disease. The client's caregiver states, "She is always wandering off. What can I do to manage this restless behavior?" How would the nurse respond? "Engage the client in scheduled activities throughout the day." A nurse prepares to discharge a client with Alzheimer's disease.

Which statement would the nurse include in the discharge teaching for this client's caregiver? "Install deadbolt locks on all outside doors." A nurse is teaching a client with chronic migraine headaches.

Which statement related to complementary therapy would the nurse include in this client's teaching? "Lie down in a darkened room when you experience a headache." A nurse delegates care for a client with Parkinson disease to an unlicensed assistive personnel (UAP). Which statement would the nurse include when delegating this client's care? "Allow the client to be as independent as possible with activities." A nurse delegates care for a client with early-stage Alzheimer's disease to an unlicensed assistive personnel (UAP). Which statement would the nurse include when delegating this client's care? "Reorient the client to the day, time, and environment with each contact." A nurse assesses a patient with a spinal cord injury at level T5. The patient's blood pressure is 184/95 mm Hg, and the patient presents with a flushed face and blurred vision. What action would the nurse take first? Palpate the bladder for distention An emergency room nurse initiates care for a patient with a cervical spinal cord injury who arrives via emergency medical services. What action would the nurse take first? Evaluate respiratory status A patient is admitted with Guillain-Barré syndrome (GBS). What assessment takes priority? Respiratory system A patient with Guillain-Barré syndrome is admitted to the hospital. The nurse plans caregiving priority to interventions that address which priority patient problem? Inadequate airway

The nurse is preparing a patient for a Tensilon (edrophonium chloride) test. What action by the nurse is most important? Obtaining atropine sulfate A patient with myasthenia gravis has the priority patient

problem of inadequate nutrition. What assessment finding indicates that the priority goal for this patient problem has been met? Weight gain of 3 lbs (1.4 kg) in 1 month An older patient is hospitalized with Guillain-Barré syndrome. A family member tells the nurse that the patient is restless and seems confused. What action by the nurse is best? Assess the patient's oxygen saturation A patient is in the preoperative holding area waiting for cataract surgery. The patient says "Oh, yeah, I forgot to tell you that I take clopidogrel, or Plavix." What action by the nurse is most important? Notify the surgeon immediately A patient does not understand why vision loss due to glaucoma is irreversible. What explanation by the nurse is best? "Because eye pressure was too high, the tissue died." A patient is taking timolol (Timoptic) eyedrops. The nurse assesses the patient's pulse at 48 beats/min. What action by the nurse is the priority? Hold the eyedrops and notify the provider A nurse is seeing patients in the ophthalmology clinic. Which patient would the nurse see first? Patient who has had cataract surgery and has worsening vision A nurse is teaching a patient about ear hygiene and health. What patient statement indicates a need for further teaching? "A soft cotton swab is alright to clean my ears with." The student nurse is performing a Weber tuning fork test. What technique is most appropriate? Placing the vibrating fork in the middle of the patient's head

The patient's chart indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause? "Have you been exposed to loud noises?"