Download NUR2755 Final Exam MDC 4: Multidimensional Care IV and more Exams Nursing in PDF only on Docsity! NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Hypothermia interventions - correct answers prevent heat loss warm up no booze blankets supine space out meds withhold IV meds until core temp 86 or higher monitor for vfib rewarm trunk Parkinson's 4 cardinal symptoms - correct answers tremor muscle rigidity bradykinesia or askinesia (slow or no movement) postural instability mask like face shuffling gate, drooling Huntington's vs. Parkinson's - correct answers often mistaken for each other, HD has choreiform or jerky movements NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Parkinson's Physcial assessment - correct answers small handwriting freezing rigidity masked faces difficult chewing/swallowing orthostatic hypotension soft speech urinary incontinence Parkinson's lab tests - correct answers CSF mahave low dopamine MRI or SPECT to rule out other brain conditions Parkinson's drug treatment - correct answers sinement-carbadopa/levadopa (stimulate dopamine receptors) COMT Inhibitor-Entacapone (prolong action of levodopa) MAOIS-rasagiline mesylate (increase dopamine concentration) Dopamine receptor agonists- Bromocriptine mesylate (promote dopamine release) Antiviral-amantadine NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen complex/automatism seizure - correct answers nonpurposeful, stereotyped, and repetitive behaviors that commonly accompany focal impaired awareness seizures (in the semiologic classification, they define automotor seizures). The behavior is inappropriate for the situation. Patients are usually amnestic to their automatisms. Simple seizure - correct answers A simple partial seizure will affect only one area of your brain. It doesn't cause you to lose consciousness Causes of seizures Primary - correct answers idiopathic genetic factors Causes fo seizures secondary - correct answers tumor or trauma metabolic disroders acute alchohol withdrawl electrolyte imbalance fever stroke TBI substances heart disease NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Seizure Diagnostic testing - correct answers EEG CT/MRI SPECT/PET metabolic labs seizure interventions medications Preventative - correct answers Phenytoin (Dilantin, Phenytek) (most widely used) • Fosphenytoin (Cerbryx) • Carbamazepine (Tegretol, Tegretol XR, Tegretol-CR image, Carbatrol) • Oxcarbazepine (Oxtellar, Trileptal) • Lamotrigine (Lamictal) • Valproic acid (Depakote, Depakoke ER, Epival image) • Primidone (Mysoline) • Gabapentin (Neurontin) • Pregabalin (Lyrica) • Levetiracetam (Keppra) • Topiramate (Topamax) • Ezogabine (Potiga) (first approved potassium channel opener drug approved for adjunctive management of partial-onset seizures) NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Seizure interventions prevent injury - correct answers bring to floor roll on side clear objects away observe and documetn loosen clothing if restrictive oral suction in mouth PRN Status epilepticus - correct answers Seizure lasting longer than 5 minutes or repeated seizures over 30 min. Medical emergency give a benzodiazepine "pam" IV phenytoin Seizure surgcial management - correct answers vagal nerve stimulation-prevents seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. It is sometimes referred to as a "pacemaker for the brain." A stimulator device is implanted under the skin in the chest. A wire from the device is wound around the vagus nerve in the neck. Brain resection/corpus callosotomy-palliative surgical procedure for the treatment of medically refractory epilepsy. In this procedure the corpus NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Thirst Nausea Sore muscles Weakness in parts of the body Injury (head, cuts, broken bones) Multiple sclerosis patho - correct answers demyelination and axonal nerve damage MS aggravators - correct answers fatigue stress overexertion temperatures MS physical assessment - correct answers muscle weakness and spasticity fatigue intention tremor dysmetria (inability to direct movement) Numbnesss ataxia-decreased coordination NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen dysarthria dysphagia diplopia nystagmus tinitius/hearing loss cognitive changes depression MS Lab diagnostics - correct answers CSF-elevated protein, myelin basic protein IgG bands MRI-brain or spinal cord plaques MS Drugs - correct answers Preventative: Avonex Betaseron Copaxon Acute-steroids and baclofen Spinal cord injury complete vs incomplete - correct answers complete- no function below injury NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen incomplete-some function below injury Spinal cord injury physical assessment - correct answers ABC's peripheral pulses and cap refill hemmorage check Glascow coma scale spinal shock- loss of motor, reflexes assess mobility/function assess bowel activity autonomic dyreflexia - correct answers sudden rise in BP with Bradycardia profuse sweating above injury flushing of skin blurred/spots in vision nasal congestion severe, throbbing headache Autonomic Dysreflexia causes - correct answers Bladder distention/UTI constipation Pain, tempurature fluxuations NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Stroke Initial assessment - correct answers B-balance E-Eyes F-face A-arms S-speech T-time Right hemisphere stroke changes - correct answers poor judgement lack of awareness visual deficits and neglect left sided weakness Left hemisphere stroke changes - correct answers language deficits anxiety/depression right sided weakness Stroke emerency interventions - correct answers Rapid ID-hemmy or ischy CT scan Glucose stick Give ateplase if ischy NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen ICU frequent vitals Hemmy-prep for surgery When to give ateplase - correct answers within 3-4.5 hours of initial onset not a massive stroke over 2/3 of a hemisphere CT done glucose stick done/rule out hyperglycemia BP below 185/110 Increased ICP symproms - correct answers decreased LOC restlessness, irritability and confusion headache nausea/vomiting change in speech pupillary changes ataxia seizuers cushing triad posturing NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Cushing triad - correct answers sign of increased ICP -Widening of pulse pressure, -Slowing HR -severe HTN Increased ICP interventions (6) Rx? - correct answers HOB elevate to 30 O2 over 94% head neutral position no sudden movements-coughing, sneezing, blowing no cluster of cares low stimulation/quiet Rx- mannitol Guillian Barre Syndrome patho - correct answers acute inflammation of axons or myelin of PNS GBS causes - correct answers infection- viral, GI vaccine autoimmune NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen MG physcial assessment - correct answers post infection, pregnancy anesthesia period of exacerbation temp weakness after vaccine, menstration, change in temp worsening of symptoms with repetitive movement drooping eyelids dysphagia voice weakens with use Myasthenic crisis - correct answers lack of meds, give a med and see if it helps Cholinergic crisis - correct answers too much meds MG lab diagosis - correct answers thyroid function SPEP AChR antibodies chest xray/ct RNS EMG Tensilon test NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen MuSK antibodies MG non-surgical interventions - correct answers respiratory assessment suctioning physiotherapy activity after meds protect eyes MG drug intervention - correct answers choliesterase inhibitors- pyridostigmine immunosuppressant-methotrexate, rituximab, steroids IVIG for acute treatment MG surgical intervention - correct answers thymectomy P.E. physical assessment (5-11) - correct answers sudden dyspnea sharp stabbing chest pain cough/bloody sputum tachycardia feelings of impending doom/anxiety NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen tachypnea crackles pleural friction rub s3 or s4 sounds diaphoresis/fever decreased SaO2 P.E. Intervention - correct answers RRT elevate HOB O2 ABG's assess respiratory/cardiac status CT angiogram anticoagulants IV fluids hypotension-norepi, dobutamine, nitroprusside P.E. Surgery - correct answers embolectomy-removal of embolist IVC filter- short term fix to block the embolist from reaching the lungs NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen high RR fluid in lungs "crackles" increased work of breathing hypercapnea noisy respirations cyanosis, pallor, retractions sweating change in LOC lung sounds normal ARDS Phases - correct answers exudative-early dyspnea and tachycardia fibroproliferative- lung injury, pulmonary HTN, fibrosis, reduced gas exchange, MODS REsolution after 14 days die or recover ARDS Interventions - correct answers vent/intubation-PEEP and PRONE assess and suction frequently antibiotics prn conservative fluid therapy NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen nutrition asap verify tube placement on vent - correct answers end-tidal CO2 and x- ray Vent care (6) - correct answers no pull at tube monitor vitals, respiratory status, ABG's HOB above 30 degrees check vent settings regularly Mouth care q 2 monitor for weaning Vent complications and prevention (3) - correct answers ulcers-PPI- dine H2 blocker prazole enteral feeding electrolyte replace Vent bundle care (4) - correct answers HOB above 30 oral care q 2 ulcer prophylaxis pulmonary hygiene NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen pneumothorax physical assessment (4) - correct answers reduced breath sounds on affected side prominence of involved side of chest deviated trachea if tension distended neck veins Pneumothorax interventions (4) - correct answers mild and stable- none chest tube needle throacostomy immediate if tension pain control pulmonary hygeine MAP equation - correct answers SBP + 2(DBP)/3 subarachnoid hemorrhage symptom - correct answers worst headache ever Shock treatment - correct answers O2 and concervative fluids NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen colds simple fractures Mass causualty triage tags - correct answers green-nonurgent yellow-urgen red emenergent black-ignore probably gonna die Primary survey (EX= pt comes into the ED after a trauma) - correct answers ABCD Airway Breathing Circulation Disability (neuro, GCS, LOC, peripheral pain Exposure Secondary survey (6) - correct answers comprehensive head to toe diagnostic labs insertion-NG tube, cath temporary dressing splints to fractures NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen sutures Heat exhaustion symptoms (3) - correct answers flu-like headache heavy sweating Heat exhaustion interventions (4) - correct answers rest in a cool place cold pack on neck, ab, groin soak in cool water rehydrate with electrolytes Heat stroke patho - correct answers temp over 104 emergency Heat stroke symptoms (6-12) - correct answers body temp over 104 hot dry skin tachycardia oliguria, 100-400 mL/24hr ALOC: confusion, bizarre behaviors, anxiety, drunk, agitation, seizures, coma NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen hypotension tachypnea electrolyte imbalance decreased renal function abnormal clotting crackles Heat stroke pre-hospital interventions (5) - correct answers cool patient down remove clothing cold water on body fan ice packs Heat stroke hospital interventions (10) - correct answers O2, intubation PRN 1 large bore IV NS cooled preferably cooling blanket rectal temp q15 indwelling urinary cath NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen ibuprofen for inflammatory cascade elevate above heart after rewarming debridement of tissue in higher degree frostbite Frostbite - correct answers superficial cold injury pain, numbness, waxy no tissue damage neurogenic shock (3) care within? Rx? - correct answers hypotension bradycardia poikilothermia within 30 min of injury dopamine/atropine Spinal shock - correct answers decreased reflexes, loss of sensation, and flaccid paralysis below the level of injury immediately with injury can be with neurogenic shock NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen clear to milky fluid filled blisters w/ partial thickness skin necrosis/ red skin with blisters - correct answers 2nd degree frostbite no blisters or edem, cold, bloodless gangrene can develop - correct answers 4th degree frostbite small blisters with dark fluid affected body part cool numb blue or red no blanch - correct answers 3rd degree frostbite Pt got stung by a bee, and gave themselves an epi pen, then what? - correct answers Call 911 S/S of flail chest (2) - correct answers paradoxical chest pain and SOB Decorticate posturing characteristics - correct answers Flexor= "cort"- arms turn inward like letter c limbs move toward the core arms adducted (arms fold to chest); flexion of elbows and wrists legs/feet flexed & internally rotated "Egyptian mummy" look NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen Decerebrate posturing - correct answers "Extension"= E= arms look like letter e neck is extended with jaw clenched arms adducted, extended, and close to the sides; hands pronated (out) fingers flexed legs are extended feet flexed more ominous sign of brain stem damage. Most Severe. tracheal deviation is a sign of - correct answers tension pnuemothorax diminished BS on affected side decreased chest expansion on affected tension pneumothorax priority intervention - correct answers needle decompression reasons why high pressure alarm goes off - correct answers Excess secretions, client biting tube, kinks, cough, edema, pneumothorax, bronchospasm NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen padded side rails bed in lowest position RN job during pt seizure - correct answers Keep them safe, remove restrictive clothing, side laying position, do not restrain sign of seizure - correct answers aura Pt education for preventing seizures - correct answers Rx-phenytoin, do not stop taking, side effects (hyperplasia of gums) need barrier contraceptives What diagnostic determine wether a stroke was hemorragic or ischemic - correct answers CT w/o contrast risk factors for ischemic strokes - correct answers A Fib TIA what medication should not be given with hemorrhagic strokes - correct answers thrombolytics anticoagulants NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen priority RN diagnosis for parkinson desease - correct answers fall risk heminopsia - correct answers blindness over half the field of vision heminopsia patient education - correct answers scan the room in all directions, rotate plate when eating, approach patient from the good side main sign of GBS - correct answers ascending paralysis (causes chest paralysis, may need mechanical ventilation) signs of meningitis - correct answers high fever nuchal rigidity photophobia altered LOC + brudinzki and kernig signs Meningitis isolation precautions - correct answers droplet Droplet precautions - correct answers NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen a client comes in with a neck injury, what is the priority intervention? - correct answers stabilize the neck and maintain airway If a pt has a halo device, they should not? - correct answers drive pre-op activities? - correct answers 1. verify permit is signed 2. obtain and record the vital signs/labs 3. Ask the client to empty the bladder 4. Instruct the patient to stay in bed 5. Administer pre-op meds post op care - correct answers prevent complications ABC altered LOC O2 sats HR BP Prevention of pneumonia - correct answers Frequent turning early ambulation deep-breathing exercises at least every 2 hours NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen encourage ambulation A client with MS is one baclofen, what is this Rx for? - correct answers muscle spasms feeding guidelines for stroke patients - correct answers Chin to chest when swallowing, speach therapy, watch for pocketing, thickened liquid, food on the unaffected side toward the back, allow enough time to eat patient education for EEG - correct answers Stay still, no caffeine, eat breakfast (don't want to develop hypoglycemia) A person with heat stroke is confused, can you give them fluids/food? - correct answers no, can lead to aspiration What is the assessing of clients to determine severity of illness/injury before admission - correct answers triage external disasters - correct answers events outside the hospital that produce a large number of victims (e.g. fires plane or train crashes earthquakes or violent civil disturbances) NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen _____ is a continued decrease in core body temperature after the victim is removed from the cold environment - correct answers After- drop (warm people too fast) spinal cord injuries can cause - correct answers flaccid paralysis A pt in the ED thinks they have TB, what is the first thing you should do? - correct answers put patient in isolation drowning can cause - correct answers alveolar collapse ARDS T/F=A sternal rub is the best way to test peripheral response to pain - correct answers False- use nail bed pressure In a mass casualty event a red tag client would exhibit - correct answers Facial injuries and difficulty breathing, MI, wheezing, chest pain Black Tag (MCI) - correct answers Not expected to live or dead asystole + severe burns/ cervical spine injury/ head injury Green Tag (MCI) - correct answers Minimal Injury (walking wounded) NUR2755 FINAL EXAM MDC 4 NUR2755 / NUR 2755 Final Exam (Latest 2023 / 2024): Multidimensional Care IV / MDC 4 - Rasmussen dislocated shoulder A group that can help communities during a disaster by setting up non acute hospital sites/first aid stations - correct answers Medical reserve corps DMAT (Disaster Medical Assistance Team) - correct answers Provides 72 hours worth of supplies and personnel EMTALA (Emergency Medical Treatment and Active Labor Act) - correct answers Cannot turn patients away, even if they don't have insurance how to prevent PTSD - correct answers *Be aware of need for breaks, rest, adequate water and nutrition *Provide emotional support *Encourage staff to support each other *Debrief with others following the incident *Encourage expression of feelings by all involved *Use offered counseling s/s of PTSD - correct answers nigthmares insomnia