MS Lecture Exam 3
What happens in the seizure ictal phase?
first to last sx of seizure activity
A client who ___ in response to to painful stimulus is displaying decorticate or decerebrate posturing and is not displaying an expected response
flexes the upper and extends the lower extremities
What does inotropic mean?
force of contraction of heart
___ aphasia is total inability to communicate
global
What is Cushing's triad?
hypertension bradycardia irregular respirations
What is agnosia?
inability to recognize objects (touch, sight, hearing)
What does chronotropic mean?
increase or decrease in HR
Pronation of the arms along with extension of the arms and legs with plantar flexion is identified as decerebrate posturing and is an indication of what?
injury to the client's brainstem
___ is ischemic muscle pain is caused by exercise, resolves within 10 minutes or less with rest, and is reproducible due to the buildup of lactic acid from anaerobic metabolism. Once the patient stops exercising, the lactic acid clears, and the pain subsides.
intermittent claudication
A ___ sided stroke is more likely to result in memory problems
left
A client who had a stroke involving the ___ cerebral hemisphere is likely to have language deficits, which include difficult using or comprehending language and difficulty writing
left
A client who had a stroke involving the ___ cerebral hemisphere is more likely to have behavior changes that include cautiousness, depression and anxiety
left
Clients with ___-side lesions are typically cautious.
left
The client who has a ___-sided lesion will have an inability to discriminate between words and letters leading to problems reading.
left
What is the most common form of heart failure
left sided heart failure
What is homonymous hemianopsia?
loss of half of the field of view on the same side in both eyes
What is akinesia?
loss or impairment of the power of voluntary movement
What do ACE inhibitor medications do?
lower blood pressure
What kind of ulcers are most common with PVD?
nonhealing arterial ulcers
What kind of skin do Parkinsons pts have?
oily skin, which results from autonomic dysfunction
What position should a pt with high intracranial pressure (ICP) following a closed-head injury
positioning the client in a neutral position with the head of the bed elevated to 30° to 45°. This placement allows the cerebral spinal fluid to flow freely through the brain and spinal cord, minimizes pressure within the central nervous system, and prevents aspiration.
What are the 4 phases of a seizure?
prodromal, aural, ictal, postictal
___ aphasia is loss of comprehension
receptive
Effect of estrogen on CAD
reduced prevalence of arterial hypertension, coronary artery disease, myocardial infarction, and stroke.
Increased ___ activates the RAAS, which in turn elevates BP
renin
What does "clonic" mean?
rhythmic jerking, either symmetric or asymmetric)
A client who has a ___-sided lesion experiences a loss of depth perception, proprioception (recognition of body position), and spatial deficits
right
A client with a ___-side lesion is likely to be impulsive
right
The nurse should expect a client who had a stroke involving the ___ cerebral hemisphere to have an impaired sense of humor.
right
The nurse should expect a client who had a stroke involving the ___ cerebral hemisphere to have loss of depth perception, visual spatial deficits and neglect of the other side visual field.
right
The nurse should expect a client who had a stroke involving the ___ cerebral hemisphere to have personality changes which can include impulsiveness, confabulation and poor judgment.
right
What is the most widely used lipid lowering drug?
statins
What do inotropic agents do?
substances that act on the myocardium to increase contractility and improve cardia output
Why should "yes" and "no" questions be avoided in pts with global aphasia?
the client might give automatic responses that are not correct.
What does angiotensin II do?
vasoconstriction
What is the most common type of seizure?
Tonic clonic
What is the TRAP mnemonic for Parkinsons?
Tremor Rigidity Akinesia Postural instability
T/F: As BP rises, CO and SVR do too
True
T/F: Raynauds disease is an example of PAD
True
T/F: neurological manifestations do not significantly differ between ischemic and hemorrhagic stroke
True
T/F: the aural phase is considered part of a seizure
True
___ is a blood clot believed to form as a result of venous stasis, endothelial injury, or hypercoagulability which can lead to a pulmonary embolism
Venous Thromboelbolism (VTE)
A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching? "I will notify my doctor before taking any other medications." "I have made an appointment to see my dentist next week." "I know that I cannot switch brands of this medication." "I'll be glad when I can stop taking this medicine."
"I'll be glad when I can stop taking this medicine." Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider.
A nursing is caring for a client who has aphasia following a stroke. A family member asks the nurse how she should communicate with the client. Which of the following responses by the nurse is appropriate? "Incorporate nonverbal cues in the conversation." "Ask multiple choice questions as part of the conversation." "Use a higher-pitched tone of voice when speaking." "Use simple, child-like statements when speaking."
"Incorporate nonverbal cues in the conversation."
A nurse is teaching the family of a client who has a new diagnosis of epilepsy about actions to take if the client experiences a seizure. Which of the following instructions should the nurse include in the teaching? "Insert a padded tongue blade into the client's mouth." "Restrain the client." "Place the client on his back." "Move objects away from the client."
"Move objects away from the client."
What gene makes pts more susceptible to hypertension?
"Salt sensitive"
A nurse is teaching an older adult client who has left-sided weakness about cane use. Which of the following instructions should the nurse include? "Hold the cane with your left hand." "When walking, move your left foot forward first." "Move the cane forward 18 inches with each step." "Keep your elbow straight when you hold the cane."
"When walking, move your left foot forward first." The client should move her weaker (left) foot with the cane first, then bring her stronger leg forward ahead of the cane and the weaker foot.
What is the PArkinsons hand tremor described as?
"pill rolling"
Describe a focal impaired awareness seizure
1-2 minute loss of consciousness producing a dreamlike state, make movements that seem purposeful but cannot interact with observers. Sometimes do embarassing things such as taking off all clothes
What are the 2 primary actions of drugs that treat hypertension?
1. Decrease volume of circulating blood 2. Reduce SVR
What are the stages of artherosclerosis?
1. Fatty streak 2. Fibrous plaque 3. Complicated lesion
What are the 3 main compensatory factors with HF?
1. RAAS 2. Ventricular dilation 3. Ventricular hypertrophy
What is Virchow's triad and what disorder is it associated with?
1. Venous stasis 2. Hypercoagulability 3. Trauma to a vessel VTE
Describe atypical absence seizure
10-30 second staring spell accompanied by by eye blinking and lip jerking
Describe myoclonic absence seizure
10-60 second rhythmic arm abduction
How far forward should a cane be moved while ambulating?
12 inches
Hypertensive crisis= BP greater than ___/___
180 120
Orthostatic BP is defined as a decrease of ___Hg or more systolic, ___Hg or more diastolic, and a increase of ___BPM for HR
20 10 20
Staticus Epilepticus is when a seizure lasts longer than ___ miutes
5
What is normal LVEF?
55-65%
Describe typical absence seizure
<10 seconds that resembles daydreaming
A nurse is reinforcing teaching with a client who has Parkinson's disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include? A. Rise slowly when standing. B. Expect urine to become dark-colored. C. Avoid foods containing tyramine. D. Report any skin discoloration.
A. Rise slowly when standing. (prevent orthostatic hypotension)
A charge nurse is anticipating the admission of four clients and planning their room assignments. Which of the following clients should the nurse assign to the room closest to the nurses' station? A client who sustained a head injury and is having periods of confusion A client who reports a severe migraine headache A client who has a suspected diagnosis of tuberculosis (TB) A client who has a history of atrial fibrillation and is on continuous ECG monitoring.
A client who sustained a head injury and is having periods of confusion A client who sustained a head injury and is confused is at risk for seizures. The nurse should place this client in a room near the nurses' station so that he can be closely monitored to prevent injury if a seizure occurs.
What dysrhythmia is common in HF pts?
A fib
___ prevent angiotensin II from binding to its receptors in the walls of the blood vessels.
A-II receptor blockers (ARBS)
A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include? (Select all that apply.) A. "Avoid taking herbal supplements while taking this medication." B. "Monitor for the presence of black, tarry stools." C. "Take this medication when you have pain." D. "Schedule a weekly PT test." E. "Limit food sources containing vitamin K while taking this medication."
A. "Avoid taking herbal supplements while taking this medication." B. "Monitor for the presence of black, tarry stools."
When teaching for a 56-year-old woman who was recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? A. "I will limit the amount of milk and cheese in my diet." B. "I can add salt when cooking foods but not at the table." C. "I will take an extra diuretic pill when I eat a lot of salt." D. "I can have unlimited amounts of foods labeled as reduced sodium ."
A. "I will limit the amount of milk and cheese in my diet."
A nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 mL/day. The client asks the nurse how to determine the appropriate amount of fluids they are allowed. Which of the following statements is an appropriate response by the nurse? A. "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink." B. "Each glass contains 8 ounces. There are 30 milliliters per ounce, so you can have a total of 8 glasses or cups of fluid each day." C. "This is the same as 2 quarts, or about the same as two pots of coffee." D. "Take sips of water or ice chips so you will not take in too much fluid."
A. "Pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink."
A nurse is providing information about a new prescription for corticosteroid cream to a client who has mild psoriasis. Which of the following instructions should the nurse include? (Select all that apply.) A. Apply an occlusive dressing after application B. Apply three to four times per day. C. Wear gloves after application to lesions on the hands. D. Avoid applying in skin folds. E. Use medication continuously over a period of several months.
A. Apply an occlusive dressing after application C. Wear gloves after application to lesions on the hands. D. Avoid applying in skin folds.
A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. Which of the following information should the nurse include in this review? (Select all that apply.) A. Avoid overwhelming fatigue. B. Remove caffeinated products from the diet. C. Limit looking at flashing lights. D. Perform aerobic exercise. E. Limit episodes of hypoventilation. F. Use of aerosol hairspray is recommended.
A. Avoid overwhelming fatigue. B. Remove caffeinated products from the diet. C. Limit looking at flashing lights.
A nurse is planning care for a client who has dysphagia and a new dietary prescription. Which of the following should the nurse include in the plan of care? (Select all that apply.) A. Have suction equipment available for use. B. Feed the client thickened liquids. C. Place food on the unaffected side of the client's mouth. D. Assign an assistive personnel to feed the client slowly. E. Teach the client to swallow with the neck flexed.
A. Have suction equipment available for use. B. Feed the client thickened liquids. C. Place food on the unaffected side of the client's mouth. E. Teach the client to swallow with the neck flexed.
A nurse is caring for a client who has experienced a right-hemispheric stroke. The nurse should expect the client to have difficulty with which of the following? (Select all that apply.) A. Impulse control B. Moving the left side C. Depth perception D. Speaking E. Situational awareness
A. Impulse control B. Moving the left side C. Depth perception E. Situational awareness
A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? A. Keep the client in a side-lying position. B. Document the duration of the seizure, C. Reorient the client to the environment. D. Provide client hygiene.
A. Keep the client in a side-lying position.
A patient with newly discovered high BP has an average reading of 158/98 mmHg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? A. Medication will be required because the BP is still not at goal. B. BP monitoring should continue for another 3 months to confirm the diagnosis of hypertension. C. Lifestyle changes are less important, since they were not effective, and medications will be started. D. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications.
A. Medication will be required because the BP is still not at goal.
A nurse is providing discharge teaching for a client who has a prescription for furosemide 40 mg PO daily. The nurse should instruct the client to take this medication at which of the following times of day? A. Morning B. Immediately after lunch C. Immediately before dinner D. Bedtime
A. Morning
A nurse is assessing a client who has a seizure disorder. The client tells the nurse, "I am about to have a seizure." Which of the following actions should the nurse implement (Select all that apply) A. Provide privacy. B. Ease the client to the floor if standing. C. Move furniture away from the client. D. Loosen the client's clothing. E. Protect the client's head with padding. F. Restrain the client.
A. Provide privacy. B. Ease the client to the floor if standing. C. Move furniture away from the client. D. Loosen the client's clothing. E. Protect the client's head with padding.
A nurse is caring for a client who has global aphasia (both receptive and expressive). Which of the following should the nurse include in the client's plan of care? (Select all that apply.) A. Speak to the client at a slower rate. B. Assist the client to use cards with pictures. C. Speak to the client in a loud voice. D. Complete sentences that the client cannot finish. E. Give instructions one step at a time.
A. Speak to the client at a slower rate. B. Assist the client to use cards with pictures. E. Give instructions one step at a time.
A nurse is completing the admission assessment of a client who has suspected pulmonary edema. Which of the following manifestations are expected findings? (Select all that apply) A. Tachypnea B. Persistent cough C. Increased urinary output D. Thick, yellow sputum E. Orthopnea
A. Tachypnea B. Persistent cough E. Orthopnea
The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease (select all that apply) A. Take your medications as they are prescribed. B. Use oxygen when you are feeling short of breath. C. Sleep in your recliner at night if you are having additional shortness of breath. D. Undertake most of your activity in the morning when rested.
A. Take your medications as they are prescribed. D. Undertake most of your activity in the morning when rested.
A nurse is teaching a client who heart failure and new prescriptions for furosemide and digoxin. Which of the following information should the nurse include? (Select all that apply). A. Weigh daily, first thing each morning. B. Decrease intake of potassium. C. Expect muscle weakness while taking digoxin. D. Hold digoxin if heart rate is less than 70/min. E. Decrease sodium intake.
A. Weigh daily, first thing each morning. E. Decrease sodium intake.
A PATIENT WITH PAD HAS NO PALPABLE PEDAL, POPLITEAL,OR POSTERIOR TIBIAL PULSES IN HER LEFT LEG AND 1+PULSES IN HER RIGHT LEG. SHE HAS A 2-CM ULCER ON HERLEFT GREAT TOE THAT IS DRY AND BL ACK. THE PATIENT COMPL AINS OF INTERMITTENT CALF PAIN AT REST. TO MAXIMIZE ARTERIAL BLOOD FLOW AND MINIMIZE THE PATIENT'S CALF PAIN, YOU WOULD INSTRUCT THE PATIENT TO A. dangle her legs over the side of the bed. B. use elastic support stockings when she ambulates. C. elevate her legs to heart level when pain is present. D. apply warm, moist compresses to legs for 20 minutes every 2 hours
A. dangle her legs over the side of the bed.
What drug is the first choice for chronic HFrEF?
ACE inhibitors
What is the most common cause of hospitilization on older adults?
Acute decompensated heart failure
___ act by decreasing the SNS effects that increase BP. they include drugs that work centrally on the vasomotor center and peripherally to inhibit norepinephrine release or to block the adrenergic receptors on blood vessels.
Adrenergic-inhibiting agents
___ prevent the conversion of angiotensin I to angiotensin II and reduce angiotensin II (A-II)-mediated vasoconstriction and sodium and water retention.
Angiotensin-converting enzyme (ACE) inhibitors
What 2 circumstances should BP be dropped ASAP?
Aortic dissection Acute ischemic stroke (allow anti-embolitics to work)
A nurse is caring for a client who has right-sided paralysis from a stroke. Which of the following interventions should the nurse implement to prevent footdrop? Place sandbags to maintain right plantar flexion. Position soft pillows against the bottom of the feet. Apply a protective boot to the right ankle. Splint the right lower extremity to maintain proper alignment.
Apply a protective boot to the right ankle. The nurse should apply padded splints or protective boots to the right ankle to keep the foot at a right angle to the leg to prevent footdrop.
A nurse is caring for a child who is having a seizure. Which of the following actions should the nurse take? (Select all that apply.) Assess the client's airway patency. Place a tongue depressor in the client's mouth. Remove objects from the client's bed. Place the client in a side-lying position. Restrain the client.
Assess the client's airway patency. Remove objects from the client's bed. Place the client in a side-lying position.
A nurse is providing teaching for a client who has a new diagnosis of hypertension and a new prescription for spironolactone 25 mg/day. Which of the following statements by the client indicates an understanding of the teaching? A. "I should eat a lot of fruits and vegetables, especially bananas and potatoes." B. "I will report any changes in heart rate to my provider." C. "I should replace the salt shaker on my table with a salt substitute." D. "I will decrease the dose of this medication when I no longer have headaches and facial redness."
B. "I will report any changes in heart rate to my provider."
A nurse is teaching a client who has a history of psoriasis about photochemotherapy and ultraviolet light (PUVA) treatments. Which of the following instructions should the nurse include in the teaching? A. Apply vitamin A cream before each treatment. B. Administer a psoralen medication before the treatment. C. Use this treatment every evening. D. Remove the scales gently following each treatment.
B. Administer a psoralen medication before the treatment.
A nurse caring for a client who has contact dermatitis and has a new prescription for diphenhydramine. For which of the following adverse effects should the nurse monitor? A. Elevated blood glucose levels B. Anorexia C. Increased salivation D. Insomnia
B. Anorexia
A nurse is caring for a client who has chronic venous insufficiency and a prescription for thigh-high compression stockings. Which of the following actions should the nurse take? A. Elevate the client's legs for 10 min, two to three times daily while wearing stockings. B. Apply the stockings in the morning upon awakening and before getting out of bed. C. Roll the stockings down to the knees to relieve discomfort on the legs. D. Remove the stockings while out of bed for 1 hr. four times a day, to allow the legs to rest.
B. Apply the stockings in the morning upon awakening and before getting out of bed.
A nurse is caring for a client who has heart failure and reports increased shortness of breath. Which of the following actions should the nurse take first? A. Obtain the client's weight. B. Assist the client into high-Fowler's position. C. Auscultate lungs sounds. D. Check oxygen saturation with pulse oximeter.
B. Assist the client into high-Fowler's position.
A nurse is educating a client on the use of calcipotriene topical medication for the treatment of psoriasis. Which of the following laboratory values should the nurse monitor? A. Potassium B. Calcium C. Sodium D. Chloride
B. Calcium (Hypercalcemia is an adverse effect of calcipotriene)
A nurse is screening a client for hypertension. The nurse should identify that which of the following actions by the client increase the risk for hypertension? (Select all that apply) A. Drinking 8 oz nonfat milk daily B. Eating popcorn at the movie theater C. Walking 1 mile daily at 12 min/mile pace D. Consuming 36 oz beer daily E. Getting a massage once a week.
B. Eating popcorn at the movie theater D. Consuming 36 oz beer daily
A 73-YEAR-OLD MAN WITH DEMENTIA HAS AVENOUS ULCER RELATED TO CHRONIC VENOUS INSUFFICIENCY. THE NURSE SHOULD PROVIDE EDUCATION ON WHICH TYPE OF DIET FOR THISPATIENT AND HIS CAREGIVER? A. Low-fat diet B. High-protein diet C. Calorie-restricted diet D. High-carbohydrate diet
B. High-protein diet (Nutrients for healing)
A nurse is assessing a client for manifestations of Parkinson's disease. Which of the following are expected findings? (Select all that apply.) A. Decreased vision B. Pill-rolling tremor of the fingers C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression
B. Pill-rolling tremor of the fingers C. Shuffling gait D. Drooling F. Lack of facial expression
A nurse is caring for a client who has left homonymous hemianopsia. Which of the following is an appropriate nursing intervention? A. Teach the client to scan to the right to see objects on the right side of the body. B. Place the bedside table on the right side of the bed. C. Orient the client to the food on the plate using the clock method. D. Place the wheelchair on the client's left side.
B. Place the bedside table on the right side of the bed.
2. A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson's disease. Which of the following actions should the nurse include? (Select all that apply.) A. Provide three large balanced meals daily. B. Record diet and fluid intake daily. C. Document weight every other week. D. Offer cold fluids such as milkshakes. E. Offer nutritional supplements between meals.
B. Record diet and fluid intake daily. D. Offer cold fluids such as milkshakes. E. Offer nutritional supplements between meals.
When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? A. Broiled fish B. Roasted duck C. Roasted turkey D. Baked chicken breast
B. Roasted duck (greasy meat)
___ is released by the ventricles in response to increased blood volume and ventricular wall stretching
BNP
___ nerve cells sense changes in BP and send this information to the vasomotor centers in the brainstem
Baroreceptor
What part of the brain is overstimulated by acetylcholine in Parkinsons?
Basal Ganglia
What do ACE inhibitors do?
Block conversion of angiotensin I to angiotensin II
A nurse is assessing a client who has Parkinson's disease. Which of the following manifestations should the nurse expect? Pruritus Hypertension Bradykinesia Xerostomia
Bradykinesia (difficulty moving in a client who has Parkinson's disease)
The nurse teaches a 28-year-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which statement by the patient requires additional education? A. "I will avoid adding salt to my food during or after cooking." B. "If I lose weight, I might not need to continue taking medications." C. "I can lower my blood pressure by switching to smokeless tobacco." D. "Diet changes can be as effective as taking blood pressure medications."
C. "I can lower my blood pressure by switching to smokeless tobacco."
A nurse is talking with a client who has class I heart failure and asks about obtaining a ventricular assist device (VAD). Which of the following statement should the nurse make? A. "VADS are only implanted during heart transplantation." B. "A VAD helps to pace the heart." C. "VADS are used when heart failure is not responsive to medications." D. "A VAD is useful for clients who also have a chronic lung issue."
C. "VADS are used when heart failure is not responsive to medications."
A nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. Which of the following statements should the nurse include in the teaching? A. "It is safe to use microwaves that are 1,200 watts or less.". B. "You should avoid the use of CT scans with contrast.". C. "You should place a magnet over the implantable device when you feel an aura occurring." D. "It is recommended that diathermy for pain management." you use ultrasound
C. "You should place a magnet over the implantable device when you feel an aura occurring."
A nurse is assessing a client. Which of the following findings indicates that the client has experienced a left-hemispheric stroke? A. Impulse control difficulty B. Poor judgment C. Inability to recognize familiar objects D. Loss of depth perception
C. Inability to recognize familiar objects
A nurse is caring for a client who is admitted to the emergency department with a blood pressure of 266/147 mm Hg. The client reports a headache and double vision. The client states, "I ran out of my diltiazem 3 days ago, and I am unable to purchase more." Which of the following actions should the nurse take first? A. Administer acetaminophen for headache. B. Provide teaching regarding the importance of not abruptly stopping an antihypertensive. C. Obtain IV access and prepare to administer an IV antihypertensive. D. Call social services for a referral for financial assistance in obtaining prescribed medication.
C. Obtain IV access and prepare to administer an IV antihypertensive.
A nurse is providing teaching to the guardian of a child who has contact dermatitis. Which of the following information should the nurse include? A. Use fabric softener dryer sheets when drying the child's clothing. B. Apply a warm, dry compress to the rash area. C. Place the child in a bath with colloidal oatmeal. D. Leave the child's hands uncovered during the night.
C. Place the child in a bath with colloidal oatmeal.
A nurse is caring for a client who displays manifestations of stage III Parkinson's disease. Which of the following actions should the nurse include? A. Recommend a community support group. B. Integrate a daily exercise routine. C. Provide a walker for ambulation. D. Perform ADLs for the client.
C. Provide a walker for ambulation.
A nurse is providing discharge instructions to a client who has a prescription for phenytoin. Which of the following information should the nurse include? A. Consider taking an antacid when on this medication. B. Watch for receding gums when taking the medication. C. Take the medication at the same time every day. D. Provide a urine sample to determine therapeutic levels of the medication.
C. Take the medication at the same time every day.
A nurse in an urgent care clinic is obtaining a history from a client who has type 2 diabetes mellitus and a recent diagnosis of hypertension. This is the second time in 2 weeks that the client experienced hypoglycemia. Which of the following client data should the nurse report to the provider? A. Takes psyllium daily as a fiber laxative B. Drinks skim milk daily as a bedtime snack C. Takes metoprolol daily after meals D. Drinks grapefruit juice daily with breakfast
C. Takes metoprolol daily after meals
___ increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular calcium into cells.
Calcium channel blockers (CCB)
A nurse who is off duty finds a woman who has collapsed and has right-sided weakness and slurred speech. Which of the following actions should the nurse take? Obtain the telephone number of the client's provider. Find a location for the client to sit. Call emergency services. Drive the client to the nearest emergency department.
Call emergency services.
Examples of atypical parkinsonism causes
Carbon monoxide expose, medications such as Reglan/Haldol, meth use
Describe B stage Heart Failure
Cardiac structural abnormalities or remodeling but no manifestations of heart failure
What is released from nicotine that increases HR, BP, peripheral vasoconstriction, increase LDL levels?
Catecholemine
primary vs precipitating causes of heart failure
Causes are the primary condition or disease process leading to the development of HF. Precipitants are triggers or contributing factors for decompensation in patients with established chronic heart disease
What age group is most likely to have absence seizures?
Children
What are some causes of secondary hypertension?
Cirrhosis, oral contraceptives', Cushing's disease, pregnancy, renal disease, sleep apnea
What is the term used to describe Parkinsons ridigity?
Cogwheel rigidity
What temperature should a pt with increased intracranial pressure (ICP) following a closed-head injury be?
Cold A client who has increased ICP can develop a fever in response to systemic trauma, the presence of blood in the cranium, infection, or as a generalized inflammatory response to the brain injury. Therapeutic cooling is often initiated, even in the absence of fever, in order to slow the brain's metabolism and prevent secondary brain injury.
___ is a condition characterized by chronic ischemic rest pain lasting more than 2 weeks, nonheal- ing arterial leg ulcers, or gangrene of the leg from PAD. Patients with PAD who have diabetes, heart failure (HF), and a history of a stroke are at increased risk for CLI.3
Critical limb ischemia (CLI)
Describe C stage Heart Failure
Current or prior manifestations of heart failure
T/F: Actions, such as deep breathing, coughing, and blowing the nose, can increase ICP
True A client who has increased ICP is at risk for brain herniation, a potentially life-threatening condition
A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. Teach the client to walk more quickly when ambulating. B. Complete passive range-of-motion exercises daily. C. Place the client on a low-protein, low-calorie diet. D. Give the client extra time to perform activities.
D. Give the client extra time to perform activities.
A nurse is assessing a client who has chronic peripheral arterial disease (PAD). Which of the following findings should the nurse expect? A. Edema around the ankles and feet B. Ulceration around the medial malleoli C. Scaling eczema of the lower legs with stasis dermatitis D. Pallor on elevation of the limbs, and rubor when the limbs are dependent
D. Pallor on elevation of the limbs, and rubor when the limbs are dependent
A nurse is teaching a client who has a new diagnosis of severe peripheral arterial disease. Which of the following instructions should the nurse include? A. Wear tightly-fitted insulated socks with shoes when going outside. B. Elevate both legs above the heart when resting. C. Apply a heating pad to both legs for comfort. D. Place both legs in dependent position while sleeping.
D. Place both legs in dependent position while sleeping.
After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of108/minute. What should the nurse suspect is happening? A. Chronic obstructive pulmonary disease B. Chronic HF C. Left-sided HF D. Right-sided HF
D. Right-sided HF
Why is a pts HOB elevated 30 degrees post stroke?
Decrease ICP Promote venous drainage
Why do pts with CHF often have anemia?
Decreased blood flow to kidneys means decreased production of erythropoietin
___ decrease the BP by relaxing the vascular smooth muscle and reducing SVR.
Direct vasodilators
What is usually the first drug ordered for treatment of HTN?
Diuretic
___ promote sodium and water excretion, reduce plasma volume, and reduce the vascular response to catecholamines.
Diuretics
What neurotransmitters are imbalanced in Parkinsons?
Dopamine and acetylcholine
A nurse is assessing the reflexes of a client who has an unrepaired femur fracture and has suddenly become stuporous. For which of the following findings should the nurse identify that the client exhibits Babinski's sign? Pinpoint pupils Jerking contractions of the head and neck Pronation of the arms Dorsiflexion of the great toe
Dorsiflexion of the great toe Dorsiflexion of the great toe and fanning of the other toes when the plantar reflex is assessed is an indication of a Babinski's sign, an abnormal response that indicates CNS pathology.
A nurse is caring for a client who has increased intracranial pressure. Which of the following interventions should the nurse take? Teach controlled coughing and deep breathing. Provide a brightly lit environment. Elevate the head of the bed. Encourage a minimum intake of 2000 mL (67.6 oz) of clear fluids per day.
Elevate the head of the bed.
A nurse is instructing a client's family members about feeding safety for a client who has dysphagia following a stroke. Which of the following instructions should the nurse include? Encourage brief exercise before meals to promote appetite. Place food in the affected side of the mouth. Encourage the client to take small bites. Place the client with the head reclined back to facilitate swallowing.
Encourage the client to take small bites. The family members should encourage the client to take small bites and chew food thoroughly in order to prevent choking.
What is the relationship between the endothelium and CAD?
Endothelium loses its ability to heal itself. Instead the smooth muscle thickens and proliferates
What does psoralen medication do?
Enhances photosensitivity
What is paroxysmal nocturnal dyspnea?
Episodes of sudden dyspnea and orthopnea that awaken the patient from sleep
A nurse at a rehabilitation center is planning care for a client who had a left hemispheric cerebrovascular accident (CVA) 3 weeks ago. Which of the following goals should the nurse include in the client's rehabilitation program? Establish the ability to communicate effectively. Compensate for loss of depth perception. Learn to control impulsive behavior. Improve left-side motor function.
Establish the ability to communicate effectively. A CVA is an interruption of the blood supply to any part of the brain, resulting in damaged brain tissue. The left hemisphere is usually dominant for language. Because this client had a left-side CVA, the nurse should anticipate the client will have some degree of aphasia and will require speech therapy to establish communication.
What type of blood pressure dysfunction is expected in Parkinsons?
Orthostatic hypotension
What is stasis dermatitis?
Stasis dermatitis occurs with venous insufficiency and valvular incompetency. The proximal skin appears thin and brown, and may occur with distal macules, papules, red irritation, skin thickening and edema.
T/F: You should apply an oxygen face mask for oxygen administration on a seizing pt
False The nurse should avoid placing anything on the client during a seizure due to the risk for injury. During the postictal phase the nurse should assess the client's oxygenation status and administer supplemental oxygen if necessary.
T/F: Phenytoin cannot be taken with food
False, Phenytoin is a gastric irritant. It should be given with or immediately after a meal to decrease gastric upset.
T/F: Diastolic BP rises progressively with age
False, SYSTOLIC does
T/F: Rest pain from PVD is alleviated with limb elevation
False, makes pain WORSE.
fluent vs non-fluent aphasia
Fluent: speech is present but has little meaningful communication Non-fluent: minimal speech activity with slow speech that requires obvious effort
Describe the FITT formula for preventing CAD
Frequency - How often you perform physical activity Intensity - How hard you perform physical activity ] Time - how long you perform physical activity Type - What kind of physical activity
Are HDLs good or bad?
GOOD; H= HAPPY
What are 2 noteable side effects of phenytonin?
Gingival sensitivity, hirsutism
What kinds of strokes are most likely to have increased ICP
Hemorrhagic
A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after stating she had a sudden, severe headache and vomiting. The client's vital signs are as follows: blood pressure of 198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2° C (100.8° F). Which of the following neurologic disorders should the nurse suspect? Transient ischemic attack (TIA) Hemorrhagic stroke Thrombotic stroke Embolic stroke
Hemorrhagic stroke A client who has a hemorrhagic stroke often experiences a sudden onset of symptoms including sudden onset of a severe headache, a decrease in the level of consciousness, and seizures. Hemorrhagic strokes occur when bleeding occurs in the brain caused by the rupture of an aneurysm or arteriovenous malformation, hypertension and atherosclerosis, or trauma.
Describe A stage Heart Failure
High Risk for Developing heart failure
What medications should not be taken with phenytoin?
Hormonal Birth control (reduces BC effectiveness) Warfarin (decreases absorption and increased oral medications metabolism)
Hypertensive emergency vs. hypertensive urgency
Hypertensive emergency --> symptoms/signs of end organ damage (brain hemorrhage, dissecting AAA. MI) Hypertensive urgency --> no symptoms/signs of end organ damage (stable angina, prior MI, CHF)
Why are IV solutions with glucose and water not recommended for pts with acute strokes?
Hypotonic, can exacerbate cerebral edema
CHF swelling in left vs right sided heart failure
In left-sided heart failure, the left side of the heart is weakened and results in reduced ability for the heart to pump blood into the body *L*eft = *L*ungs In right-sided heart failure, the right side of the heart is weakened and results in fluid in your veins, causing swelling in the legs, ankles, and liver.
A nurse is caring for a client who who has had a stroke involving the right hemisphere. Which of the following alterations in function should the nurse expect? Difficulty reading Inability to recognize his family members Right hemiparesis Aphasia
Inability to recognize his family members The right hemisphere is involved with visual and spatial awareness. A client who is unable to recognize faces would have involvement with the right hemisphere.
what is ridigity?
Increased muscle tone with Parkinsons
Digoxin is an example of what kind of medication?
Inotropic
A nurse is caring for a client who had a stroke involving the left cerebral hemisphere. The nurse should monitor for which of the following findings? Impaired sense of humor Loss of depth perception Poor judgment Intellectual impairment
Intellectual impairment A client who had a stroke involving the left cerebral hemisphere is likely to have deficits that involve language, mathematical skills, and thinking.
___ is a classic symptom of PVD
Intermittent claudication
What does "tonic" mean?
Stiffening of muscles
What diet may be beneficial for pts with seizure disorders?
Ketogenic diet (high fat-low carb)
A ___ sided stroke is more likely to exhibit cautious behavior
Left
What is the most common cause of right sided heart failure?
Left sided heart failure
What chamber of the heart compensates for HTN?
Left ventricle (LVH)
what is a normal cholesterol level?
Less than 200 mg/dL
What does the DASH diet consist of?
Less: saturated fat, cholesterol, sugar, red meat More: fruits, vegetables, low-fat dairy, whole grains, fish, poultry, nuts, and foods rich in Mg, Ca, K, protein, and fiber
A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? Piperacillin/tazobactam Levothyroxine Levodopa/carbidopa Carbamazepine
Levodopa/carbidopa
What 3 types of meds are commonly used for PAD treatment?
Lipid management drugs ACE inhibitors Antiplatelet agents
What is apraxia?
Loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements
Why should BP be slowly lowered medically even in hypertensive emergencies?
Lowering too fast can cause loss of cerebral/renal/coronary perfusion
What type of test is used to dx ischemic stroke?
MRI
___ are enlarged, twisted, and superficial veins that can occur in any part of the body; however, they are commonly observed in the lower extremities and in the esophagus.
Varicose veins
A nurse is caring for a client who is experiencing Cushing's Triad following a subdural hematoma. Which of the following medications should the nurse plan to administer? Albumin 25% Dextran 70 Hydroxyethyl glucose Mannitol 25%
Mannitol 25% Cushing's Triad is an indication that the client is experiencing increased intracranial pressure. The nurse should administer mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema.
A nurse is caring for a client who has a traumatic head injury and is exhibiting signs of increasing intracranial pressure. Which of the following medications should the nurse plan to administer? Albumin 25% Dextran 70 Hydroxyethyl glucose Mannitol 25%
Mannitol 25% The nurse should plan to administer mannitol 25%, an osmotic diuretic that lowers intracranial pressure by promoting diuresis.
___ refers to a cluster of risk factors for CAD whose underlying pathophysiology may be related to insulin resistance
Metabolic syndrome
___ lesions are distinct and appear as red, scaling papules that merge to form plaques. The affected area is normally rounded, with adherent silver scales that bleed easily when removed. Plaques are common on the knees, elbows, scalp, hands, feet, and lower back. They are often pruritic and may be painful. Clinical presentation varies
Psoriasis
Are pts aware of generalized onset seizures?
No, impaired awareness from seconds to minutes
A nurse is shopping and finds a woman who has collapsed with right-sided weakness and slurred speech. Which of the following action should the nurse take? Provide the client with water to test the gag reflex. Perform carotid massage. Notify emergency management services. Drive the client to the nearest medical facility.
Notify emergency management services.
A nurse working on a medical unit is caring for a client who is prescribed seizure precautions. Which of the following interventions should the nurse include in the client's plan of care? Obtain IV access. Keep the lights on when the client is sleeping. Place the client's bed in the high position. Keep a padded tongue blade available at the client's bedside.
Obtain IV access.
What is cardiogenic shock?
Occurs when the heart is damaged and unable to supply sufficient blood to the body
peripheral artery disease vs atherosclerosis
Organic PVD refers to the blockage of blood vessels, most commonly caused by atherosclerosis. Atherosclerosis is a buildup of fat, cholesterol, and other substances in the bloodstream that results in narrowing or blockage of artery walls which can cause PVD
What is a common side effect of HTN drugs?
Orthostatic hypotension
What disease is indicative of femoral and aortic bruits?
PAD
Will capillary refill >3 seconds be seen in peripheral artery disease or venous disease?
PAD
Will cool peripheral extremity temperature be seen in peripheral artery disease or venous disease?
PAD
Will decreased or absent peripheral pulses be seen in peripheral artery disease or venous disease?
PAD
Will thickened, brittle nails be seen in peripheral artery disease or venous disease?
PAD
Will ulcers on the tips of toes, foot, and LATERAL malleolus be seen in peripheral artery disease or venous disease?
PAD
Will ulcers that are round, smooth, and have a "punched out" apperance be seen in peripheral artery disease or venous disease?
PAD
Will ulcers with black eschar or pale granulation be seen in peripheral artery disease or venous disease?
PAD
PAD vs PVD
PAD: arteries can't pump blood away from heart, claudication and necrosis PVD: veins can't bring blood back to the heart, swelling and pooling
A nurse is assessing a client who has ataxia. Which of the following actions should the nurse take to evaluate the client's ability to safely ambulate? Observe for the presence of Kernig's sign. Perform a Romberg's test. Check the function of cranial nerve V. Inspect for the presence of clubbing.
Perform a Romberg's test. The nurse should perform a Romberg's test to check the client's ability to maintain an upright position without swaying when standing with feet close together, with eyes open and with eyes closed. The nurse must stand close enough to prevent the client from falling.
A nurse enters a client's room and finds him on the floor in the clonic phase of a tonic-clonic seizure. Which of the following actions should the nurse take? Insert a padded tongue blade into the client's mouth. Place a pillow under the client's head. Gently restrain the client's extremities. Apply a face mask for oxygen administration.
Place a pillow under the client's head.
Describe Class IV Heart Failure
Pt has manifestations at rest
Describe Class III Heart Failure
Pt has manifestations with minimal exertions
A nurse is caring for a client who had a stroke involving the right cerebral hemisphere. The nurse should monitor for which of the following findings? Poor impulse control Unable to discriminate words and letters Deficits in the right visual field Motor retardation
Poor impulse control A client who had a stroke involving the right cerebral hemisphere is likely to have personality changes, which can include impulsiveness, confabulation, and poor judgment.
A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take? Attempt to stop the seizure. Restrain the child's arms. Use a padded tongue blade. Position the child laterally.
Position the child laterally.
A nurse is caring for a child who is having a tonic-clonic seizure and vomiting. Which of the following actions is the nurse's priority? Place a pillow under the child's head. Position the child side-lying. Loosen restrictive clothing. Clear the area of hazards.
Position the child side-lying.
Describe Class II Heart Failure
Pt has manifestations with ordinary exertions
Primary vs. secondary hypertension
Primary: No identifiable cause. Chronic and progressive. Will continue to increase without treatment. Most common cause of HTN (90-95% of people) Secondary: Identifiable cause and fixing problem will fix high BP. Ex: Tumor causing increase in hormone that increases BP.
What food decreases levodopa carbidobas absorption?
Protein
A nurse is teaching a client who has a new diagnosis of atrial fibrillation. The nurse should instruct the client to monitor for which of the following complications? Bradycardia Pulmonary embolism Peripheral vascular disease Hypertension
Pulmonary embolism Altered atrial contractions can cause blood pooling and thrombus formation. The client is at risk for developing a pulmonary embolism or embolic stroke. The client should monitor and report immediately manifestations, such as shortness of breath, or neurological changes.
What do calcium channel blockers do?
Vasodilation of arteries and decrease heart rate
Which are harder to heal- arterial or venous ulcers?
Venous
A nurse is creating a plan of care for a client who has a history of tonic-clonic seizure disorder. Which of the following interventions should the nurse include? (Select all that apply.) Provide a suction setup at the bedside. Elevate the side rails near the head when the client is in bed. Place the bed in the lowest position. Keep an oxygen setup at the bedside. Furnish restraints at the bedside.
Provide a suction setup at the bedside. Elevate the side rails near the head when the client is in bed. Place the bed in the lowest position. Keep an oxygen setup at the bedside.
A nurse is providing teaching to the family of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching? Provide client supervision. Limit client physical activity. Speak loudly to the client. Leave the television on continuously.
Provide client supervision.
FLAG A nurse is assessing a client who has a traumatic head injury to determine motor function response. Which of the following client responses to painful stimulus is expected? Pushes the painful stimulus away Extends her body toward the painful stimulus Shows no reaction to the painful stimulus Flexes the upper and extends the lower extremities in response to the painful stimulus
Pushes the painful stimulus away
What happens in the postictal prodromal phase?
Recovery period after seizure
What is dependent rubor?
Redness of extremities seen in PAD
Describe D stage Heart Failure
Refractory end stage heart failure
A nurse caring for a client who had a right-sided stroke and is exhibiting homonymous hemianopsia when eating. Which of the following actions should the nurse take? Provide a nonskid mat to alleviate plate movement. Encourage the client to use his right hand when feeding himself. Remind the client to look for food on the left side of the tray. Encourage the use of the wide grip utensils.
Remind the client to look for food on the left side of the tray. The nurse's action to remind the client to look for food on the left side of the tray will train the client to scan the tray by moving his head and eyes, which will help to resolve the problem of homonymous hemianopsia.
What are automatisms?
Repetitive, nonpurposeful activities Lip smacking, grimacing, patting/rubbing clothing Common feature of complex partial seizures
What causes "rest pain" in PVD and why is it worse at night?
Rest pain occurs when blood flow is insufficient to meet basic metabolic requirements of the distal tissue and occurs more often at night because cardiac output tends to drop during sleep and the limbs are at the level of the heart
A ___ sided stroke is more likely to exhibit impulsive behavior
Right
A ___ sided stroke is more likely to have problems with spatial perceptual orientation
Right
hepatomegaly occurs from what sided heart failure?
Right
What heart sounds are heard in pulmonary edema?
S3 and S4
What nervous system regulates BP?
SNS
___ hypertension is related to hypertensive crisis
Secondary
___ are obtained using Doppler ultrasound and a sphygmomanometer at the thigh, below the knee, and at ankle level while the patient is supine. A drop of BP of greater than 30 mm Hg suggests PAD.
Segmental BPs
What happens in the seizure prodromal phase?
Sensation/behavior changes preceding a seizure by hours/days
A nurse is assessing a client who has a concussion from a sports injury. Which of the following manifestations should the nurse expect? Loss of consciousness lasting 30 to 60 min Glasgow Coma Scale score of 11 Nuchal rigidity Sensitivity to light
Sensitivity to light
What happens in the seizure aural phase?
Sensory warning that is similar each time a seizure occurs
A nurse is caring for a 2-year-old child who has seizures and is receiving phenytoin in suspension form. Which of the following actions should the nurse take before administering each dose? Shake the container vigorously. Be sure the child has not eaten within the hour. Perform mouth care. Check the child's blood pressure.
Shake the container vigorously. A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension because the child can be under-medicated if the medication is not evenly distributed.
What is festinating gait?
Short, fast steps with shuffling
A nurse in the emergency department is caring for a client who sustained a head injury. The nurse notes the client's IV fluids are infusing at 125 mL/hr. Which of the following is an appropriate action by the nurse? Slow the rate to 20 mL/hr. Continue the rate at 125 mL/hr. Slow the rate to 50 mL/hr. Increase the rate to 250 mL/hr.
Slow the rate to 50 mL/hr. The nurse should decrease the rate to 50 mL/hr to minimize cerebral edema and prevent increased intracranial pressure.
Kidneys contribute to BP regulation by controlling ___ and ___
Sodium excretion, ECF
A nurse is caring for a client who has global aphasia. Which of the following actions should the nurse take? Speak to the client about one idea at a time. Ask the client to multi-task. Limit questions to yes and no answers. Focus on a single form of communication.
Speak to the client about one idea at a time. The nurse should speak using sentences that contain one clear thought or idea for better communication and understanding.
What is amaurosis fugax?
Sudden, transient loss of vision in one or both eyes
A nurse is caring for a client following a CVA and observes the client experiencing severe dysphagia. The nurse notifies the provider. Which of the following nutritional therapies will likely be prescribed? NPO until dysphagia subsides Supplements via nasogastric tube Initiation of total parenteral nutrition Soft residue diet
Supplements via nasogastric tube
What is stage 1 HTN?
Systolic: 130-139 Diastolic: 80-89
What is stage 2 HTN?
Systolic: >140 Diastolic: >90
A nurse is assessing a client who sustained a basal skull fracture and notes a thin stream of clear drainage coming from the client's right nostril. Which of the following actions should the nurse take first? Test the drainage for glucose. Suction the nostril. Notify the physician. Ask the client to blow his nose.
Test the drainage for glucose. This is the priority nursing action. Because of the high risk of cerebral spinal fluid (CSF) leak in clients with basal skull fractures, the nurse should realize there is a possibility that the clear fluid coming from the client's nostril is CSF, which will test positive for glucose.
___ is a PAD screening tool. It is done using a hand-held Doppler and is calculated by dividing the ankle systolic BPS (SBPs) by the higher of the left and right brachial SBPS.
The ankle-brachial index (ABI)
What is RAAS?
The renin-angiotensin-aldosterone system (RAAS) is a homeostatic feedback circuit that maintains adequate blood pressure and volume.
How do limbs look with PAD?
Thin, shiny, taut, loss of hair on legs, decreased pedal pulses, foot pallor
A nurse is receiving a transfer report for a client who has a head injury. The client has a Glasgow Coma Scale (GCS) score of 3 for eye opening, 5 for best verbal response, and 5 for best motor response. Which of the following is an appropriate conclusion based on this data? The client can follow simple motor commands. The client is unable to make vocal sound. The client is unconscious. The client opens his eyes when spoken to.
The client opens his eyes when spoken to. A GCS of 3-5-5 indicates that the client opens his eyes in response to speech, is oriented, and is able to localize pain.
What is cerebral autoregulation?
The mechanism by which the brain protects itself from changes in MAP by vasodilation and constriction.
What kind of stimulus should a client who has increased intracranial pressure have?
The nurse should provide the client with a nonstimulating environment to limit the risk of seizure activity.
What kind of stroke is preceded by a TIA?
Thrombotic
Thrombotic stroke vs. embolic stroke
Thrombotic strokes are caused by a blood clot (thrombus) in an artery going to the brain from an injury to blood vessel wall and when inflamed, causes infarction Embolic strokes occur when a clot that's formed elsewhere (usually in the heart or neck arteries) travels in the blood stream and clogs a blood vessel in or leading to the brain
A nurse is in a client's room when the client begins having a tonic-clonic seizure. Which of the following actions should the nurse take first? Turn the client's head to the side. Check the client's motor strength. Loosen the clothing around the client's waist. Document the time the seizure began.
Turn the client's head to the side. The first action the nurse should take when using the airway, breathing, circulation approach to client care is to turn the client's head to the side. This action keeps the client's airway clear of secretion to prevent aspiration.
A nurse is caring for a client who has increased intracranial pressure (ICP) following a closed-head injury. Which of the following actions should the nurse take? Instruct the client to cough and deep breathe. Place the client in a supine position. Place a warming blanket on the client. Use log rolling to reposition the client.
Use log rolling to reposition the client.
Will lower leg edema be seen in peripheral artery disease or venous disease?
VD
Will puritis be seen in peripheral artery disease or venous disease?
VD
Will ulcers near MEDIAL malleolus be seen in peripheral artery disease or venous disease?
VD
Will ulcers with a moderate to large amount of drainage be seen in peripheral artery disease or venous disease?
VD
Will ulcers with yellow slough or dark red "ruddy" granulation be seen in peripheral artery disease or venous disease?
VD
___ occurs secondary to incompetent valves in the deeper veins of the lower extremities, which allows pooling of blood and dilation of the veins. Inability to carry fluid and wastes from the lower extremities precipitates the development of swelling, venous stasis ulcers, and in advanced cases, cellulitis.
Venous insufficiency
What is paradoxical intoxication seen in Parkinsons drugs?
Worsen rather than treat sx
A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Drug therapy will be needed because the BP is still not at goal. b. BP monitoring should continue for 3 months to confirm a diagnosis of hypertension. c. Lifestyle changes are less important since they were not effective, and drugs will be started. d. More changes in the patient's lifestyle are needed for a longer time before starting drug therapy.
a. Drug therapy will be needed because the BP is still not at goal.
A patient is admitted to the hospital in a hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategies would be most appropriate for this patient? (select all that apply) a. Measuring hourly urine output b. Continuous BP monitoring with an arterial line c. Decreasing the MAP by 50% within the first hour d. Maintaining bed rest and giving tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status
a. Measuring hourly urine output b. Continuous BP monitoring with an arterial line e. Assessing the patient for signs and symptoms of heart failure and changes in mental status
A patient with chronic heart failure and atrial fibrillation is treated with low-dose digitalis and a loop diuretic. What does the nurse need to do to prevent complications of this drug combination? (select all that apply) a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate. c. Withhold digitalis if pulse rhythm is irregular. d. Keep an accurate measure of intake and output. e. Teach the patient about dietary potassium restrictions.
a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate.
A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. What should be the nurse's initial action? a. Notify the HCP of the change in perfusion. b. Start anticoagulant therapy with IV heparin. c. Elevate the leg to improve the venous return. d. Position the patient in reverse Trendelenburg.
a. Notify the HCP of the change in perfusion.
Which BP-regulating mechanism(s) can result in the development of hypertension if defective? (select all that apply) a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the parasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system
a. Release of norepinephrine c. Stimulation of the sympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system
Which statements accurately describe heart failure with preserved ejection fraction (HFPEF)? (select all that apply) a. Uncontrolled hypertension is the primary cause. b. Left ventricular ejection fraction may be within normal c. The pathophysiology involves ventricular relaxation and limits filling. d. Multiple evidence-based therapies have been shown to decrease mortality. e. Therapies focus on symptom control and treatment of underlying conditions.
a. Uncontrolled hypertension is the primary cause. b. Left ventricular ejection fraction may be within normal c. The pathophysiology involves ventricular relaxation and limits filling. e. Therapies focus on symptom control and treatment of underlying conditions.
Common psychosocial problems a patient may have post stroke include (select all that apply) a. depression. b. disassociation. c. sleep problems. d. intellectualization e. denial of severity of stroke.
a. depression. c. sleep problems. e. denial of severity of stroke.
What is the Bobath method?
approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system
When is the function of cranial nerve V assessed?
assess sensory nerve function of the face
What is the major cause of CAD?
atherosclerosis
THE NURSE TEACHES A PATIENT WITH PERIPHERALARTERIAL DISEASE. THE NURSE DETERMINES THAT FURTHER TEACHING IS NEEDED IF THE PATIENT MAKES WHICH STATEMENT? a. "I should not use heating pads to warm my feet." b. "I should cut back on my walks if it causes pain in my legs." c. "I will examine my feet everyday for any sores or red areas." d. "I can quit smoking if I use nicotine gum and a support group."
b. "I should cut back on my walks if it causes pain in my legs."
After teaching about ways to decrease risk factors for CAD, the nurse recognizes that further instruction is needed when the patient says a. "I can keep my blood pressure normal with medication." b. "I would like to add weight lifting to my exercise program." c. "I can change my diet to decrease my intake of saturated fats." d. "I will change my lifestyle to reduce activities that increase my stress"
b. "I would like to add weight lifting to my exercise program."
Which patient has the highest risk for a having a stroke? a. An obese 45-yr-old Native American. b. A 65-yr-old black man with hypertension c. A 35-yr-old Asian American woman who smokes. d. A 32-yr-old white woman taking oral contraceptives.
b. A 65-yr-old black man with hypertension
When teaching a patient about rest pain with PAD, what should the nurse explain as the cause of the pain? a. Vasospasm of cutaneous arteries in the feet. b. Decrease in blood flow to the nerves of the feet. c. Increase in retrograde venous perfusion to the lower legs. d. Constriction in blood flow to leg muscles during exercise.
b. Decrease in blood flow to the nerves of the feet.
While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is a. A low-calcium diet. b. Excess alcohol intake. c. A family history of hypertension. d. Consumption of a high-protein diet.
b. Excess alcohol intake.
A 50-year-old woman who weighs 95 kg has a history of tobacco use, high blood pressure, high sodium intake, and sedentary life- style. Which is the most important risk factor for peripheral artery disease (PAD) to address in the nursing plan of care? a. Salt intake b. Tobacco use c. Excess weight d. Sedentary lifestyle
b. Tobacco use
In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply) a. diffuse involvement of plaque formation in coronary veins. b. abnormal levels of cholesterol, especially low-density lipoproteins. c. accumulation of lipid and fibrous tissue within the coronary arteries. d. development of angina due to a decreased blood supply to the heart muscle. e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm.
b. abnormal levels of cholesterol, especially low-density lipoproteins. c. accumulation of lipid and fibrous tissue within the coronary arteries. d. development of angina due to a decreased blood supply to the heart muscle.
Bladder training in a male patient who has urinary incontinence after a stroke includes a. limiting fluid intake. b. helping the patient to stand to void. c. keeping a urinal in place at all times. d. catheterizing the patient every 4 hours.
b. helping the patient to stand to void.
During the assessment of a patient, you note an area of red, sharply defined plaques covered with silvery scales that are mildly itchy on the patient's knees and elbows. You would describe this finding as a. lentigo. b. psoriasis. c. actinic keratosis. d. seborrheic keratosis.
b. psoriasis.
In teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell the patient that (select all that apply) a. the cream form is the most efficient system of delivery. b. short-term use of topical corticosteroids usually does not cause systemic side effects. c. use a glove to apply small amounts of creams or ointments to prevent further infection. d. abruptly stopping the use of topical corticosteroids may cause the dermatitis to reappear. e. systemic side effects from topical corticosteroids are likely if the patient is malnourished.
b. short-term use of topical corticosteroids usually does not cause systemic side effects. d. abruptly stopping the use of topical corticosteroids may cause the dermatitis to reappear.
For a patient who is suspected of having a stroke, the most important piece of information that the nurse can obtain is a. time of the patient's last meal. b. time at which stroke symptoms first appeared. c. patient's hypertension history and management. d. family history of stroke and other cardiovascular diseases.
b. time at which stroke symptoms first appeared.
The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says, a. "I should not eat any red meat such as beef, pork, or lamb." b. "I should have some type offish at least 3 times a week." c. "Most of my fat intake should be from olive oil or the oils in nuts." d. "If I reduce the fat in my diet to about 5% of my calories, I will be much healthier."
c. "Most of my fat intake should be from olive oil or the oils in nuts."
The nurse is caring for a patient with acute decompensated heart failure who is receiving IV dobutamine. Why would this drug be prescribed? (select all that apply) a. It dilates renal blood vessels. b. It will increase the heart rate. c. Heart contractility will improve. d. Dobutamine is a selective ẞ-agonist. e. It increases systemic vascular resistance.
c. Heart contractility will improve. d. Dobutamine is a selective ẞ-agonist.
A patient is having word finding difficulty and weakness in his right arm. What area of the brain is most likely involved? a. brainstem. b. vertebral artery. c. left middle cerebral artery. d. right middle cerebral artery.
c. left middle cerebral artery.
The nurse explains to the patient with a stroke who is scheduled for angiography that this test is used to determine the a. presence of increased ICP b. site and size of the infarction. c. patency of the cerebral blood vessels. d. presence of blood in the cerebrospinal fluid.
c. patency of the cerebral blood vessels.
A patient having TIAs is scheduled for a carotid endarterectomy. The nurse explains that this procedure is done to a. decrease cerebral edema. b. reduce the brain damage that occurs during a stroke in evolution. c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow. d. provide a circulatory bypass around thrombotic plaques obstructing cranial circulation.
c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow.
Why shouldnt HF pts take NSAIDs?
can contribute to sodium retention and HF exacerbation
Blood pressure= ___________ X ____________
cardiac output x systemic vascular resistance
Where are baroreceptors found?
carotid sinus and aortic arch
What does dromotropic mean?
conductivity of heart
Describe focal awareness seizures
conscious and alert but have unusual feelings, sensations, or unexplained emotions
In teaching a patient with hypertension about controlling the ill- ness, the nurse recognizes that a. All patients with elevated BP need drug therapy. b. Obese persons must achieve a normal weight to lower BP. c. It is not necessary to limit salt in the diet if taking a diuretic. d. Lifestyle modifications are needed for all persons with elevated BP.
d. Lifestyle modifications are needed for all persons with elevated BP.
What compensatory mechanism involved in both chronic heart failure and acute decompensated heart failure leads to fluid retention and edema? a. Ventricular dilation. b. Ventricular hypertrophy c. Increased systemic blood pressure d. Renin-angiotensin-aldosterone activation
d. Renin-angiotensin-aldosterone activation
A priority consideration in the management of the older adult with hypertension is to a. Prevent primary hypertension from converting to secondary hypertension. b. Recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult. c. Ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. d. Use precise technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.
d. Use precise technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.
The factor related to cerebral blood flow that most often determines the extent of cerebral damage from a stroke is the a. O2 content of the blood. b. amount of cardiac output. c. level of CO2 in the blood. d. degree of collateral circulation.
d. degree of collateral circulation.
A barrier to hospice referrals for patients with stage D heart failure is a. family member refusal. b. scarcity of hospice facilities. c. history of pacemaker placement. d. difficulty in estimating prognosis.
d. difficulty in estimating prognosis.
Information provided by the patient that would help distinguish a hemorrhagic stroke from a thrombotic stroke includes a. sensory changes. b. a history of hypertension. c. presence of motor weakness. d. sudden onset of severe headache.
d. sudden onset of severe headache.
What is the first med rx for HTN?
diuretics
What is xerostomia in Parkinsons disease?
dry mouth in a client who has Parkinson's disease.
Do embolic or thrombotic strokes have sudden onset?
embolic
What kind of stroke often occurs rapidly, giving little time to accommodate to an obstructed blood vessel with the development of collateral circulation, the patient is usually conscious, although they may have a headache?
embolic
Thrombotic vs embolic stroke:
embolic: clot travels to the brain from another part of the body thrombotic: clot develops in an artery
___ aphasia is inability to produce language
expressive
A client who ___ in response to to painful stimulus is manifesting increased intracranial pressure and is not displaying an expected response
extends her body toward the stimulus
