Med surg test 10
the nurse caring for a post op hip replacement patient knows that the pt shouldn't cross his legs at any time for _____
4 months after surgery
sinus tract tumor
5
a patient is admitted to the hospital with an ICP reading of 20 mm Hg and a mean arterial pressure of 90 mm Hg. what would the nurse calculate the CPP to be
70 mm HG
the approximate percentage of total body calcium present in the bones is
98%
a patient comes to the ED with severe pain in the face that was stimulated by brushing the teeth. what cranial nerve does the nurse understand can cause this type of pain
V
the earliest sign of increased ICP is
a change in the level of consciousness
the nurse is caring for a patient who had a total hip replacement. what lethal post op complication should you monitor for
PE
the clinical feature unique to the patient with st louis encephalitis
SIADH with hyponatremia
the brain center responsible for balancing and coordination is the
cerebellum
nursing post op management includes detecting and reducing
cerebral edema relieving pain preventing seizures and monitoring increased ICP and neurological status
the leading cause of seizures in the elderly is
cerebrovascular disease
the most effective cleansing saluting for care of a pin site is
chloranyaxine solution
the nurse is caring for a pregnant patient with pregnancy induced hypertension. when assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the food. what would the nurse document this finding as?
clonus
vagal body tumors
cn10
trigeminal neuralgia
cn5
bells palsy
cn7
herpes zoster
cn7
meniere's syndrome
cn8
A patient is scheduled for an EEG in the morning. what food on the patients tray should th enurse remove prior to the test
coffee
what is impingement syndrome and what measures are necessary to promote shoulder healing
describes impaired movement of rotator cuff of shoulder. usually occurs from repetitive overhead movement of arm
5 risks for an unfavorable outcome for bacterial meningitis
heart rate greater than 120 BPM, old age low GCS
what does the nurse recognize as the earliest sign of serious impairment of brain circulation related to increasing iCP?
lethargy and stupor
list four reasons for a patient to have traction application
maintain and reduce aliment, decrease muscle spasms and pressure ulcers, lessen deformities, increase space between joint
the correction and alignment of the fracture after surgical dissection and exposure of the fracture
open reduction
the most common begin bone tumor is
osteochondroma
potential collaborative problems for a patient with an altered LOC
respiratory distress, pneumonia, aspiration, pressure ulcer, dvt
the nurse is performing a neurologic assessment and requests that the patient stand with eyes open and then closed for 20 seconds to assess balance. what type of test is the nurse performing?
romberg test
function of osteoblasts
secretes bone matrix
a patient arrives in the ED with a suspected bone fracture of the right arm. how does the nurse expect the patient to describe the pain?
sharp and piercing
a patient has been dx with meningococcal meningitis at a community living home. when should prophylactic therapy begin for those who have had close contact with the patient
within 24 hours after exposure
a pt tells the nurse "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" what is the best response?
your muscles were in a state of hypertrophy from weight lifting but it will persist only if the exercise is continued
a patient is having repeated tears of the joint capsule in the shoulder ,and the physician orders an arthrogram. what intervention should the nurse provide after the procedure is completed?
apply a compression bandage to the area, administer a mild analgesic, inform the pt that a clicking or crackling noise in the joint may persist for a couple days
the leading cause of musculoskeletal related disability in the US is
arthritis
the repair of joint problems through the operating arthroscope or through open joint surgery
arthroplasty
a pt is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the pt pain. what procedure will the nurse prepare the patient for?
arthroscopy
nurse is caring for a patient with GBS in the intensive care unit and is assessing the patient for autonomic dysfunction .what interventions should be provided in order to determine the presence of autonomic dysfunction
assess the BP and HR
a pt with an arm cast complains of pain. what nursing interventions should the nurse provide in order to reduce the incidence of complications
assess the fingers for color and temperature assess for a pressure sore determine the exact site of pain
what strategies can the nurse educate the patient with MS about to avoid the disabling effects of fatigue?
avoiding hot temps, effective occupational and physical therapy, nutrition, changing lifestyles
if a patient with an altered LOC requires suctioning, what intervention is a priority for the nurse to provide?
before and after suctioning patient is adequately ventilated to prevent hypoxia
a patient had a small pituitary adenoma removed by the transsphenoidal approach and has developed diabetes insipid us. what pharmacologic therapy will the nurse be administering to this patient to control symptoms
vasopressin
a patient arrives to have an MRI done in the outpatient department. what information provided by the patient warrants further assessment to prevent complications related to the MRI?
"I am trying to quit smoking and have a patch on."
the nurse is caring for a patient in the neurologic ICU who sustained head trauma in a physical altercation. what would the nurse know is an optimal range of ICP for this patient
0 to 10 mm HG
the nurse is caring for a patient who was involved in a motor vehicle accident and sustained a head injury. when assign DTR, the nurse observes diminished or hypoactive reflexes. how will the nurse document this finding?
1+
approx. _______ mg of calcium daily is essential to maintain adult bone mass
1,000-1,200
the recommended adequate intake level of calcium for al individuals is
1000-1500 a day mg
the normal adult produces about ____mL of cerebrospinal fluid daily from the ventricles
150
in the human body, there are ____ bones
206
a college student goes to the infirmary with a fever, headache, and a stiff neck. the nurse suspects the student may have meningitis and has the student transferred to the hospital, if the dx is confirmed what should the nurse insitiute for those who have been in contact with this student?
Administration of rifampin administration of cipro administration of rocephin
GBS
CN 10
The nurse obtains a snellen eye chart when assessing cranial nerve function. which cranial nerve is the nurse testing when using the chart?
CN 2
optic neurtitis
CN 2
pituitary tumor
CN2
brain stem ischemia
CN6
acetylcholine
primarily excitatory; can produce vagal stimulation of heart
general functions of the musculoskeletal system
protect and support the body, faster movement of extremities, mobility
what is the function of the blood-brain barrier
protects and filters all substances entering the CSF
the major hormonal regulators of calcium homeostasis are
pth and calcitonin
the pt has a fracture of the right femur sustained in an automobile accident. what process of the fracture healing does the nurse understand will occur?
reactive phase, reparative phase, remodeling phase
what is the process of fracture healing, including the 3 stages of progression
reactive phase, reparative phase, remodeling phase
describe the role and functions of the autonomic nervous system
regulates the activities of internal organns, maintains internal homeostasis
___ is the neurotransmitter that helps control mood and sleep
serotonin
the nurse expects that _____ of weight can be used for a patient in skeletal traction
25 lbs
the nurse is caring for a patient with a total hip replacement. how should the nurse allow the patient to turn
45 degrees onto the unoperated side if the affected hip is kept abducted
primary osteoporosis in women usually veins between the ages of
45-55 and after menopause
the nurse is performing an assessment of cranial nerve function and asks the patient to cover one nostril at a time to see if the patient can smell coffee, alcohol and mint. the patient is unable to smell any of the odors. the nurse is aware that the patient has a dysfunction of what cranial nerve?
CN1
a patient had a total hip replacement. what recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?
abduction
_____ describes the grating, crackling sound heard over irregular joint surfaces like the knee
creptius
the nurse suspects "compartment syndrome" for a casted extremity. what characteristics symptoms would the nurse assess that would confirm these suspicions?
decreased sensory function, excruciating pain and loss of motion
explain what demyelination refers to in reference to MS
destruction of myelin-fatty and protein material that surrounds nerve fibers
norepinephrine
excitatory response, mostly affecting moods
the nurse assess for perineal nerve injury by checking the patients casted leg for the primary symptoms of
numbness, tingling, and burning
the intervertbral disks that are subject to the greetst mechanical stress and greater degenerative changes are
L$ L5 and S1
the placement of bone to promote healing, to stabilize, or to replace diseased bone
bone graft
the infectious disorders of the nervous system are
ecephalitis, brain absees, and meningitis
when education a patient about the use of anti seizure medication, what should the nurse inform the patient is a result of longterm use of the medication in women
osteoporosis
the nurse is performing an assessment for a patient who may have peripheral neuromuscular dysfunction. what signs does the patient present with that indicate circulation is impaired?
pale, cyanotic or mottled color cool temperature at the extremity more than 3-second cap refill
a pt comes to the clinic and informs the nurse of numbness tingling and a burning sensation in the arm from the elbow down to the fingers. what type of symptom would this be documented as?
paresthesia
a patient has a long leg cast cap plied. where does the nurse understand a common pressure problem may occur
peroneal nerve
the "master gland" is also known as the
pituitary gland
if a patient has impaired cough reflex
place patient in a lateral position
three major potential complications in a patient with depressed level of consciousness are
pneumonia, aspiration and respiratory failure
what potential immobility related complications may develop when a patient is in skeletal traction
pressure ulcers, atelactsis, uti, pneumonia that lead to pe or dvt
ulnar test
prick the distal fat pad of the small finger
tibial test
prick the medial and lateral surface of the sole
peroneal test
prick the skin midway between the great and second toe
radial test
prick the skin midway between the thumb and second finger
median test
prick the top or distal surface of the index finger
a patient diagnosed with MS two years ago has been admitted to the hospital with another relapse. the previous relapse followed a complete recovery with exception of occasional vertigo. what type of MS does the nurse recognize this patient is most likely to have
relapsing-remitting (RR)
a pt has a fracture that is being treated with open rigid compression plate fixation devices. how will the progress of bone healing be monitored?
serial xrays
name 3 major complications of an extremity that is casted, braced or splinted.
skin breakdown, necrosis, compartment syndrome
a major potential complication of epilepsy is
status epileptius
red bone marrow is located in the shaft of four long and flat bones; the
sternum ilum, vertabra, ribs, and skull
role of estrogen
stimulates osteoblasts and inhibits osteoclast, bone formation is enhanced and reabsorption is inhibited
what are the bacteria responsible for the majority of cases of bacterial meningitis in adults
streptococcus pnemonia, neissera and meningitis ?
what is tendinitis
stretch tendons
a patient with bells palsy says to the nurse "it doesn't hurt anymore to touch my face. how am i going to get muscle tone back so i don't look like this anymore" what intervention can nurse suggest?
suggest massaging the face several times daily using a gentle upward motion to maintain muscle tone
what methods for preventing hip prosthesis dislocation would the nurse teach a pt
supine position and don't cross legs, head elevated, don't bend forward, cradle boot, keep knees apart, pillow between legs, use high seated chair, don't flex hip to dress
a pt had a total left hip arthroplasty what clinical manifestation would indicate to the nurse that prosthesis is dislocated?
the left leg is internally rotated
after a bone density test, an older adult female pt tells the nurse "I don't understand why i have osteoporosis bc I eat well and take my calcium" what does the nurse understand is the reason she may have it?
the loss is from withdrawal of estrogen and decrease in activity levels
the nurse assess soft subcutaneous nodules along the line of the tendons in a patients hand and wrist. what does this finding indicate to the nurse?
the patient has rheumatoid arthritis
the nurse caring for a patient with bacterial meningitis is administering dexamethasone that has been ordered as an adjunct to antibiotic therapy. when does the nurse know is appropriate time to administer this medication?
15 to 20 mins before the 1st dose of antibiotic and every 6 hours for the next 4 days
older adult pt had a hip replacement, when should the pt begin with assisted ambulation with a walker?
24 hours
a nurse assess the patients LOC using the glasgow coma scale, what score indicates severe impairment of neurologic function?
3
after a total hip replacements, the pt is usually able to resume daily activities after
3 months
after a total hip replacements, stair climbing is kept to a minimum for
3-6 weeks
the nurse is assisting with administering a tension test to a patient with ptosis, if test is positive for myasthenia gravis what will occur
30 sec after administration, facial weakness and ptosis will be relived for 5 mins
the preganglionic fibers of the sympathetic neurons are located in the segments of the spinal cord identified as
C8 to L3
the nurse is assisting with a lumbar puncture and observes that when the physician obtains CSF, it is clear and colorless. what does this finding indicate?
a normal finding; the fluid will be sent for testing to determine other factors
a patient has a cast removed after bone healing takes place. what should the nurse instruct the patient to do after removal
apply an emollient lotion to soften the skin, control swelling with elastic bandages as directed, gradually resume activities and exercise
if a patient has foot drop or paralyzed extremity
assist with daily active or passive range of motion
the major consequence of osteoporosis is
bone fracture
function of osteocytes
bone maintaince
a nurse caring for a patient with head trauma will be monitoring the patient for Cushing's triad. what will the nurse recognize as the symptoms associated with cushing's triad?
bradycardia, bradypnea, hypertension
the 3 diagnostic test used to support diagnosis of Creutzfeldt-jakob are
brain biopsy, MRI, EEG, spinal fluid test
the primary lethal complication of ICP is
brain herination resulting in death
a patient who has suffered a stroke is unable to maintain respiration and so is intubated and placed on mechanical ventilator support. what portion of the brain is most likely responsible for the inability to breathe?
brain stem
three primary complications of increased ICP are
brain stem herinations, diabetes insipidus, and SIADH
a patient has a severe neurologic impairment from a head trauma, what does the nurse recognize is the type of posturing that occurs with the most severe neurologic impairment?
flaccid
a pt has had a stroke and is unable to move the right upper and lower extremity. during assessment the nurse picks up the arm and it is limp without tone. how would the nurse document this finding
flaccidity
what is a volkmann's contracture
flexion of hang at wrist, claw like deformity
the nurse is very concerned about the potential debilitation complication of perineal nerve injury ,what symptoms does the nurse recognize as a result of the complication
footdrop
describe compartment syndrome
large amount of pressure in muscle compartment-phasionomy
what is scoliosis
lateral curving of spine
the nurse is caring for a patient admitted to the hospital with a brain abscess that developed from an untreated case of otitis media. what assessment data is a priority to alert the nurse to changes in intracranial pressure
level of consciousness
a patient has a lesion affecting the pons, resulting in paralysis and the inability to speak, but has vertical eye movements and lid elevation. this patient is suffering from
locked in syndrome
the nurse is called to attend to a patient having a seizure in the waiting area. what nursing care is provided for a patient who is experiencing a compulsive seizure
loosening constrictive clothing, positioning patient on their side wit head flexed forward, providing privacy
if a patient has footdrop
maintain dorsiflexion to affected area
the nurse is caring for a patient with an altered LOC. what is the first priority of treatment for this patient?
maintenance of a patient airway
the nurse is caring for a patient with increased ICP. as the pressure rises, what osmotic diuretic does the nurse prepare to administer
mannitol
the excision of damaged joint fibrocartilage
menisectomy
a nurse is assesing a patients urinary output as an indicator of diabetes insipid us. the nurse knows that an hourly output of what volume over 2 hours may be a positive indicator?
more than 200 mL/h
function of osteoclasts
multinuclear cells dissolve and reabsorb bone
gamma-aminobutyric acid
muscle and nerve inhibitory transmissions
a pt with myasthenia gravis is in the hospital for treatment of pneumonia. the patient informs the nurse that it is very important to take pyridostigmine bromide on time. the nurse gets busy and deosnt give the med until after breakfast. what will be the outcome of late dose
muscles will become fatigued and the patient will not be able to chew or swallow pills
the primary pathology of multiple sclerosis (MS) is damage to the
myelin sheath
unrelieved pain for a patient in a cast must be immediately repotted to avoid ...
necrosis, impaired tissue perfusion , press ulcers and paralysis
a nursing goal for a patient with skeletal traction is to avoid infection and the development of _____ at the site of pin insertion
osteomylitis
the nurse suspects that a patient with an arm cast has developed a pressure ulcer. where should the nurse assess for the pre scene of the ulcer?
ulna styloid
the nurse knows to assess a patient for deep vein thrombosis by assessing the lower extremities for
unilateral pain, tenderness, swelling, and increased calf circumference
classic clinical features of guillain-barre syndrome are
weakness, and aphyia tingling
a pt tells the physicians about shoulder pain that is present even without any strenuous movement. the physician identifies a sac filled with synovial fluid. what condition should the nurse educate the patient about
bursitis
three medications used to treat pagers disease are
calcitonin, biphosphonates and pilcamycin
the majority of patients with myasthenia gravis exhibit these two clinical signs
diplopia and ptsosis
a pt in pelvic traction needs circulatory status assessed. how should the nurse asses for a positive hormans sign
have the pt extend each leg and dorsifex each foot to determine if pain or tenderness is present in the lower leg
the replacement of one of the articular surfaces
hemiarthroplasty
the most common cause of acute encephalitis in the US is
herpes simplex
the nurse is educating a patient with a seizure disorder. what nutritional approach for seizure management would be beneficial for this patient?
high in protein and low in carbs
the sleep-wake cycle regulator and the site of the hunger center is known as the
hypothalamus
The parasympathetic division of the autonomic nervous system yields impulses that are mediated by the secretion of ___ the dominant neurotransmitter in parasympathetic nervous system functions
acetylcholine
myasthenia gravis is considered an autoimmune disease in which antibodies are directed against
acetylcholine
an artificial joint for total hip replacement involves an implant that consists of
actable? socket, spherical ball, femoral shaft
musculoskeletal problems that can cause acute low back pain
acute lumbosacral strain, weak lumbosacral muscles, osteoarthritis of spine, obesity
the two medications of choice for acute encephalitis is
acyclovir and gancirclavair
bone formation is enhanced by
calcium intake, muscular activity and weight baring
the nurse is assessing the pupils of a patient who has had a head injury. what does the nurse recognize as a parasympathetic effect
constricted pupils
the nurse is caring for a patient with MS who is having spasticity in the lower extremities that decreases physical mobility. what interventions can the nurse provide to assist with relieving the spasms?
demonstrate daily muscle stretching exercises apply warm compresses to the affected areas allow the patient adequate time to perform exercises
osteomyelitis with vascular insufficiency, which most commonly affects the feet, is seen most often amoung patients with
diabetes and peripheral vascular disease
Parkinson's disease is caused by an imbalance in the neurotransmitter known as
dopamine
list the danger signs of possible circulatory constriction that the nurse should assess for in a a casted extremeity
dusky pale appearance, poor cap refill, inability to move fingers and toes, temp changes and odd pain
enkephalin
excitatory; inhibits pain transmission
the nurse is caring for a patient post op after inter cranial surgery for the treatment of a subdural hematoma. the nurse observes an increase in the patients BP from the baseline and a decrease in the HR from 86 to 54. the patient has crackles in the base of the lungs, what does the nurse suspect is occurring?
increased ICP
a patient has expressive speaking aphasia after having a stroke. which portion of the brain does the nurse know has been affected?
inferior posterior frontal areas
the layman's term for onychocrptosis, a common foot condition is
ingrown toenail
serotonin
inhibits pain pathways and can control sleep
if a patient is incontinent
institute a bowel training program
the stabilization of the reduced fracture by the use of metal screws, plates, wires, nails and pins
internal fixation
what is the difference between isotonic and isometric contractions
isometric; almost all of the energy is released the form of heat during isotonic contractions some of the energy is expanded in mechanical form
the nurse is performing an assessment on an older adult patient and observes the patient has an increased forwards curvature of the thoracic spine. what does the nurse understand is this common finding known as?
kyphosis
the nurse asses a pt after total right hip arthroplassty and observes a shortening got the extremity ,and the patient complains of severe pain in the right side of the groin, what is the priority action of the nurse
notify the physician
voluntary muscle control is governed by a vertical band of "motor cortex" located in the
frontal lobe
a patient is having a lumbar puncture and the physician has removed 20 mL of cerebrospinal fluid. what nursing intervention is a priority after the procedure?
have the patient lie flat for 6 hours
the nurse is caring for a patient in the ED with an onset of pain related to trigeminal neuralgia. what subjective data stated by the patient does the nurse determine triggered the paroxysms of pain?
i was brushing my teeth
purpose for having a cast application
immobilize, correct deformities, stabilize, pressure
disease-modifying therapies that are available to treat MS include
immunomodulating therapies and immunosuppresion agents
the primary deficit in osteomalacia is ___ which promotes calcium absorption from the GI tract
inactivated vitamin D
how does vitamin d regulate the balance between bone formation and bone reabsorption
increase calcium in the blood by promoting calcium reabsorption from the GI tract and by accelerating the mobilization of calcium from the bone
what is lordosis
increase in concave curvature of lumbar
what is kyphosis
increase in the convex curvature of the thoracic spine
a patient 3 days post op, from a craniotomy informs the nurse "i feel something trickling down the back of my throat and I fast something salty" what priority intervention does the nurse initiate?
notify the physician of a possible cerebrospinal fluid leak
dopamine
affects behavior, attention, and fine movement
the nurse is caring for a patient post op following orthopedic surgery. the nurse assesses an oxygen stat of 89 percent, confusion, and a rash on the upper torso. what does the nurse suspect is occurring with this patient
fat emboli syndrome
compare the advantage of a fiberglass to those of plaster cast
fiberglass- most durable plastic- cheaper
a patient sustained a head injury during a fall and has changes in personality and affect. what part of the brain does the nurse recognize has been affected in this injury?
frontal lobe
a persons personality and judgement are controlled by the area of the brain known as the
frontal lobe
during tension test to determine if pt has myasthenia gravis, pt complains of cramping and becomes diaphoretic. vital signs are BP 130/78, HR 42 and respiration 18. what intervention should the nurse prepare to do
administer atropine to control side effects of edrophonium
the removal of a body part
amputation
A patient is being tested for a gag reflex. when the nurse places the tongue blade to the back of the throat, there is no response elicited. what dysfunction does the nurse determine the patient has?
dysfunction of the vagus nerve
testosterone role
effects bone growth and formation; causes skeletal growth in adolescence and throughout life span
if a patient has impaired cough reflex or paralyzed diaphragm
elevate the head of the bed 30 degrees
a patient suspected of having gbs has had a lumbar puncture for CSF evaluation. when reviewing the lab results what does the nurse find that is dx for this disease
elevated protein levels in the CSF
the incision and diversion of the muscle fascia to relieve muscle constriction, as in compartment syndrome, or to reduce fascia contracture
fasciotomy
a patient had a lumbar puncture 3 days ago in the outpatient clinic and calls the nurse with complaints of a throbbing headache. what can the nurse educate the patient to do for relief of the discomfort?
force fluids (unless contraindicated), get plenty of bed rest, take some over the counter analgesics
the lobe of the cerebral cortex that is responsible for the understanding of language and music is the
temporal lobe
the insertion of a tendon to improve function
tendon transfer
the major receiving and communication center for afferent sensory nerves is the
thalamus
