Porth's PrepU: Chapter 19- Disorders of Motor Function, Porth's Patho Ch. 14: Somatosensory function, pain, headache, and temperature regulation, clinical assessment of Somatosensory function, Porth's Patho Ch. 16: Disorders of Brain Function, NUR334...
The nurse contacts the healthcare provider regarding a client's early signs of diminishing level of consciousness based on which manifestations? Select all that apply.
-Disorientation. -Blunted responsiveness. -Inattention.
A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which of the following?
Home-grown and canned vegetables
A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis?
Ischemic stroke Explanation: Thrombolytic therapy for the acute treatment of ischemic stroke consists of the intravenous administration of tPA. This drug would exacerbate a subarachnoid hemorrhage by inhibiting the clotting mechanism, and it is not relevant to the care of clients with encephalitis or status epilepticus.
A patients emergency magnetic resonance imaging (MRI) has been examined by the physician and tPA has been administered to the patient. What was this patients most likely diagnosis?
Ischemic stroke
After the formulation of nursing diagnoses, which phase of the nursing process would occur next? Planning Implementation Evaluation Assessment
Planning
Spinal nerves that form complex nerve networks are called which of the following?Spinal nerves that form complex nerve networks are called which of the following?
Plexuses
Guillain-Barré syndrome is characterized by which of the following forms of neuron damage?
Polyneuropathy
Multiple sclerosis is characterized by what type of neuron damage?
Polyneuropathy
Which parts of the brain make up the brain stem?
Pons and medulla oblongata
Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia?
Position the patient in upright position, and correct the initiating stimulus
The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts? calcium magnesium potassium zinc
Potasium
The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts? Calcium Magnesium Potassium Zinc
Potassium
When educating a patient about to undergo a pacemaker insertion, the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will stress that membranes must be repolarized before they can be re-excited. Within the cell, the nurse understands that:
Potassium channels open and while sodium channels close causing repolarization to the resting state.
dorsal column (medial lemniscal pathway)
crosses at base of medulla
medial lemniscus
crosses at medulla & reaches thalamus on opposite side of brain where sensation began
Extreme cerebral edema may cause the brain to herniate into another compartment. Upward herniation from the infratentorial compartment against the aqueduct of Sylvius causes:
hydrocephalus
cluster (headache)
hypothalamus is believed to play a key role in this pathology
cluster headache
hypothalamus is believed to play a key role in this pathology
A clinician is assessing the muscle tone of a patient who has been diagnosed with a lower motor neuron (LMN) lesion. Which of the following assessment findings is congruent with the patients diagnosis?
hypotonia
discriminative touch
identify size/shape of object moving across skin surface
TMJ (temporomandibular joint pain)
imbalance in joint movement because of poor bite, bruxism (teeth grinding), inflammation, trauma or degenerative changes
phantom limb pain
may be the result of regenerating nerve tissue being trapped within scar tissue at the amputation site or the spontaneous firing of spinal cord neurons that have lost their sensory input from the amputated limb
tension-type
may result from oromandibular dysfunction, stress, anxiety, depression, overuse of analgesics or caffeine
myelinated
mechanical or thermal stimuli
primary (headache)
migraine, cluster, tension-type
PAG (periaqueductal gray) region
modulates ascending pain impulses by producing a state of analgesia = endogenous analgesia center
migraine headache
more common in women, may have a hereditary linkage
Coup and contrecoup cerebral contusion caused by blunt head trauma against a fixed object results in:
permanent brain tissue damage
chronic
persistent pain that may be accompanied by loss of appetite, depression, sleep disturbances & other debilitating responses
Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of meningitis, include:
petechiae
What is the branch of pharmacology that uses drugs to treat, prevent, and diagnose disease? pharmacotherapeutics pharmacology pharmacodynamics chemistry
pharmacotherapeutics Explanation: Pharmacotherapeutics is a branch of pharmacology specifically focused on the use of drugs as therapy, to treat, prevent, and diagnose disease. Pharmacology is the all-encompassing term for the study of the biological effects of chemicals. Pharmacodynamics is one topic discussed in pharmacotherapeutics that addresses what the drug does to the body, while pharmacokinetics addresses what the body does to the drug. The drugs being used to treat, diagnose, and prevent disease are chemicals, but the study of chemistry includes far more than just therapeutic chemicals.
A drug has been approved by the Food and Drug Administration. What study phase would occur next? phase IV study phase III study phase II study phase I study
phase IV study
A patient with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The patients psychomotor deficits are likely the result of:
vascular dementia
Autonomic dysreflexia (autonomic hyperreflexia) is characterized by:
vasospasms and hypertension
temperature
warmth & cold
tactile
when _____ information is lost → total anesthesia (numbness)
Pacinian corpuscles
within hypodermis
general visceral (afferent neurons)
within visceral structures
Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement:
without causing paralysis
trigger points
localized points on skin or mucous membranes that produce immediate intense pain when stimulated by light tactile stimulation
postherpetic neuralgia
localized recurrent infection by the varicella virus that has remained latent in the dorsal root ganglia since the initial attack of chickenpox
special somatic (afferent neurons)
located in muscles, tendons & joints
headache
many factors may precipitate a ________ including: foods/food additives (MSG, aged cheese, chocolate), missed meals, menstral periods (estrogen levels), certain medications
pain tolerance
maximum duration & intensity of pain that a person can endure
Headaches
may be primary or secondary
pain
can be classified according to location, referral, & duration
migraine headache
can occur without or with aura
sensory unit
cell body of dorsal root ganglion neuron + its receptor + its central axon
Merkels disks
continuous determination of touch against the skin
aspirin (& NSAIDs)
control pain because they block enzyme needed for PG synthesis
special somatic (afferent neurons)
convey information on position & movement of body
general somatic (afferent neurons)
convey sensations of pain, touch & temperature
general visceral (afferent neurons)
convey sense of fullness & discomfort
secondary (headache)
due to meningitis, tumor or cerebral aneurysm
tension-type
dull, aching, diffuse, nondescript headaches occurring in a hatband distribution around the head
NTs
endogenous analgesic mechanisms involve three families of opioid peptides that can function as ____ 1.enkephalins 2.endorphins 3.dynorphins
cluster headache
episodic occurrences
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced:
generalized seizure. Explanation: When seizure activity begins simultaneously in both cerebral hemispheres, it is considered a generalized seizure.
What will conduct injurious stimuli to alert the body to potential damage?
Nociceptors
dorsal column (medial lemniscal pathway)
relays precise information regarding spatial orientation
The nurse caring for a client with a newly diagnosed intracranial tumor anticipates that the neoplasm will be which of the following?
Astrocytic neoplasms Collectively, astrocytic neoplasms are the most common type of primary brain tumor in adults; therefore the nurse anticipates that this is the cause of the client's intracranial tumor.
The nurse caring for a client with a newly diagnosed intracranial tumor anticipates that the neoplasm will be which of the following? a) Oligodendroglioma b) Meningioma c) Astrocytic neoplasms d) Metastatic carcinoma
Astrocytic neoplasms Collectively, astrocytic neoplasms are the most common type of primary brain tumor in adults; therefore the nurse anticipates that this is the cause of te client's intracranial tumor.
The two main categories of glial tumors include which of the following?
Astrocytic.
The parasympathetic nervous system is part of which of the following systems?
Autonomic nervous system
Fever in infants and young children is not an uncommon event. Many trips to the pediatrician's office occur because of fever in children ages one day to three years. Which sign or symptom does not indicate fever and an infant?
Avid feeding
A client is taking low-dose aspirin daily for her heart. The client is not receiving all the dosage of the aspirin that is being ingested because of: Biotransformation. First-pass effect. Liver metabolism. Portal circulation.
First-pass effect
An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following?
Flaccid motor response A score of 3 on the Glasgow Coma Scale indicates the lowest possible score in each of the three scoring categories (eye opening, motor response, and verbal response) and includes flaccid or no motor response, no verbal response and the inability to open the eyes.
An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following? a) Normal flexion b) Confused conversation c) Flaccid motor response d) Spontaneous eye opening
Flaccid motor response A score of 3 on the Glasgow Coma Scale indicates the lowest possible score in each of the three scoring categories (eye opening, motor response, and verbal response) and includes flaccid or no motor response, no verbal response and the inability to open the eyes.
A sudden traumatic complete transection of the spinal cord results in what type of injury below the site?
Flaccid paralysis
A client who is diagnosed with seizures describes feeling confused after experiencing a seizure. The family members report that the client has been smacking his lips prior to having a seizure. The client most likely experienced which type of seizure?
Focal Focal seizures with impairment of consciousness sometimes referred to as psychomotor seizures are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common.
A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused but is oriented to person and place but not time. What type of seizure did this client most likely experience?
Focal seizure with impairment to consciousness Focal seizures with impairment of consciousness, sometimes referred to as psychomotor seizures, are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common.
tension-type
analgesic relief provided by aspirin and NSAIDs
The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be which of the following?
"Because the skull sutures are not fused there may be no brain damage."
The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be which of the following?
"Because the skull sutures are not fused there may be no brain damage." When hydrocephalus develops in utero, before the cranial sutures have fused, the head can swell and decrease intracranial pressure, thereby decreasing the amount of brain tissue that is compressed.
The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be which of the following? a) "The cranial sutures are fused and decrease brain damage." b) "Infants never have symptoms from hydrocephalus." c) "Because the skull sutures are not fused there may be no brain damage." d) "Unfortunately, there usually is significant brain dysfunction."
"Because the skull sutures are not fused there may be no brain damage." When hydrocephalus develops in utero, before the cranial sutures have fused, the head can swell and decrease intracranial pressure, thereby decreasing the amount of brain tissue that is compressed.
A patient is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The patient tells the nurse at the physician's office that all this started after he had a car accident earlier that year. Which of the following would be the most important question for the nurse to ask?
"Did you sustain any injuries in the accident?"
A patient is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The patient tells the nurse at the physician's office that all this started after he had a car accident earlier that year. Which of the following would be the most important question for the nurse to ask?
"Did you sustain any injuries in the accident?" Postconcussion syndrome can interfere with daily living and also with relationships and can continue for months. The syndrome can include amnesia, insomnia, headache, difficulty concentrating, and irritability. In this situation, it would be very important to determine if the patient sustained a head injury to rule out postconcussion syndrome.
A patient is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The patient tells the nurse at the physician's office that all this started after he had a car accident earlier that year. Which of the following would be the most important question for the nurse to ask? a) "What is your normal routine before bedtime?" b) "Did you go to the hospital following the accident?" c) "How long have you been married?" d) "Did you sustain any injuries in the accident?"
"Did you sustain any injuries in the accident?" Postconcussion syndrome can interfere with daily living and also with relationships and can continue for months. The syndrome can include amnesia, insomnia, headache, difficulty concentrating, and irritability. In this situation, it would be very important to determine if the patient sustained a head injury to rule out postconcussion syndrome.
A 20 year-old has been diagnosed with an astrocytic brain tumor located in the brainstem. Which of the following statements by the oncologist treating the client is most accurate?
"Your prognosis will depend on whether we can surgically resect your tumor."
Mr. Abo, an African American male, asks the nurse why the health care provider orders a diuretic as part of his treatment plan for hypertension, when the health care provider ordered an ACE inhibitor for his friend with the same diagnosis. After consulting with the provider, how would the nurse respond? "Diuretics are more cost-effective." "Diuretics are shown to be more effective than ACE inhibitors for African American males with hypertension." "The provider ordered diuretics to reduce the stress on your heart." "You must take the drug that the provider orders because the provider knows best how to manage your hypertension."
"Diuretics are shown to be more effective than ACE inhibitors for African American males with hypertension."
The nurse is assessing a client who is being admitted to the healthcare facility. When asked about allergies, the client states, "I'm allergic to penicillin." What is the nurse's best initial response? "Do you remember what happened the last time you received penicillin?" "We'll make sure that none of your antibiotics are similar to penicillin." "I'll make sure to pass that information along to the pharmacy." "Are there other antibiotics that have worked well for you in the past?"
"Do you remember what happened the last time you received penicillin?"
The client tells the nurse about a new drug being tested to treat the client's disease and asks the nurse whether the client can be prescribed a medication still in the pre-clinical phase of testing. What is the nurse's best response? "The prescriber would have to complete a great deal of paperwork to get approval to prescribe that drug." "Sometimes pharmaceutical companies are looking for volunteers to test a new drug, and the prescriber could give them your name." "Drugs in the pre-clinical phase of testing are tested only on animals and so would not be available to you." "Drugs in the pre-clinical phase of testing are given only to healthy young men and so would not be available to you."
"Drugs in the pre-clinical phase of testing are tested only on animals and so would not be available to you."
Mrs. Hone asks the nurse to open her Effexor XR capsule and mix the contents in applesauce to make it easier to swallow. How should the nurse respond? "Not a problem; I will mix the medication for you." "I am sorry, but opening the capsule may cause you to absorb too much medication too quickly." "The health care provider gave you this form of your medication because it is easier to take by mouth." "Effexor XR may only be mixed with food with a provider's order."
"I am sorry, but opening the capsule may cause you to absorb too much medication too quickly." Explanation: Because controlled-release tablets and capsules contain high amounts of drug intended to be absorbed slowly and act over a prolonged period of time, they should never be broken, opened, crushed, or chewed. Such an action allows the full dose to be absorbed immediately and constitutes an overdose, with potential organ damage or death
The nurse is caring for a client with a gastrointestinal bleed. Which statement by the client would alert the nurse to a potential cause of the bleed? "I have not had much of an appetite lately." "When I have indigestion, I use an antacid to help with the symptoms." "I take aspirin a couple times a day to manage aches and pains." "I have noticed blood in my stools lately."
"I take aspirin a couple times a day to manage aches and pains."
The nurse, working on the maternity unit, receives a call from a pregnant woman asking how she can know whether a medication is safe to take while pregnant. What is the nurse's best response? "You can take any drug indicated as a category A." "No medications should be taken during pregnancy." "Never take medication until you receive approval from your health care provider." "Most medications are safe but you need to weigh benefit against risk."
"Never take medication until you receive approval from your health care provider." Explanation: The best response to a pregnant woman asking about medication usage is to talk with her obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While category A drugs have no known risk, they may be contraindicated by the woman's health condition or pregnancy issues, and many pregnant women would not know what a "category A" drug is. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner.
A nurse is teaching the client about the use of over-the-counter (OTC) drugs. Which statement best informs the client about their safe use? "OTC drugs are products that are available without prescription for self-treatment of minor health issues." "OTC drugs are considered medications and should be reported on a drug history." "OTC drugs were approved as prescription drugs but later were found to be safe without the need of a prescription." "OTC drugs need to be taken with caution; they can mask the signs and symptoms of an underlying disease and interfere with prescription drug therapy."
"OTC drugs need to be taken with caution; they can mask the signs and symptoms of an underlying disease and interfere with prescription drug therapy."
The nurse explains the Drug Enforcement Agency's (DEA's) schedule of controlled substances to the nursing assistant who asks, "Do you ever get a prescription for Schedule I medications?" What is the nurse's best response? "Schedule I medications have no medical use so they are not prescribed." "Schedule I medications have the lowest risk for abuse and do not require a prescription." "Schedule I medications are only prescribed in monitored units for client safety." "Schedule I medications are found in antitussives and antidiarrheals sold over the counter."
"Schedule I medications have no medical use so they are not prescribed."
A nurse demonstrates an understanding of the impact the National Institutes of Health (NIH) Revitalization Act has had on the policies currently guiding drug trials, when making which statement? "Every drug research study must include the gathering of data on the medication's effect on men." "There is such a important information now available since both women and minorities are included in drug research studies." "The safety of the participants has improved since animal testing must be completed prior to human drug testing." "The inclusion of a double-blind testing format adds credibility to the findings of human drug testing."
"There is such a important information now available since both women and minorities are included in drug research studies." Explanation: Historically, drug research was done mainly with young, white males as subjects. In 1993, Congress passed the National Institutes of Health (NIH) Revitalization Act, which formalized a policy of the NIH that women and minorities must be included in human subject research studies funded by the NIH and in clinical drug trials.
A patient discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The patient's spouse is extremely upset because the physician stated that the patient cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. Which of the following is the nurse's most accurate response?
"Thrombolytics may cause cerebral hemorrhage."
A patient discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The patient's spouse is extremely upset because the physician stated that the patient cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. Which of the following is the nurse's most accurate response?
"Thrombolytics may cause cerebral hemorrhage." A previous stroke, occurring within 3 months of the administration of thrombolytics, significantly increases the risk of intracranial hemorrhage.
A patient discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The patient's spouse is extremely upset because the physician stated that the patient cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. Which of the following is the nurse's most accurate response? a) "All the brain tissue damage is already done." b) "Thrombolytics may cause cerebral hemorrhage." c) "The medications do not work with subsequent strokes." d) "The stroke is hemorrhagic, not thrombotic."
"Thrombolytics may cause cerebral hemorrhage." A previous stroke, occurring within 3 months of the administration of thrombolytics, significantly increases the risk of intracranial hemorrhage.
The spouse of a patient diagnosed with Alzheimer's disease asks the nurse why the patient often neglects to take a shower. The spouse states that the patient was always diligent with hygiene in the past; however, over the past few months that has not been the case. Which of the following is the nurse's best response?
"You should remind the patient to shower."
The spouse of a patient diagnosed with Alzheimer's disease asks the nurse why the patient often neglects to take a shower. The spouse states that the patient was always diligent with hygiene in the past; however, over the past few months that has not been the case. Which of the following is the nurse's best response?
"You should remind the patient to shower." The patient should be reminded to shower because most likely he or she has difficulty remembering to do so. In the moderate stage of Alzheimer's disease, which can last for several years, it is not unusual for hygiene to be neglected because the person may just not remember if he or she did or did not shower.
The spouse of a patient diagnosed with Alzheimer's disease asks the nurse why the patient often neglects to take a shower. The spouse states that the patient was always diligent with hygiene in the past; however, over the past few months that has not been the case. Which of the following is the nurse's best response? a) "The patient would be fine without showering." b) "You should remind the patient to shower." c) "The patient is experiencing a temporary relapse." d) "The patient just does not care anymore."
"You should remind the patient to shower." The patient should be reminded to shower because most likely he or she has difficulty remembering to do so. In the moderate stage of Alzheimer's disease, which can last for several years, it is not unusual for hygiene to be neglected because the person may just not remember if he or she did or did not shower. There is no information in the question to support the remaining responses.
A 20 year-old has been diagnosed with an astrocytic brain tumor located in the brainstem. Which of the following statements by the oncologist treating the client is most accurate? a) "Your prognosis will depend on whether we can surgically resect your tumor." b) "This is likely a result of a combination of heredity and lifestyle." c) "The major risk that you face is metastases to your lungs, liver or bones." d) "Our treatment plan will depend on whether your tumor is malignant or benign."
"Your prognosis will depend on whether we can surgically resect your tumor." The prognosis of people with pilocytic astrocytomas is influenced primarily by their location. The prognosis is usually better for people with surgically resectable tumors, such as those located in the cerebellar cortex, than for people with less accessible tumors, such as those involving the hypothalamus or brain stem. -Because of infiltration of brain tissue that prevents total resection, surgery rarely cures brain tumors. -The binary of malignant and benign is not used to characterize brain tumors and the etiology and substantive risk factors are largely unknown. - Brain tumors rarely metastasize outside the CNS.
astereogenesis
*Dorsal Column Medial Lemniscal Pathway* if medial lemniscal pathway is functional but somatosensory cortex is damaged, you can describe object but not recognize the specific object type
stereogenesis
*Dorsal Column Medial Lemniscal Pathway* conveys information on size/shape of object without visual input
without aura
*Migraine* increased sensitivity to light & sound
without aura
*Migraine* may be accompanied by nausea & vomiting
without aura
*Migraine* pulsating, throbbing, unilateral headache that lasts 1-2 days and is aggravated by physical activity
with aura
*Migraine* same symptoms as without aura + visual or neurologic symptoms that precede the headache cluster headache
chickenpox (varicella)
*Postherpetic Neuralgia* herpes zoster (shingles) is caused by the same herpesvirus that causes...
The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply.
-Cognition -Level of consciousness -Motor function -Sensory function Explanation: Brain injuries can cause changes in level of consiousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a client with a traumatic brain injury should assess for changes in these areas.
The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply.
-Level of consciousness. -Sensory function. -Motor function. -Cognition.
Manifestations of peripheral neuropathy include which of the following? Select all that apply.
-Sensory changes -Muscle wasting -Muscle weakness
A client arrives at the emergency department with symptoms of stroke. What evidence should the nurse gather to determine if the client is a candidate for thrombolytic therapy? Select all that apply.
-Time of symptom onset. -Blood pressure. -History of stroke.
proprioceptive receptors
-muscle spindle fibers -Golgi tendon organs
A nurse is monitoring the intracranial pressure (ICP) of a client. The nurse would consider the client to have a normal reading when the results identify:
0 to 15 mm Hg The cranial cavity contains blood, CSF, and brain tissue. Each of these three volumes contributes to ICP, which is normally maintained within a range of 0 to 15 mm Hg when measured in the lateral ventricles.
A nurse is monitoring the intracranial pressure (ICP) of a client. The nurse would consider the client to have a normal reading when the results identify:
0 to 15 mm Hg.
A client has been prescribed a one-time dose of 4 mg morphine IV. The medication is available in ampules of 10 mg/mL. What volume of morphine should the nurse draw up?
0.4 Explanation: The client requires 4 mg of the 10 mg that are available in one mL. Dividing 4 by 10 yields a volume of 0.4 mL.
A pediatric nurse is caring for a child who weighs 42 lbs. The health care provider has ordered methylprednisolone sodium succinate (Solu-Medrol), 0.03mg/kg/day IV in normal saline. How many milligrams should the nurse prepare to give? 6.5 6 0.65 0.6
0.6 Explanation: This method of prescribing takes into consideration the varying weights of children and the need for a higher dose of the drug when the weight increases. For example, if a child with postoperative nausea is to be treated with Vistaril (hydroxyzine), the recommended dose is 1.1 mg/kg by intramuscular injection. If the child weighs 22 kg, the dosage for this child would be 1.1 mg times 22 kg or 24.2 mg, rounded down to 24 mg. If a child weighed only 6 kg, the recommended dose would be 1.1 mg times 6 kg or 6.6 mg.
The nurse is preparing to administer a 500-mg dose of medication. It is available as 0.5 g per tablet. How many tablets will the nurse administer to a client to achieve the prescribed dose?
1 Explanation: 1 g = 1,000 mg; 0.5 g = 500 mg
Carpal Tunnel Treatments (2):
1. Avoid movements that causes pain. 2. Splinting and anti-inflammatory medication.
Mononeuropathies (4):
1. Caused by localized conditions such as trauma, compression, or infections that affect a single spinal nerve, plexus, or peripheral nerve trunk. 2. Fractured bones may lacerate or compress nerves. 3. Excessively tight tourniquets may injure nerves directly or produce ischemic injury. 4. Infections such as herpes zoster may affect a single segmental afferent nerve distribution.
Following his annual influenza vaccination, a patient begins to feel achy, like he has developed the flu. An hour later, the patient is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Choose all that apply.
1.Rapid deterioration of respiratory status 2. Flaccid paralysis of limbs 3. Pale, cool, dry skin
The PCP orders amoxicillin 250 mg by mouth two times a day. The drug label reads "Amoxicillin 125 mg/5 ml." How much will the nurse administer? 5 mL 2.5 mL 10 mL 7.5 mL
10 mL
According to the Glasgow Coma Scale, opening one's eyes to only painful stimuli would receive which score?
2 Only opening eyes to painful stimulation is scored as a 2. Spontaneously opening eyes is scored as a 4; opening eyes to speech is scored as a 3; no opening is scored as a 1.
A client with Paget disease who weighs 110 lbs is prescribed 8 mg/kg PO of etidronate disodium. The nurse should administer how many 200 mg tablets? 2 1 1/2 3
2 Explanation: 110 lbs = 50 kg. The client is to receive 8 mg per kilogram, so 8mg X 50 = 400 mg. 400 mg divided by 200 mg/tablet = 2 tablets.
thalamus
2 parallel pathways transmit information from spinal cord to the _______: 1.dorsal column medial lemniscal pathway 2.anterolateral pathway
Which individual has the highest chance of having a primary central nervous system lymphoma?
A 24-year-old man with acquired immunodeficiency syndrome (AIDS) and behavioral and cognitive changes
A child weighs 11 kilograms. The health care provider orders a drug as follows: 0.2 mg/kg intravenously. What dose should the nurse administer?
2.2 Explanation: Using the mg/kg method, the nurse would set up this calculation: 0.2 mg/1 kg = X mg/11 kg; Cross multiplying and solving for X: X = 0.2 × 11; X = 2.2 mg.
The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again? 1 hours after the original dose 2 hours after the original dose 3 hours after the original dose 4 hours after the original dose
3 hours after the original dose
deep
pain that isdiffuse, throbbing pain that originates in muscles, bones, & tendons & radiates to the surrounding tissues
Which of the following individuals has the highest chance of having a medulloblastoma?
A 4-year-old child who has become uncoordinated in recent months
An older adult client states that he takes 5 grains of aspirin every day. The nurse would determine that the client takes how many milligrams every day? 300 mg 150 mg 450 mg 600 mg
300 mg Explanation: One grain is equivalent to 60 mg. So 5 grains would be equivalent to 300 mg. Using the ratio and proportion method 1 grain/60 mg = 5 grains/X: Cross multiply to determine 300 mg = 5 grains.
The nurse witnesses a client go into cardiac arrest. If the nurse delays intervention, when will the death of brain cells begin?
4-6 minutes
Fluoxitine is given to a client at a dosage of 500 mg every 6 hours. Assuming that the half-life of this drug is 3 hours, at what point would the drug level in the body be 62.5 mg of the original dose? 6 hours after the original dose 7 hours after the original dose 8 hours after the original dose 9 hours after the original dose
9 hours after the original dose
The nurse is preparing medication for a 30-month-old with right otitis media. The child weighs 33 pounds. The health care provider has ordered cephalexin, 50 mg/kg/day in divided doses every 8 hours. The medication concentration is 250mg/5mL. How many milliliters should the nurse give the toddler? 5 5.5 10 10.5
5
The nursing student is studying drug dosing with liquids. The student knows that a specific amount of drug will be in a given volume. A particular drug label reads "Augmentin 125 mg/5 mL." Which is the correct volume? 5 mL 125 mg 2.5 mL 725 mg
5 mL Explanation: In liquid drugs, a specific amount of drug is in a given volume of solution. In this example, there is 125 mg/5 mL, so 5 mL is the volume (quantity) in which there is 125 mg of drug. The other calculations are incorrect and if given would be a drug error.
A nurse is teaching a parent how to take an axillary temperature on the child. The nurse indicates that the glass thermometer should be held in the axillary Fossa for which amount of time?
5 to 10 minutes
Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the Autonomic Nervous System (ANS)? a) 44 year old patient complaining of constant movement and pain in the legs that gets worse when they try to sleep. b) 85 year old patient experiencing drooping of the right side of face and numbness in right arm and leg. c) 56 year old complaining of tingling sensations and has both an elevated pulse and BP. d) 22 year old complaining of a stiff neck and achiness, along with some nausea and vomiting.
56 year old complaining of tingling sensations and has both an elevated pulse and BP. Sensory symptoms correlate with the location of seizure activity on the contralateral side of the brain and may involve somatic sensory disturbance (tingling). With abnormal cortical discharge stimulating ANS, see tachycardia, diaphoresis, hypo- or hypertension, or papillary changes. Distractor A is associated with restless leg syndrome (RLS). Distractor B is associated with stroke (CVA). Distractor D is associated with meningitis.
The regulation of cerebral blood flow is accomplished through both autoregulation and local regulation. This allows for the brain to meet its metabolic needs. What is the low parameter for arterial blood pressure before cerebral blood flow becomes severely compromised?
60 mm Hg If blood pressure falls below 60 mm Hg, cerebral blood flow becomes severely compromised, and if it rises above the upper limit of autoregulation, blood flow increases rapidly and overstretches the cerebral vessels.
Order: Ibuprofen 150 mg. orally Available: Ibuprofen 100mg/ 5ml How many mL will the nurse administer?
7.5 Explanation: To determine the number of mL, 100/5 = 20 mg/mL. 150mg/20mg = 7.5 FORMULA: 5mL:100mg::XmL:150mg 5 mL X 150 mg 100 mg X 750/100 = 7.5 mL 7.5 mL
A hypotensive client is to receive 500 mL of 0.45% NaCl over the next hour using a microdrip delivery system. Rounded to the nearest mL, how much fluid should the client receive in 1 minute?
8 Explanation: The nurse would divide 500 mL by 60 minutes, which would result in 8.3 mL per minute. Rounded to the nearest mL, this is 8 mL.
-History of stroke -Time of onset -blood pressures Prior stroke or head injury within 3 months, a blood pressure greater than 185/110 mm Hg, or symptoms that have been present for greater than 4.5 hours exclude the client as a candidate for thrombolytic therapy. Neither age nor heart rate are part of thrombolytic therapy treatment criteria.
A client arrives at the emergency department with symptoms of stroke. What evidence should the nurse gather to determine if the client is a candidate for thrombolytic therapy? Select all that apply. -History of stroke -Age -Blood pressure -Heart rate -Time of symptom onset
-Brain Death Explanation: Severe brain injury that results in seriously compromised brain function can result in brain death.
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for: -Brain death -Paraplegia -Confusion -Amnesia
Anticoagulation therapy Explanation: The risk of stroke recurrence is highest in the first week after stroke, and the use of anticoagulation in cardioembolic stroke is imperative.
A client is admitted for cardioembolic stroke. Which therapy to best prevent recurrence of embolic stroke should the nurse monitor for effectiveness? -Anticoagulation therapy -Blood pressure management -Correction of dyslipidemia -Antiarrhythmic therapy
- Cognitive and personality changes -seizure activity -nausea and vomiting Explanation: The clinical manifestations of brain tumors depend on the size and location of the tumor. General signs and symptoms include headache, nausea, vomiting, mental changes, papilledema, visual disturbances (e.g., diplopia), alterations in sensory and motor function, and seizures. Tinnitus, ear pain, and epistaxis are not among the more common signs and symptoms of a brain tumor.
A client reports "the worst headache" of her life with associated blurred vision. Subsequent diagnostic testing has resulted in a diagnosis of an intra-axial brain tumor. What other clinical manifestations would be consistent with this diagnosis? Select all that apply. -Tinnitus and earaches, with no accompanying signs of infection -Recurrent epistaxis (nosebleeds) -Cognitive and personality changes -Seizure activity -Nausea and vomiting
What client is most likely to have impaired drug metabolism? A client who has a diagnosis of hepatitis C A client who is being treated for basal cell skin cancer A client who requires dialysis for renal failure A client who is dehydrated following several days of diarrhea
A client who has a diagnosis of hepatitis C Explanation: The liver is the single most important site of drug metabolism. The skin plays a role in drug excretion. The kidneys play the most important role in drug excretion. The feces via the bowel play a role in drug excretion.
- Deep coma - Respiratory rate of 8 with intermittent sighs - Bilateral small, fixed pupils Explanation: Infratentorial herniation results from increased pressure in the infratentorial compartment. Herniation may occur superiorly (upward) through the tentorial incisura or inferiorly (downward) through the foramen magnum. The most prominent signs of upward (uncal) herniation include immediate onset of deep coma; small equal, fixed pupils; and abnormal respirations (slow rate with intermittent sighs or ataxia) and other vital signs. Downward displacement of the midbrain through the tentorial notch (or of the cerebellar tonsils through the foramen magnum) can interfere with medullary functioning and cause cardiac or respiratory arrest. Tissue infarction and intracranial bleeding are causes of cerebral edema, rather than an outcome of herniation. Rhythmic movement of arms and legs could be caused by many things and is not specific to infratentorial herniation.
A client with a traumatic brain injury has developed extreme cerebral edema. Which clinical manifestations of brain herniation correlate to upward herniation of the midbrain known as uncal herniation? Select all that apply. -Deep coma -Rhythmic movement of arms and legs -Respiratory rate of 8 with intermittent sighs -Intracranial bleeding from nose and ears -Bilateral small, fixed pupils
Which client is most likely to experience the benefits of the the placebo effect? A client with an infection who states, "I know this antibiotic is going to work for me" A client with pain who says, "I hope this drug works faster than the first one you gave me." A client who expresses skepticism about the need for medications. A client who states, "I'm not the type of person who likes to take pills."
A client with an infection who states, "I know this antibiotic is going to work for me"
Infants are at a greater risk of hypothermia than children because of which of the following?
A high ratio of surface area to body mass
-An ischemic stroke involving the middle cerebral artery Explanation: A stroke in the territory of the middle cerebral artery is the most common aphasia-producing stroke, causing this sign more commonly than a hemorrhagic stroke or a TIA. The middle cerebral artery feeds blood to the language centers. The posterior, basilar, and anterior arteries feed different regions of the brain and a stroke in these arteries would produce different symptoms.
A male client has smoked cigarettes for decades and currently drinks around 10 beers a day. His diet is high in fat and low in fiber. This morning he has arrived at the emergency department with weakness on his left side and an inability to speak. What is most likely causing his symptoms? -A transient ischemic attack (TIA) -A hemorrhagic stroke -An ischemic stroke involving the middle cerebral artery -An ischemic stroke involving the anterior cerebral artery
A nurse is unfamiliar with a drug that a client in the community has recently been prescribed. What information should the nurse consult? Drug Facts and Comparisons A nurse's drug guide The website www.drugs.com The Physicians' Drug Reference
A nurse's drug guide Explanation: A nurse's drug guide provides nursing implications and client teaching points that are most useful to nurses in addiction to need-to-know drug information in a very user-friendly organizational style. Lippincott's Nursing Drug Guide (LNDG) has drug monographs organized alphabetically and includes nursing implications and client teaching points. Numerous other drug handbooks are also on the market and readily available for nurses to use. Although other drug reference books such as Drug Facts and Comparisons and PDR can all provide essential drug information, they will not contain nursing information and teaching points. They can also be more difficult to use than nurse's drug guides. A reputable drug guide is a better source than a consumer website.
What happens during the depolarization phase of nerve cells?
A rapid change in polarity to one that is positive on the inside and the membrane becomes open to sodium.
-Encephalitis Explanation: Encephalitis represents a generalized infection of the parenchyma of the brain or spinal cord. A virus, such as West Nile virus, usually causes encephalitis, although it may be caused by bacteria, fungi, and other organisms. Encephalitis is characterized by fever, headache, and nuchal rigidity. However, more often, people also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma.
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which medical diagnosis listed below may be associated with these clinical manifestations? -Rocky mountain spotted fever -Lyme disease -Encephalitis -Spinal infection
A 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced?
A tonic-clonic seizure.
A 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced?
A tonic-clonic seizure. A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities.
A 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? a) An absence seizure b) A myoclonic seizure c) A complex partial seizure. d) A tonic-clonic seizure.
A tonic-clonic seizure. A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities. -A myoclonic seizure involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities. -Absence seizures are nonconvulsive and -complex partial seizures are accompanied by automatisms (aimless and apparently undirected behavior that is not under conscious control and is performed without conscious knowledge).
A patient who experienced a traumatic head injury from a severe blow to the back of his head now lives with numerous function deficits, including an inability to maintain steady posture while he is in a standing position, although he is steadier when walking. Which of the following disorders most likely resulted from his injury?
A vestibulocerebellar disorder
What best explains symptoms of ALS including dysphagia, muscle weakness and spasticity, and dysphonia?
ALS is caused by both an upper motor neuron and lower motor neuron disturbance
College students were given various amounts of alcohol within a specified timeframe and then asked to drive an obstacle course. The rationale for poor performance in driving as the amount of alcohol intake increased includes, "The blood-brain barrier:
Allows alcohol, a very lipid-soluble molecule to rapidly enter the brain."
Neuromodulators can produce slower and longer-lasting changes in membrane excitability by acting on postsynaptic receptors. What do neuromodulators do?
Alter the release of or response to neurotransmitters
Reflex activity involves which of the following?
All of the above
Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?
Altered level of consciousness
A nurse who is testing a client's response to passive movement of the fingers with the client's eyes closed notes that the client cannot accurately identify on which side the movement occurred or in what position the finger was placed. What is an appropriate interpretation of this result?
Abnormal discrimination pathway function
A nurse is caring for a client who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the client's care, the nurse should consider a possible alteration in which aspect of pharmacokinetics? Absorption Distribution Metabolism Elimination
Absorption
Myasthenia gravis is characterized by muscle weakness caused by antibody-mediated destruction of which of the following?
Acetylcholine receptors
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline?
Acetylcholinesterase inhibitors
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline? a) Psychotherapy b) Acetylcholinesterase inhibitors c) Antioxidant therapy d) Lipid-lowering agents
Acetylcholinesterase inhibitors Cognitive function in Alzheimer's disease (AD) can be enhanced by the use of medications. The acetylcholinsterase inhibitors donepezil, rivastigmine, and galantamine all increase concentration of acetylcholine in the cerebral cortex. -There has been no demonstrated improvement of cognitive function with use of lipid-lowering statins or antioxidant nutritional supplement therapy. -Psychotherapy is appropriate for depression.
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline?
Acetylcholinesterase inhibitors.
A client fell from a ladder and broke his ankle and is being seen in the emergency department for severe ankle pain with swelling and limited range of motion. What type of pain does the nurse recognize the client experiencing?
Acute pain
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to:
Administer IV tissue plasminogen activator (tPA)
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to:
Administer IV tissue-type plasmin activator (tPA)
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to: a) Prepare the client for emergency surgery b) Monitor vital signs closely for improvement c) Administer IV tissue-type plasmin activator (tPA) d) Administer analgesics for the relief of pain
Administer IV tissue-type plasmin activator (tPA) tPA administration is the treatment of choice for an ischemic stroke after confirmation that it is not a hemorrhagic stroke. Monitor vital signs and provide pain relief to prevent complications
The nurse is caring for a client who has returned from surgery after having a colon resection. What is the best method for the nurse to use when administering an opioid for pain in order to optimize pain control?
Administer the opioid preemptively and before pain becomes extreme.
The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed?
Administration of antibiotics Explanation: The nurse should prepare to administer antibiotics as ordered by the physician while the diagnostic tests are being completed. Delay in initiation of antimicrobial therapy, most frequently due to medical imaging prior to lumbar puncture or transfer to another medical facility, can result in poor client outcomes.
The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed?
Administration of antibiotics The nurse should prepare to administer antibiotics as ordered by the physician while the diagnostic tests are being completed. Delay in initiation of antimicrobial therapy, most frequently due to medical imaging prior to lumbar puncture or transfer to another medical facility, can result in poor client outcomes.
The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed?
Administration of antibiotics.
What action should the nurse perform during the implementation step of the nursing process? Administrations and documentation of medications. Obtain information about the client's chronic condition. Determine the client's level of understanding. Question the client about financial resources.
Administrations and documentation of medications. Explanation: Administration of medication and documentation occurs during the implementation phase. Information about the client's chronic condition would be obtained during assessment. Information about the client's level of understanding would be obtained during the evaluation phase of the nursing process. Information about the client's financial resources would be obtained during assessment.
The nurse is caring for an older adult and is teaching the client about medications. The nurse should address what topic during medication education? Teratogenic effects Toxic effects Adverse effects Paradoxical effects
Adverse effects
Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?
Altered level of consciousness.
For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders?
Amygdala
For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders?
Amygdala The most common surgery consists of removal of the amygdala and an anterior part of the hippocampus and entorhinal cortex, as well as a small part of the temporal pole, leaving the lateral temporal neocortex intact. Only a portion of the hippocampus and entorhinal cortex, and temporal pole are removed.
For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders? a) Amygdala b) Temporal neocortex c) Hippocampus d) Entorhinal cortex
Amygdala The most common surgery consists of removal of the amygdala and an anterior part of the hippocampus and entorhinal cortex, as well as a small part of the temporal pole, leaving the lateral temporal neocortex intact. Only a portion of the hippocampus and entorhinal cortex, and temporal pole are removed.
For which older adult client would pain assessment likely be most challenging for the nurse?
An 87-year-old client with vascular dementia and numerous other health problems, such as heart failure
The nurse is conducting a staff inservice on increased intracranial pressure. The nurse determines that the participants are understanding the information when they identify that blood pressure increases in increased intracranial pressure because of which of the following?
An attempt to increase cerebral perfusion Blood pressure increases in increased intracranial pressure due to the body's attempt to increase tissue perfusion. When the pressure in the cranial cavity approaches or exceeds the mean arterial pressure, tissue perfusion becomes inadequate.
-Atherosclerotic lesions in cerebral vessels Explanation: The traditional definition of TIAs as a neurologic deficit resolving within 24 hours was developed before the mechanisms of ischemic cell damage and the penumbra were known and before the newer, more advanced methods of neuroimaging became available. A more accurate definition now is a transient deficit without time limits, best described as a zone of penumbra without central infarction. TIAs are important because they may provide warning of impending stroke. The causes of TIAs are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. The most common predisposing factors for cerebral hemorrhage are advancing age and hypertension; other causes include aneurysm rupture. Cerebral electrical malfunctions usually occur with seizure activity.
An elderly client is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now she is back to her normal self. Suspecting a transient ischemic attacks (TIAs), the health care provider will order diagnostic testing looking for which cause of this episode? -Aneurysm leakage -Minor residual deficits -Diffuse cerebral electrical malfunctions -Atherosclerotic lesions in cerebral vessels
For which patient will the nurse need to consult the Beers Criteria prior to administering medications? A toddler who has just been prescribed an antibiotic for an infection A newborn who has just been prescribed a medication for reflux An elderly patient who has been prescribed new medications for pain control A teenage patient newly diagnosed with type 1 diabetes mellitus
An elderly patient who has been prescribed new medications for pain control Explanation: The Beers Criteria is a list of medications generally considered inappropriate when given to the elderly. The nurse should consult this list prior to administering new medications to an elderly patient. Newborns, toddlers, and teenage patients would not be covered by this list of medications.
-Flaccid motor response Explanation: A score of 3 on the Glasgow Coma Scale indicates the lowest possible score in each of the three scoring categories (eye opening, motor response, and verbal response) and includes flaccid or no motor response, no verbal response and the inability to open the eyes.
An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following? -Spontaneous eye opening -Flaccid motor response -Normal flexion -Confused conversation
What medication teaching should be done for a woman of childbearing age with a seizure disorder?
Antiseizure drugs increase the risk for congenital abnormalities.
What medication teaching should be done for a woman of childbearing age with a seizure disorder?
Antiseizure drugs increase the risk for congenital abnormalities. For women with epilepsy who become pregnant, antiseizure drugs increase the risk for congenital abnormalities and other perinatal complications.
A client is admitted for cardioembolic stroke. Which therapy to best prevent recurrence of embolic stroke should the nurse monitor for effectiveness?
Anticoagulation therapy.
A nurse is teaching a client newly diagnosed with a seizure disorder about medications. The most important information for the nurse to provide would be:
Antiepileptic medications should never be discontinued abruptly.
A nurse is teaching a client newly diagnosed with a seizure disorder about medications. The most important information for the nurse to provide would be:
Antiepileptic medications should never be discontinued abruptly. Consistency in taking seizure medications is essential to obtaining and maintaining therapeutic blood levels of the medication. Abrupt withdrawal can cause seizure recurrence. Monitoring and assessment of drug levels are important.
A nurse is teaching a client newly diagnosed with a seizure disorder about medications. The most important information for the nurse to provide would be: a) Antiepileptic medications should never be discontinued abruptly. b) Pregnant women should reduce the dose of medication they are taking. c) All antiepileptic medications should be taken with food. d) Children can build up a tolerance to the medication quickly.
Antiepileptic medications should never be discontinued abruptly. Consistency in taking seizure medications is essential to obtaining and maintaining therapeutic blood levels of the medication. Abrupt withdrawal can cause seizure recurrence. Monitoring and assessment of drug levels are important. Each prescribed drug will provide information regarding administration to provide client safety.
What medication teaching should be done for a woman of childbearing age with a seizure disorder? a) Antiseizure drugs do not interact with oral contraceptives. b) Antiseizure drugs increase the risk for congenital abnormalities. c) All women of childbearing age should be advised to take a vitamin C supplement. d) Some antiseizure drugs can interfer with vitamin K metabolism.
Antiseizure drugs increase the risk for congenital abnormalities. For women with epilepsy who become pregnant, antiseizure drugs increase the risk for congenital abnormalities and other perinatal complications. - Many of the antiseizure medications interact with oral contraceptives and can interfere with vitamin D metabolism. -All woman should be advised to take folic acid supplementation.
Which intervention is an appropriate action by the nurse to take in attempting to decrease a client's temperature through conduction?
Apply cooling blanket
A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:
Arms
-protect the client from injury
As the nurse is performing a physical assessment of a client, the client begins to have seizure activity including loss of consciousness and limb jerking. The nurse's priority is to: -protect the client from injury. -stop the seizure. -preserve brain functioning. -treat underlying disease.
The nurse has administered a client's medication. What action should the nurse perform next? Assess for drug effects. Perform a head-to-toe assessment. Educate the client about the purpose of the drug. Assess for preexisting conditions.
Assess for drug effects. Explanation: After the medication is administered, the nurse assesses the client for drug affects, both therapeutic and adverse. The nurse would assess the client for allergies, and preexisting conditions before administering a medication. Assessing for drug effects does not normally necessitate a comprehensive health (head-to-toe) assessment.
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?
Assess for other signs/symptoms of increased intracranial pressure
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first? a) Document the finding as it is an expected symptom b) Assess for signs/symptoms of cerebral vascular accident c) Assess for other signs/symptoms of increased intracranial pressure d) Contact physician for anti-nausea medication orders
Assess for other signs/symptoms of increased intracranial pressure The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?
Assess for other signs/symptoms of increased intracranial pressure.
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?
Assess for other signs/symptoms of increased intracranial pressure. The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.
The spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should:
Assess the client for additional signs and symptoms of increased intracranial pressure
The client has a daily antihypertensive medication ordered. Taking the blood pressure prior to administration of the medication is which step of the nursing process? Implementing Assessing Planning Diagnosing
Assessing
Which of the following cell types are responsible for repair and scar formation (also called gliosis)in the brain?
Astrocytes
Following a stroke, injury to nerve cells within the central nervous system needs to be repaired. The health care provider knows that which of the following processes explains how this occurs?
Astrocytes fill up the space to form a glial scar, repairing the area and replacing the CNS cells that cannot regenerate.
The two main categories of glial tumors include which of the following? a) Meningiomas b) Oligohydraminos c) Ependymomas d) Astrocytic
Astrocytic Glial tumors are divided into two main catgories: astrocytic and oligodendroglial.
The nurse caring for a client with an aneurysmal subarachnoid hemorrhage understands that the most common cause of this condition is which of the following?
Berry aneurysm Aneurysmal subarachnoid hemorrhage is a type of hemorrhagic stroke caused by the rupture of a cerebral aneurysm and resultant bleeding into the subarachnoid space. Most of these aneurysms are small saccular aneurysms, called berry aneurysms.
A nurse caring for a client with hypo thermia anticipates that the client's temperature will be:
Below 35°C (95°F)
The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be:
Because the skull sutures are not fused, there may be no brain damage
The nurse is preparing to move to another state. What action should the nurse prioritize? Become familiar with the nurse practice act of the new state. Obtain local providers' Drug Enforcement Agency (DEA) number for prescribing controlled substances. Become familiar with pregnancy drug categorization system used in the new state. Learn about the particular OTC drugs that are for sale in the new state.
Become familiar with the nurse practice act of the new state. Explanation: The nurse needs to learn the rules and regulations in the Nurse Practice Act of the new state she is moving to because regulating of the nurses practice is done by state and they are not all the same. Some are more rigorous than others. Nurses do not memorize a provider's DEA numbers. The DEA is a federal agency that monitors controlled substances in all states. Pregnancy drug categories are standardized nationwide and there is minimal variation on the availability of OTC drugs.
A practitioner is preparing to do a lumbar puncture on a patient with suspected meningitis. Which of the following areas on the spine does the practitioner choose to obtain a cerebrospinal fluid (CSF) sample?
Between L3 and L4
Following a collision while mountain biking, the diagnostic work up of a 22 year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis?
Blood has accumulated between the man's dura and subarachnoid space.
Following a collision while mountain biking, the diagnostic work up of a 22 year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis?
Blood has accumulated between the man's dura and subarachnoid space. A subdural hematoma develops in the area between the dura and the arachnoid space while epidural hematomas exist between the skull and dura.
Following a collision while mountain biking, the diagnostic work up of a 22 year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis? a) Blood has accumulated between the man's dura and subarachnoid space. b) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP. c) Blood has displaced CSF in the ventricles as a consequence of his coup-contrecoup injury. d) Vessels have burst between the client's skull and his dura.
Blood has accumulated between the man's dura and subarachnoid space. A subdural hematoma develops in the area between the dura and the arachnoid space while epidural hematomas exist between the skull and dura. -Intracerebral hematomas are located most often in the frontal or temporal lobe and the ventricles are not directly involved in a subdural hematoma.
The cardinal symptoms of Parkinson disease (PD) include which of the following?
Bradykinesia
A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?
Brain contusions and hematomas
A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?
Brain contusions and hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as a acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas.
A teenager has been in a car accident and experienced an acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?
Brain contusions and hematomas Explanation: Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as an acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. Status epilepticus is not related to this situation.
A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication? a) Status epilepticus b) Brain contusions and hematomas c) Momentary unconsciousness d) TIAs and cerebrovascular infarction
Brain contusions and hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as a acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. -TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. - In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. -Status epilepticus is not related to this situation.
A teenager has been in a car accident and experienced acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication? a) Brain contusions and hematomas b) Momentary unconsciousness c) TIAs and cerebrovascular infarction d) Status epilepticus
Brain contusions and hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as a acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. -TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. -In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. -Status epilepticus is not related to this situation.
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:
Brain death
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:
Brain death Explanation: Severe brain injury that results in seriously compromised brain function can result in brain death.
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:
Brain death Severe brain injury that results in seriously compromised brain function can result in brain death.
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:
Brain death.
Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?
Brain edema and disturbances in blood flow
Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?
Brain edema and disturbances in blood flow Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema.
Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors? a) Brain edema and disturbances in blood flow b) Brain compression and decreased ICP c) Tumor infiltration and decreased ICP d) Tumor infiltration and increased blood pressure
Brain edema and disturbances in blood flow Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema. Blood pressure, either increased or decreased, is not a manifestation of a brain tumor.
A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following? a) Recurrence of primary CNS lymphoma b) Decrease in intracranial pressure c) Onset of early dementia d) AIDS-induced encephalopathy
Brain edema and disturbances in blood flow Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema. -Blood pressure, either increased or decreased, is not a manifestation of a brain tumor.
Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?
Brain edema and disturbances in blood flow.
An increased blood pressure is detected by the carotid sinus baroreceptor and results in stimulation of the vagus nerve to decrease the heart rate. At which of the following levels of the nervous system does this reflex adjustment occur?
Brain stem (medulla and pons)
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?
Brudzinski sign and Kernig sign
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?
Brudzinski sign and Kernig sign Two assessment techniques can help determine whether meningeal irritation is present. Kernig sign is resistance to extension of the knee while the person is lying with the hip flexed at a right angle. Brudzinski sign is elicited when flexion of the neck induces flexion of the hip and knee.
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present? a) Kernig sign and Chadwick sign b) Chvostek sign and Guedel sign c) Brudzinski sign and Chadwick sign d) Brudzinski sign and Kernig sign
Brudzinski sign and Kernig sign Two assessment techniques can help determine whether meningeal irritation is present. Kernig sign is resistance to extension of the knee while the person is lying with the hip flexed at a right angle. Brudzinski sign is elicited when flexion of the neck induces flexion of the hip and knee. The other answers are incorrect.
A soccer player has been diagnosed with a brain contusion after being injured in a game. The best explanation of the injury by the nurse would be:
Bruising on the surface of the brain occurred.
A soccer player has been diagnosed with a brain contusion after being injured in a game. The best explanation of the injury by the nurse would be:
Bruising on the surface of the brain occurred. Contusions represent bruising on the surface of the brain, and lacerations are a tearing of brain tissue.
A nurse is preparing to administer morphine. The nurse understands that this drug is categorized as which schedule of a controlled substance? C-II C-III C-IV C-V
C-II
A nurse is preparing to administer morphine. The nurse understands that this drug is categorized as which schedule of a controlled substance? C-II C-III C-IV C-V
C-II Explanation: Morphine is a schedule II (C-II) controlled substance.
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?
CT scan
prostaglandins
released from inflamed tissues enhance the sensitivity of pain endings but they don't directly stimulate them
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?
CT Scan.
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?
CT Scan.
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?
CT scan
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?
CT scan The diagnosis of subarachnoid hemorrhage and intracranial aneurysms is made by clinical presentation, CT scan, and angiography.
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?
CT scan The nurse should anticipate that the client will be ordered a CT scan to rule out hemorrhagic stroke that would preclude the administration of tissue plasminogen activator (tPA).
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include? a) CT scan b) MRI c) Intravenous antibiotics d) pain medication
CT scan The nurse should anticipate that the client will be ordered a CT scan to rule out hemorrhagic stroke that would preclude the administration of tissue plasminogen activator (tPA).
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made? a) CT scan b) Loss of cranial nerve reflexes c) MRI d) Venography
CT scan The diagnosis of subarachnoid hemorrhage and intracranial aneurysms is made by clinical presentation, CT scan, and angiography. - An MRI is not necessary for the diagnosis of subarachnoid hemorrhage and intracranial aneurysm. -Loss of cranial nerve reflexes is not diagnostic of subarachnoid hemorrhage and intracranial aneurysm, and neither is venography.
Peripheral Neuropathy Involvement:
Can involve a single nerve (mononeuropathy) or multiple nerves (polyneuropathy).
What will the nurse teach a patient with trigeminal neuralgia about the condition?
Carbamazepine is a first-line treatment.
A compression of the medial nerve:
Carpal Tunnel Syndrome
Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?
Carpal tunnel syndrome
Cerebrospinal fluid (CSF) is produced by which of the following structures?
Choroid plexus
An 80-year-old patient with a history of heavy alcohol use is being seen by his provider for drowsiness, confusion, and headache. His family states that he fell and hit his head "several weeks ago." Which type of hematoma does the provider suspect?
Chronic subdural
An elderly male patient has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care teams emphasis on restoring circulation?
Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored
somatosensory
Central processing of _________ information perception involves: -awareness of stimuli -localization & discrimination of its characteristics -interpretation of its meaning
The nurse is conducting a community education program on concussions. The nurse evaluates that the participants are understanding the education when they state that which of the following offers the brain protection from external forces?
Cerebral spinal fluid The brain is protected from external forces by the rigid confines of the skull and the cushioning afforded by the cerebrospinal fluid.
The nurse is conducting a community education program on concussions. The nurse evaluates that the participants understand the education when they state that which of these offers the brain protection from external forces?
Cerebrospinal fluid
Which intracranial volume is most capable of compensating for increasing intracranial pressure?
Cerebrospinal fluid
Which intracranial volume is most capable of compensating for increasing intracranial pressure?
Cerebrospinal fluid Explanation: Initial increases in intracranial pressure (ICP) are largely buffered by a translocation of cerebrospinal fluid (CSF) to the spinal subarachnoid space and increased reabsorption of CSF. Of the intracranial volumes, the tissue volume is least capable of undergoing change. Surface sulcus fluid is negligible and not a factor in increased ICP. The compensatory ability of the intravascular blood compartment is also limited by the small amount of blood that is in the cerebral circulation. As the volume-buffering capacity of this compartment becomes exhausted, venous pressure increases and cerebral blood volume and ICP rise.
Drugs like diazepam (Valium), a benzodiazepine, exert their action on ion channels. These drugs do not open the GABA-operated ion channel, but they:
Change the effect that GABA has when it binds to the channel at the same time as the drug
A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:
Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing Expressive or nonfluent aphasia is characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing.
A client is experiencing difficulty swallowing a large oral tablet. What action by the nurse would be most appropriate? Check to determine whether the drug can be crushed or mixed with food. Ask the prescriber to change the medication to a parenteral form. Have the client drink a large glass of water to aid in swallowing. Contact the pharmacy to order the drug in liquid form.
Check to determine whether the drug can be crushed or mixed with food. Explanation: Not all drugs can be crushed, chewed, or cut. The nurse needs to consult a reputable reference to see if this is possible. Parenteral administration is invasive and should be avoided if there are other options. Some drugs also are not available in parenteral form. Clients with physical problems making swallowing difficult would not be aided by drinking more water. Even healthy clients who have trouble swallowing are often not helped by drinking more water. The nurse cannot change the form of the medication without a prescriber's order because this is outside the scope of practice of the nurse.
Which of the following clients is at least risk for rapid bleeding?
Client with a subdural hematoma
Which of the following clients is at least risk for rapid bleeding?
Client with a subdural hematoma A subdural hematoma develops in the area between the dura and arachnoid space and is usually the result of a tear in small bridging veins that connect the surface of the cortex to dural sinuses. This is a slow source of bleeding, thus the client with a subdural hematoma is less likely to develop a rapid bleed than a client with an epidural hematoma, red stroke, and/or subarachnoid hemorrhage.
The nurse is working in the emergency room. One client's presenting symptoms include the worst headache ever, nuchal rigidity and nausea. Another client's presenting symptoms include fever, stiff back, and positive Kernig's sign. Which client should the nurse assess first?
Client with the worst headache, nuchal rigidity and nausea The nurse should assess the client with presenting symptoms of worst headache ever, nuichal rigidity and nausea because these are presenting signs of aneurysmal subarachnoid hemorrhage from a ruptured cerebral aneurysm. The client with the presenting symptoms of fever, stiff back, and positive Kernig's sign is experiencing symptoms of meningitis. Ruptured cerebral aneurysm is a medical emergency with a higher priority than meningitis.
The nurse is working in the emergency room. One client's presenting symptoms include the worst headache ever, nuchal rigidity and nausea. Another client's presenting symptoms include fever, stiff back, and positive Kernig's sign. Which client should the nurse assess first?
Client with the worst headache, nuchal rigidity, and nausea.
A client's emergency room report includes the presence of a contrecoup injury. The nurse plans care for a client with which of the following?
Closed head injury opposite the area of impact Explanation: In a contrecoup injury, the client experiences a rebound injury on the side of the brain opposite the site of external force.
A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly but her respiratory rate is 45 breaths per minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?
Coma
A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly but her respiratory rate is 45 breaths per minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? a) Vegetative state b) Brain death c) Delirium d) Coma
Coma The continuum of loss of consciousness is marked by the degree of client responsiveness to stimuli, in addition to the preservation of brain stem reflexes. -Since this client still exhibits a pain response (the extended arms and legs indicate decerebrate posturing), even though her pupils are not responsive to light, she has sustained sufficient brain function that she fails to qualify as brain-dead or in a vegetative state.
A nurse on a neurology unit is assessing a client with a brain injury. The client is unresponsive to speech, with dilated pupils that do not react to light. The client is breathing regularly with a respiratory rate is 45 breaths per minute. In response to a noxious stimulus, the client's arms and legs extend rigidly. What is the client's level of impairment?
Coma.
A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly but her respiratory rate is 45 breaths per minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?
Coma.
Which type of seizure begins in a localized area of the brain but may progress rapidly to involve both hemispheres?
Complex partial Complex partial type seizures begin in a localized area of the brain but may progress rapidly to involve both hemispheres.
The loss of heat from the body through the circulation of air currents is known as:
Convection
A patient who is diagnosed with seizures describes feeling a strange sensation before losing consciousness. The family members report that the patient has been smacking their lips prior to having a seizure. Which type of seizure disorder presents with these symptoms?
Complex partial or focal seizure with impairment of consciousness
A patient with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the patient appears confused and is oriented to person and place but not time. What type of seizure did this patient most likely experience?
Complex partial seizure
Wernicke-Korsakoff syndrome is a dementia that is associated with chronic alcoholism. It is caused by a deficiency in thiamine (vitamin B12). What is the most distinctive sign or symptom of this syndrome?
Confabulation Confabulation (i.e., recitation of imaginary experiences to fill in gaps in memory) is probably the most distinctive feature of the disease.
What is the manufacturer's responsibility during phase IV of a drug trial? Find healthy volunteers to test for adverse effects. Continue to monitor the drug's effects while the drug is in general use. Match clients with similar characteristics to test drug effectiveness. Determine if the drug is too toxic for human use.
Continue to monitor the drug's effects while the drug is in general use. Explanation: During phase IV of a drug trial, it is the manufacturer's responsibility to continue to monitor the drug's effects while the drug has been placed in general use. During phase I, healthy volunteers are found to test the drug. In phase II, clients with a disease are divided into two groups, and one receives the new drug and the other receives a placebo. During phase III, it is determined if the drug's benefits outweigh the adverse effects.
The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computerized tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? a) Craniotomy and clipping of the affected vessel. b) STAT administration of tissue-type plasminogen activator (tPA). c) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP. d) Monitoring in ICU for signs and symptoms of cerebral insult.
Craniotomy and clipping of the affected vessel. Surgery for treatment of aneurysmal subarachnoid hemorrhage involves craniotomy and inserting a specially designed silver clip that is tightened around the neck of the aneurysm. Administration of tPA would exacerbate bleeding and a diuretic would not address the issue of bleeding. Monitoring alone would be an insufficient response given the severity of the problem.
A patient suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the patient paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies do which of the following?
Decrease metabolic needs and increase oxygenation.
The nurse is caring for a 31-year-old trauma victim admitted to the neurologic intensive care unit. While doing the initial assessment, the nurse finds that the client is flexing the arms, wrists, and fingers. There is adduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would the nurse describe this in the notes?
Decorticate posturing
The nurse is caring for a 31-year-old trauma victim admitted to the neurologic intensive care unit. While doing the initial assessment, the nurse finds that the client is flexing the arms, wrists, and fingers. There is adduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would the nurse describe this in the notes?
Decorticate posturing Decorticate (flexion) posturing is characterized by flexion of the arms, wrists, and fingers, with adduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities.
The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will:
Decrease the likelihood of further neurological deficits
The nurse is caring for a 31-year-old trauma victim admitted to the neurologic intensive care unit. While doing the initial assessment, the nurse finds that the client is flexing the arms, wrists, and fingers. There is adduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would the nurse describe this in the notes?
Decorticate posturing.
A patient suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the patient paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies do which of the following?
Decrease metabolic needs and increase oxygenation The general goal of treatment with global cerebral ischemia is to decrease metabolic needs and increase oxygenation to the injured cerebral tissue. Artificial ventilation provides appropriate oxygenation; keeping the patient paralyzed decreases the body's metabolic needs.
A patient suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the patient paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies do which of the following? a) Increase oxygen demands and metabolic needs b) Decrease the patient's ability to attempt suicide again c) Decrease metabolic needs and increase oxygenation d) Decrease intracranial fluid volumes and pressures
Decrease metabolic needs and increase oxygenation The general goal of treatment with global cerebral ischemia is to decrease metabolic needs and increase oxygenation to the injured cerebral tissue. Artificial ventilation provides appropriate oxygenation; keeping the patient paralyzed decreases the body's metabolic needs.
The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis (MS) is the result of which of the following?
Decreased oligodendrocytes
The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will do which of the following?
Decrease the likelihood of further neurological deficits.
What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body? Decreased activity. Decreased gastric motility. Decreased cognition. Decreased glomerular filtration rate.
Decreased glomerular filtration rate
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:
Decreased level of oxygen
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:
Decreased level of oxygen Explanation: Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain. Metabolic factors affecting cerebral blood flow include an increase in carbon dioxide and hydrogen ion concentrations; cerebral blood flow is affected by decreased O2 levels and increased hydrogen ions, carbon dioxide, and PCO2 levels.
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:
Decreased level of oxygen Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain. Metabolic factors affecting cerebral blood flow include an increase in carbon dioxide and hydrogen ion concentrations; cerebral blood flow is affected by decreased O2 levels and increased hydrogen ions, carbon dioxide, and PCO2 levels.
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be: a) Decreased level of carbon dioxide b) Decreased hydrogen ions c) Decreased level of PCO2 d) Decreased level of oxygen
Decreased level of oxygen Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain. Metabolic factors affecting cerebral blood flow include an increase in carbon dioxide and hydrogen ion concentrations; cerebral blood flow is affected by decreased O2 levels and increased hydrogen ions, carbon dioxide, and PCO2 levels.
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:
Decreased level of oxygen.
A nurse assessing an older adult for signs and symptoms of infection in the absence of a fever should assess for which of the following? Select all that apply.
Decreased mental status Change in functional capacity Fatigue
The client has a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part?
Diaphragm
The thalamus is located in which of the following parts of the brain?
Diencephalon
Which is an example of a black box warning by the Food and Drug Administration (FDA)? Loss of bowel and bladder control Difficulty breathing and maintaining an airway Feelings of chest tightness and heaviness Decrease in appetite and food consumption
Difficulty breathing and maintaining an airway Explanation: Over the past 25 years, the FDA has issued black box warnings about drugs that can cause serious adverse effects. Difficulty breathing and maintain an airway is a serious adverse effect. The others are mild adverse effects.
After evaluating the patient, the physician thinks that his elderly patient is exhibiting signs and symptoms of normal pressure hydrocephalus. Which of the following symptoms would be seen?
Disturbances in gait
After evaluating the patient, the physician thinks that his elderly patient is exhibiting signs and symptoms of normal pressure hydrocephalus. Which of the following symptoms would be seen? a) Papilledema b) Headache c) Vomiting d) Disturbances in gait
Disturbances in gait In adults, slowly developing hydrocephalus may produce deficits such as progressive dementia and gait changes. The other options are symptoms of increased ICP seen in acute onset hydrocephalus.
A client affected by postural hypotension will likely display what symptoms?
Dizziness and pallor when moved to upright position
A patient with Alzheimer's disease (AD) is forgetful and has started to lose interest in social activities. Which of the following treatment routines would be beneficial for the patient?
Donepezil (Aricept) The cholinesterase inhibitor donepezil (Aricept) has been effective in slowing cognitive decline in early stages of AD.
A client's recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the client's levels of:
Dopamine
Which agency is responsible for the enforcement of controlled substances? U.S. Department of Justice Drug Enforcement Agency Department of Health and Human Services Food and Drug Administration
Drug Enforcement Agency Explanation: The Drug Enforcement Agency, a part of the U.S. Department of Justice, is the agency responsible for enforcing the control of substances with abuse potential. The FDA, an agency in the U.S. Department of Health and Human Services, is responsible for studying drugs and determining their abuse potential.
Prescription practices of primary health care providers for controlled substances are monitored by which agency? U.S. Pharmacopeia (USP) Food and Drug Agency (FDA) Drug Enforcement Agency (DEA) World Health Organization (WHO)
Drug Enforcement Agency (DEA)
Which statement best describes drug efficacy/toxicity in pediatric clients? Drug requirements for infants have been extensively studied. Drug dosage is altered by age and weight in children. Children always need smaller doses of medication than adults. Infants and children are always at greater risk for drug toxicity with any medication.
Drug dosage is altered by age and weight in children. Explanation: All aspects of pediatric drug therapy must be guided by the child's age, weight, and level of growth and development. Drug requirements for infants have not been extensively studied.
A client who sustained a complete C6 spinal cord injury 6 months ago has been admitted to the hospital for pneumonia. The nurse observes the client with diaphoresis above the level of C6 and the blood pressure is 260/140 mm Hg. What is the first intervention the nurse should provide?
Elevate the head of the bed
A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following?
Encephalitis
A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following?
Encephalitis Explanation: Less frequent causes of encephalitis include ingesting toxic substances such as lead. People experience neurologic disturbances such as lethergy, disorientation, seizures, focal paralysis, delirium and coma. Bacterial and viral meningitis are caused by bacterial and viral infections. Meningiomas are a type of brain tumor that are seen in the middle or later years of life.
A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following?
Encephalitis Less frequent causes of encephalitis include ingesting toxic substances such as lead. People experience neurologic disturbances such as lethergy, disorientation, seizures, focal paralysis, delirium and coma.
A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following? a) Encephalitis b) Bacterial meningitis c) Viral meningitis d) Meningioma
Encephalitis Less frequent causes of encephalitis include ingesting toxic substances such as lead. -People experience neurologic disturbances such as lethergy, disorientation, seizures, focal paralysis, delirium and coma. - Bacterial and viral meningitis are caused by bacterial and viral infections. -Meningiomas are a type of brain tumor that are seen in the middle or later years of life.
A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following?
Encephalitis.
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?
Encephalitis.
Pyrogens are substances that produce fever in the body. Substances such as bacterial products, bacterial toxins, or whole microorganisms enter the body and stimulate The host cells to produce certain mediators. What are these called?
Endogenous pyrogens
The CT scan report identified that a client with a skull fracture has developed a hematoma that resulted from a torn artery. The report would be interpreted as:
Epidural hematoma
The CT scan report identified that a client with a skull fracture has developed a hematoma that resulted from a torn artery. The report would be interpreted as: a) Epidural hematoma b) Intracranial hematoma c) Subdural hematoma d) Chronic subdural hematoma
Epidural hematoma An epidural hematoma is one that develops between the inner side of the skull and the dura, usually resulting from a tear in an artery, most often the middle meningeal, usually in association with a head injury in which the skull is fractured. -A subdural hematoma results from a torn vein; -chronic subdural hematoma is common in older persons: -brain atrophy causes the brain to shrink away from the dura and to stretch fragile bridging veins. - An intracranial hematoma occurs when a blood vessel ruptures within your brain or between your skull and your brain.
FDA approval of a drug for OTC availability includes: Analysis of the cost of the drug to the consumer. Evaluation of evidence that the consumer can use the drug safely, using information on the product label. Studies involving the safe use of the medication by the consumer. Analysis of the diagnoses for which the medication may be used by the consumer.
Evaluation of evidence that the consumer can use the drug safely, using information on the product label. Explanation: FDA approval of a drug for OTC availability involves evaluation of evidence that the consumer can use the drug safely, using information on the product label, and shifts primary responsibility for safe and effective drug therapy from health care professionals to consumers. With prescription drugs, a health care professional diagnoses the condition, often with the help of laboratory and other diagnostic tests, and determines a need for the drug.
Which of the following potentials, when combining a neurotransmitter with a receptor site, causes partial depolarization of the postsynaptic membrane?
Excitatory postsynaptic
Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?
Excitotoxic
Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?
Excitotoxic Excitotoxicity is a final common pathway for neuronal cell injury and death. It is associated with excessive activity of excitatory amino acid neurotransmitters.
Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?
Excitotoxic Explanation: Excitotoxicity is a final common pathway for neuronal cell injury and death. It is associated with excessive activity of excitatory amino acid neurotransmitters. Hypoxic injury involves oxygen deprivation. Ischemic injury is caused by a decrease of blood flow. Increased intracranial pressure may result in all three but is not caused by the excitotoxic effects.
Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?
Excitotoxic.
The nurse is preparing to administer a prescribed drug to a client with a history of renal disease. Why should the nurse anticipate administering a lower dose than for a client with healthy kidneys? Excretion is likely to take place slowly. The client likely has impaired drug metabolism. Distribution will be delayed, increasing the risk of adverse effects. Absorption will be increased because of fluid accumulation.
Excretion is likely to take place slowly. Explanation: If the kidneys are not functioning properly, a drug may not be excreted properly and could accumulate in the body. Metabolism may be altered if the client has liver disease, not kidney disease. Distribution would be most impacted by alteration in cardiovascular function causing reduced perfusion of the tissues. Absorption is most impacted by gastrointestinal alterations.
The nurse assessing for the doll's head response (doll's eye response) in an unconscious client documents which of the following as an abnormal response?
Eyes turn right when head is turned right
The nurse assessing for the doll's head response (doll's eye response) in an unconscious client documents which eye movement as an abnormal response?
Eyes turn right when head is turned right Explanation: The normal doll's head response (doll's eye response) is movement of the eyes in conjugate gaze to the opposite side or direction when the head is moved from side to side or up and down. An abnormal response is fixed position of the eyes or movement in the same direction as the head.
The nurse assessing for the doll's head response (doll's eye response) in an unconscious client documents which of the following as an abnormal response? a) Eyes turn up when head is tilted down b) Eyes turn toward right when head is turned to left c) Eyes turn right when head is turned right d) Eyes turn down when head is tilted up
Eyes turn right when head is turned right The normal doll's head response (doll's eye response) is movement of the eyes in conjugate gaze to the opposite side or direction when the head is moved from side to side or up and down. An abnormal response is fixed position of the eyes or movement in the same direction as the head.
Select the most appropriate pain assessment tool for a health care provider to use when caring for children between the ages of 3 to 7 years old.
Faces pain scale
The underlying causative problem in Parkinsonism is which of the following?
Failure of dopamine release
Bradykinesia occurring in Parkinson's disease places the Parkinson's client most at risk for which of the following?
Falls and injury
The adrenal medulla is innervated by parasympathetic nerve fibers.
False
A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused but is oriented to person and place but not time. What type of seizure did this client most likely experience? a) Focal seizure with impairment to consciousness b) Atonic seizure c) Tonic-clonic seizure d) Myoclonic seizure
Focal seizure with impairment to consciousness Focal seizures with impairment of consciousness, sometimes referred to as psychomotor seizures, are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common. -Atonic seizures are characterized by loss of muscle tone, and -myoclonic seizures involve brief involuntary muscle contractions induced by stimuli of cerebral origin. -With tonic-clonic seizures, formerly called grand mal seizures, a person has a vague warning (probably a simple focal seizure) and experiences a sharp tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness.
In response to the client's question about whether drugs are safe, the nurse explains that all medications in the United States undergo rigorous testing controlled by what organization? Food and Drug Administration (FDA) Drug Enforcement Agency (DEA) Centers for Disease Control and Prevention (CDC) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Food and Drug Administration (FDA) Explanation: The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met.
The nurse is educating the patient about potential negative effects with monoamine oxidase inhibitors (MAOIs). What type of foods should the nurse inform the patient to avoid? Foods high in iron Foods with gluten Foods high in vitamin D Foods high in tyramine
Foods high in tyramine Explanation: Negative effects from drug interactions are those that decrease the therapeutic effect or increase the adverse effects of a drug. Consuming foods high in tyramine while taking an MAOI can lead to pronounced elevation of blood pressure and may induce a hypertensive crisis.
The cerebral cortex is associated with which of the following structures?
Forebrain
Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a pregnant woman arranged for prenatal genetic testing, during which her child was diagnosed with DMD. As her son develops, the woman should watch for which of the following early signs that the disease is progressing?
Frequent falls and increased muscle size
The spinal cord contains the basic factors necessary to coordinate function when a movement is planned. It is the lowest level of function. What is the highest level of function in planning movement?
Frontal cortex
Following surgical removal of a large malignant brain tumor, the nurse should anticipate discussing which treatment option that allows delivery of high-dose radiation to deep tumors while sparing surrounding brain tissue?
Gamma knife radiation Explanation: Most malignant brain tumors respond to external irradiation. Irradiation can increase longevity and sometimes can allay symptoms when tumors recur. The treatment dose depends on the tumor's histologic type, responsiveness to radiation, and anatomic site and on the level of tolerance of the surrounding tissue. A newer technique called gamma knife combines stereotactic localization of the tumor with radiosurgery, allowing delivery of high-dose radiation to deep tumors while sparing the surrounding brain. Chemotherapy for brain tumors is somewhat limited by the blood-brain barrier, although in some cases it can be administered directly into the spinal canal.
Following surgery for a large malignant brain tumor, the nurse should anticipate discussing which further treatment option with the family that may ensure that any remaining cancer cells will be killed? a) Gamma knife radiation b) Immunotherapy c) Chemotherapy d) Stem cell transplant
Gamma knife radiation Most malignant brain tumors respond to external irradiation. Irradiation can increase longevity and sometimes can allay symptoms when tumors recur. The treatment dose depends on the tumor's histologic type, responsiveness to radiation, and anatomic site and on the level of tolerance of the surrounding tissue. A newer technique called gamma knife combines stereotactic localization of the tumor with radiosurgery, allowing delivery of high-dose radiation to deep tumors while sparing the surrounding brain.
The nurse is currently participating in phase IV of a clinical study of a chemotherapeutic drug. What action would the nurse be expected to perform during this phase of testing? Gathering data from clients taking the drug after it has been released to market. Recruiting a small number of healthy volunteers to take the drug. Administering the drug to clients who have a diagnosis of cancer. Publicizing the therapeutic benefits of the drug to cancer support groups.
Gathering data from clients taking the drug after it has been released to market.
A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence?
Headaches and poor concentration
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced which of the following?
Generalized seizure
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced:
Generalized seizure
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced which of the following?
Generalized seizure When seizure activity begins simultaneously in both cerebral hemispheres, it is considered a generalized seizure.
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced which of the following?
Generalized seizure.
What statement describes a required characteristic of all generic drugs? Generic drugs are required to be protected by a current American patent. Generic drugs are designated and patented exclusively by the manufacturer. Generic drugs are categorized according to overall usefulness and potential for abuse. Generic drugs must be therapeutically equivalent and less expensive than trade name drugs.
Generic drugs must be therapeutically equivalent and less expensive than trade name drugs.
What statement describes a required characteristic of all generic drugs? Generic drugs are required to be protected by a current American patent. Generic drugs are designated and patented exclusively by the manufacturer. Generic drugs are categorized according to overall usefulness and potential for abuse. Generic drugs must be therapeutically equivalent and less expensive than trade name drugs.
Generic drugs must be therapeutically equivalent and less expensive than trade name drugs. Explanation: Generic drugs must be therapeutically equivalent to the brand name drug and are usually less expensive. Generic drugs are categorized in the same fashion as are brand name drugs. The remaining statements are descriptive of brand name drugs.
true
Global or diffuse brain injury is manifested by changes in the level of consciousness. True False
A client is having an upper endoscopy to determine the presence of a gastric ulcer. After the procedure is performed, the nurse instructs the client that he cannot have anything to eat or drink until the return of the gag reflex. Which nerve is the nurse testing for return of function?
Glossopharyngeal
Nutrition students are studying the nervous system, which has a high rate of metabolism. Which of the following is its major fuel source?
Glucose
The nurse measures a blood glucose level of 40 mg/dL for a client with diabetes type I. Why would it be important for the nurse to institute an intervention to elevate the glucose level in this client?
Glucose is not stored in the brain and is a major fuel source for brain function.
A client is diagnosed with hypercholesterolemia and is prescribed a statin. As part of client education, the nurse should teach the client to avoid eating: grapefruit. cheese. chicken. corn.
Grapefruit
Which of the following disorders of neuromuscular function typically has the most rapid onset?
Guillain-Barr Syndrome
Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult:
Has had a gradual onset of weakness, headache and visual disturbances over the last two days. A cardinal trait of the manifestations of stroke is that the onset is sudden, and a gradual onset of symptoms over two days would suggest an alternative etiology.
Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult:
Has had a gradual onset of weakness, headache, and visual disturbances over the last two days.
A 9 year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate? a) "Does your son have a history of cancer?" b) "Has your son had any sinus or ear infections in the last little while?" c) "Was your son born with any problems that affect his bone marrow or blood?" d) "Is your son currently taking any medications?"
Has your son had any sinus or ear infections in the last little while?" The most common symptoms of acute bacterial meningitis are fever and chills; headache; stiff neck; back, abdominal, and extremity pains; and nausea and vomiting. Risk factors associated with contracting meningitis include otitis media and sinusitis or mastoiditis. -Particular medications, a history of neoplasm and hematopoietic problems would be unlikely to relate directly to his symptoms of meningitis.
A high school senior sustained a concussion during a football game. Which of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury?
Headaches and memory lapses
One of the phases of drug development is the post-marketing surveillance phase. Which activity is carried out during this phase? Health care providers report adverse effects to FDA. Healthy volunteers are involved in the test. In vitro tests are performed using human cells. The drug is given to clients with the disease.
Health care providers report adverse effects to FDA
A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with:
Hearing
A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts are likely responsible for his symptoms? a) Increased tissue perfusion at the site of the malformation. b) High pressure and local hemorrhage of the venous system. c) Hydrocephalus and protein in the cerebral spinal fluid. d) Localized ischemia with areas of necrosis noted on CT angiography.
High pressure and local hemorrhage of the venous system. Answer B is incorrect since arteriovenous malformation is associated with blood vessels and not the fluid within the ventricles of the brain. Answer D is incorrect in that there is blood flow to the area. Ischemia is associated with decreased arterial flow resulting in death to brain tissue. In arteriovenous malformations, a tangle of arteries and veins acts as a bypass between the cerebral arterial and venous circulation, in place of the normal capillary bed. However, the capillaries are necessary to attenuate the high arterial blood pressure before this volume drains to the venous system. As a result, the venous channels experience high pressure, making hemorrhage and rupture more likely; the lack of perfusion of surrounding tissue causes neurologic deficits such as learning disorders. Headaches are severe, and people with the disorder may describe them as throbbing (synchronous with their heartbeat). Increased tissue profusion means that more oxygenated blood is brought to the area which is not the case. The elevated arterial and venous pressures divert blood away from the surrounding tissue, impairing tissue perfusion.
Which factors will decrease the rate of drug absorption? Select all that apply. Increased blood flow rate Higher drug concentration in the circulatory system Drug given by a subcutaneous route versus an intramuscular route A disease that alters the stomach and small intestine lining
Higher drug concentration in the circulatory system Drug given by a subcutaneous route versus an intramuscular route A disease that alters the stomach and small intestine lining
A patient with memory loss is concerned about the possibility that it may be inherited. Which of the following disorders is an inherited dementia?
Huntington's disease
A patient with memory loss is concerned about the possibility that it may be inherited. Which of the following disorders is an inherited dementia?
Huntington's disease Huntington's disease is an inherited disorder with chorea and dementia.
A patient with memory loss is concerned about the possibility that it may be inherited. Which of the following disorders is an inherited dementia? a) Vascular dementia b) Wernicke-Korsakoff syndrome c) Frontotemporal dementia d) Huntington's disease
Huntington's disease Vascular dementia occurs as a result of brain injury from hemorrhage or occlusion. Frontotemporal dementia causes atrophy of the brain but is not hereditary. Wernicke-Korsakoff syndrome is a result of chronic alcoholism. Huntington's disease is an inherited disorder with chorea and dementia.
What is the most common cause of drug fever?
Hypersensitivity reaction to medication
A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing?
Hypoglossal
A client is unable to stick out his tongue as a result of injury to cranial nerve XII. The nurse recognizes that the client has sustained as damage to which nerve?
Hypoglossal
The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following?
Hypoxia produces a generalized depressive effect on the brain.
The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following?
Hypoxia produces a generalized depressive effect on the brain. Hypoxia denotes a deprivation of oxygen with maintained blood flow (perfusion), whereas ischemia is a situation of greatly reduced or interrupted blood flow. Hypoxia produces a generalized depressant effect on the brain. Ischemia interferes with delivery of oxygen and glucose as well as the removal of metabolic wastes.
The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following? a) Ischemia does not interfere with delivery of glucose. b) Ischemia denotes a deprivation of oxygen with maintained perfusion. c) Hypoxia denotes an interruption in blood flow. d) Hypoxia produces a generalized depressive effect on the brain.
Hypoxia produces a generalized depressive effect on the brain. Hypoxia denotes a deprivation of oxygen with maintained blood flow (perfusion), whereas ischemia is a situation of greatly reduced or interrupted blood flow. Hypoxia produces a generalized depressant effect on the brain. Ischemia interferes with delivery of oxygen and glucose as well as the removal of metabolic wastes.
A 9 year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. The nurse knows which of the following aspects of the nervous system listed below would her healthcare providers focus their diagnostic efforts?
Impaired function of her hypothalamus
The route medication must be given to achieve 100% bioavailability is given: IM. IV. PO. Sub q.
IV
Which of the following statements by the husband of a patient with Alzheimer disease demonstrates an accurate understanding of his wifes medication regimen?
Im really hoping these medications will slow down her mental losses
Which current multiple sclerosis drug treatments are designed to slow the progress of myelin degeneration?
Immunnomodulators
A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the clients' temperature is 102°F. Which other clinical manifestations may lead to the diagnosis of encephalitis?
Impaired neck flexion resulting from muscle spasm Like meningitis, encephalitis is characterized by fever, headache, and nuchal rigidity (impaired neck flexion resulting from muscle spasm), but more often clients also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma
A family is sitting with a patient in the intensive care unit who sustained significant head injuries in a motorcycle accident. They are questioning the nurse about why the patient's eyes open but do not stay open for long. The nurse explains that the patient is probably in which of the following states?
In a stuporous state due to a reticular activated system (RAS) injury Injury to the RAS would be suspected due to the change in the level of consciousness. The RAS and functional cerebral hemispheres are necessary for arousal and wakefulness; damage to either will negatively affect a person's level of consciousness.
A family is sitting with a patient in the intensive care unit who sustained significant head injuries in a motorcycle accident. They are questioning the nurse about why the patient's eyes open but do not stay open for long. The nurse explains that the patient is probably in which of the following states? a) In a stuporous state due to a reticular activated system (RAS) injury b) In a stuporous state due to acidosis c) In an obtunded state due to possible brain injury d) In an obtunded state due to a concussion
In a stuporous state due to a reticular activated system (RAS) injury Injury to the RAS would be suspected due to the change in the level of consciousness. The RAS and functional cerebral hemispheres are necessary for arousal and wakefulness; damage to either will negatively affect a person's level of consciousness.
Neurotransmitters are small molecules that exert their actions through specific proteins, called receptors, embedded in the postsynaptic membrane. Where are neurotransmitters synthesized?
In the axon terminal
A client has developed global ischemia of the brain. The nurse determines this is:
Inadequate to meet the metabolic needs of the entire brain
A client has developed global ischemia of the brain. The nurse determines this is:
Inadequate to meet the metabolic needs of the entire brain Global ischemia occurs when blood flow is inadequate to meet the metabolic needs of the entire brain. The result is a spectrum of neurologic disorders reflecting diffuse brain dysfunction.
A client has developed global ischemia of the brain. The nurse determines this is: a) Inadequate perfusion of the nondominant side of the brain b) Inadequate perfusion to the dominant side of the brain c) Inadequate perfusion of the right side of the brain d) Inadequate to meet the metabolic needs of the entire brain
Inadequate to meet the metabolic needs of the entire brain Global ischemia occurs when blood flow is inadequate to meet the metabolic needs of the entire brain. The result is a spectrum of neurologic disorders reflecting diffuse brain dysfunction.
A client has developed global ischemia of the brain. The nurse determines this is:
Inadequate to meet the metabolic needs of the entire brain.
Which of the following pathophysiologic processes occurs in cases of bacterial meningitis?
Inflammation allows pathogens to cross into the cerebrospinal fluid
In which of the following patients with a transecting spinal cord injury should the nurse anticipate an impaired ability for temperature regulation?
Injury at T2 Explanation: Spinal cord injuries that transect the cord at T6 or above can seriously impair temperature regulation because the Thermoregulatory centers in the hypothalamus can no longer control skin blood flow and sweating. T9, L4, and L1 injuries are below the level of T6 and do not impair the hypothalamus' ability to control skin blood flow and sweating.
Neurons that connect sensory and motor neurons are known as which of the following?
Interneurons
Which of the following neurons connect sensory and motor neurons?
Interneurons
Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end, or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus?
Intravenous lorazepam
Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end, or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus?
Intravenous lorazepam.
The health care provider is performing a spinal tap on a client with suspected infection. The provider would perform the procedure at:
L3 or L4
The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted?
Large number of polymorphonuclear neutrophils
The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted?
Large number of polymorphonulcear neutrophils Explanation: Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The CSF typically contains large numbers of polymorphonuclear neutrophils (up to 90,000/mm3), increased protein content, and reduced sugar content.
The region of the brain involved in emotional experience and control of emotional behavior is the:
Limbic system
The healthcare provider is obtaining a pain history from a client. Which information is most important to obtain? Select all that apply.
Localization, quality, self-report, intensity, pain onset
Based on assessment parameters for motor response on the Glasgow Coma Scale, to which client should the nurse assign a score of 5?
Localizes pain
The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advised by the nurse is most appropriate?
Many people find that maintaining regular eating and sleeping habits is beneficial
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:
Lumbar puncture
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:
Lumbar puncture The diagnosis of bacterial meningitis is confirmed with abnormal CSF findings. Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure.
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be: a) Lumbar puncture b) Sputum culture c) CT of the head d) Blood cultures
Lumbar puncture The diagnosis of bacterial meningitis is confirmed with abnormal CSF findings. Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The other options do not confirm the diagnosis.
What does the nurse need to do when there is any indication of an allergic reaction in clients? Obtain early warning of noncompliance in drug therapy. Increase the effectiveness of a specific medication. Maintain the client's safety during drug therapy. Reduce the risk of adverse effects during drug therapy.
Maintain the client's safety during drug therapy.
A client has been diagnosed with Guillain-Barre syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priority intervention when caring for this client?
Maintenance of the client's airway
The nurse is aware that the primary function of the sympathetic nervous system is:
Maintenance of vital functions and responding when there is a critical threat to the integrity of the individual
Brain edema and disturbances in blood flow Explanation: Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema. Blood pressure, either increased or decreased, is not a manifestation of a brain tumor.
Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors? -Tumor infiltration and increased blood pressure -Brain compression and decreased ICP -Brain edema and disturbances in blood flow -Tumor infiltration and decreased ICP
When involved in phase III drug evaluation studies, what action should the nurse perform? Work with animals who are given experimental drugs. Select appropriate clients to be involved in the drug study. Monitor and observe clients closely for adverse effects. Make decisions that will determine effectiveness of the drug.
Monitor and observe clients closely for adverse effects. Explanation: Phase III studies involve use of a drug in a vast clinical population in which clients are asked to record any symptoms they experience while taking the drugs. Nurses may be responsible for helping collect and analyze the information to be shared with the Food and Drug Administration (FDA) but would not conduct research independently because nurses do not prescribe medications. Use of animals in drug testing is done in the pre-clinical trials. Select clients who are involved in phase II studies to participate in studies where the participants have the disease the drug is intended to treat. These clients are monitored closely for drug action and adverse effects. Phase I studies involve healthy human volunteers who are usually paid for their participation. Nurses may observe for adverse effects and toxicity.
A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do? Monitor laboratory blood values. Place the client on protective isolation. Facilitate cardiac monitoring. Prepare the client for dialysis.
Monitor laboratory blood values.
The nurse is assessing a client with a traumatic brain injury and assesses for changes in which neurologic component? Select all that apply.
Motor function, cognition, level of consciousness, sensory function
Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of:
Multiple Sclerosis (MS)
The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition?
Muscle atrophy
The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition?
Muscle atrophy Explanation: Muscle atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.
Results of Peripheral Neuropathy:
Muscle weakness, with or without atrophy and sensory changes.
Muscular dystrophy is characterized by what pathophysiologic changes?
Muscular necrosis, with replacement with fat and connective tissue
A client has been brought to the emergency department following an overdose of insulin that resulted in unconsciousness. When explaining the rationale for this to the family, the nurse will emphasize that neurons:
Must rely on glucose from the blood to meet their energy needs
Disorder of transmission at the neuromuscular junction that affects communication between the motor neuron and the innervated muscle cell:
Myasthenia Gravis
The basal ganglia play a role in coordinated movements. Part of the basal ganglia system is the striatum, which involves local cholinergic interneurons. What disease is thought to be related to the destruction of the cholinergic interneurons?
Myasthenia gravis
Which of the following is the primary component of white matter?
Myelinated fibers
Which of the following peripheral nerve injuries will likely result in cellular death with little chance of regeneration?
Nerve fibers destroyed close to the neuronal cell body
During embryonic development, which of the following structures develops into the central nervous system (CNS)?
Neural tube
A client has a fever that was induced by damage to the hypothalamus due to intracranial bleeding. The nurse plans care for which type of fever?
Neurogenic
Which one of the following is the most common primary intracranial tumor in adults?
Neurogliomas or neoplasms of astrocytic origin Neurogliomas or neoplasms of astrocytic origin are the most common type of primary brain tumor in adults.
Hypoxic injury will result in which of the following effects on the brain?
Neuronal cell injury and death
Hypoxic injury will result in which of the following effects on the brain?
Neuronal cell injury and death Neuronal cell injury and death is directly caused by hypoxic injury. The others are specific to several other brain injury types.
Hypoxic injury will result in which of the following effects on the brain? a) Can be focal or global with only one part of the brain being underperfused or all of the brain being compromised b) Depends on the brain's compensatory mechanisms and the extent of the swelling c) Neuronal cell injury and death d) Clouding of consciousness, bilaterally small pupils (approximately 2 mm in diameter) with a full range of constriction, and motor responses to pain that are purposeful or semipurposeful (localizing) and often asymmetric
Neuronal cell injury and death Neuronal cell injury and death is directly caused by hypoxic injury. The others are specific to several other brain injury types.
A nurse has identified the half-life of drug that will be administered to a client for the first time. The nursing drug guide states the drug's half-life is 90 minutes. The nurse should identify what implication of this fact? Ninety minutes after drug levels peak, there will be 50% of the peak level In three hours, there will be no detectable levels of the drug presents in the client's body Drug levels will rise steadily after administration, reaching 50% of maximum concentration after 90 minutes Peak drug levels will be achieved 90 minutes after the drug is administered
Ninety minutes after drug levels peak, there will be 50% of the peak level Explanation: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half the peak level it previously achieved. In this case, 50% of peak levels will be achieved 90 minutes after the peak.
A two-day postoperative client's temperature was 98.5°F at 3:00 PM. At 6:00 PM, the unlicensed assistant (UAP) notifies the nurse that the client's temperature is 102°F. Which action should the nurse take?
Notify the physician
The nurse is preparing a client for oculovestibular reflex assessment (cold caloric test). The nurse explains that the test is used to elicit which of the following?
Nystagmus
The nurse is working in a community outreach clinic. What should the nurse teach a client about over-the-counter medications? The only risks of OTC medications are associated with overdoses and drug interactions. They are best used to enhance the effects of prescription medications. They are always more cost effective than prescription medications. OTC medications are not risk free.
OTC medications are not risk free. Explanation: Over-the-counter, or OTC, medications are those that can be purchased without a prescription. Because the individual can purchase these drugs without the guidance of a provider, it is important to read and follow the directions carefully to avoid self-harm. They pose numerous potential risks and can be costly.
pain transmission
PAG region also interacts with pontile noradrenergic neurons and the medullary nucleus raphe magnus (serotonin acts as NT) to block what?
A client asks if pain threshold and pain tolerance are the same. The best response by the healthcare provider would be:
Pain threshold is the point at which a stimulus is perceived as painful
Signs and Symptoms of Carpal Tunnel:
Pain, paresthesia, and numbness of the thumb and first two and one half digits of the hand; pain in the wrist and hand; decreased grip.
Disorders of the pyramidal tracts, such as a stroke, are characterized by:
Paralysis
A client who has experienced a spinal cord injury still has use of the arms and has impaired motor and sensory function of the trunk, legs, and pelvic organs. The injury would be classified as:
Paraplegia
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?
Parkinson Disease
What is a major disadvantage of using over-the-counter (OTC) medications? Cause increased visits to the health care practitioner. Consumers resist the effort to learn more about their condition. People may choose an OTC that interacts with another medication. There is a lack of autonomy.
People may choose an OTC that interacts with another medication. Explanation: Disadvantages of using an OTC include inaccurate self-diagnoses and potential risks of choosing a wrong or contraindicated drug, delayed treatment by a health care professional, and development of adverse drug reactions and interactions. Advances include greater autonomy, faster and more convenient access to effective treatment, possibly earlier resumption of usual activities of daily living, fewer visits to a health care provider, and possibly increased efforts by consumers to learn about their symptoms/conditions and recommended treatments.
Any primary disorder of the peripheral nerves:
Peripheral Neuropathy
For which common manifestation of acute meningococcal meningitis should the school nurse be assessing students?
Petechiae
A nurse working in radiology administers iodine to a client who is having a CAT scan. The nurse working on the oncology unit administers chemotherapy to clients who have cancer. At the Public Health Department, a nurse administers an MMR to a 14-month-old child as a routine immunization. Which branch of pharmacology best describes the actions of all three nurses? Pharmacoeconomics Pharmacotherapeutics Pharmacodynamics Pharmacokinetics
Pharmacotherapeutics
A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem?
Placement of a shunt
A patients recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem?
Placement of a shunt
As a client explains to the nurse what occurred prior to the onset of seizure activity, the client describes perceiving a feeling or warning that the seizure would occur. The nurse documents the perceived warning as which of the following?
Prodrome Explanation: The nurse should document the perception of a warning of impending seizure activity as a prodrome; it is also referred to as an aura.
A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. Which is the most accurate description? This drug:
Produces paralysis of the larynx muscles by blocking acetylcholine release
Death caused by muscular dystrophy in early adulthood is usually due to which of the following?
Respiratory and cardiac muscle involvement
A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which statement is most accurate?
Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus
There are two types of nervous tissue cells. One type is neurons, and the other type is the supporting cells. What is the function of the supporting cells?
Protect the nervous system and provide metabolic support for the neurons
A client began a new medication four days ago and presents with a temperature of 38.2° C (100.8 °F), dependent edema, and swollen cervical lymph nodes. The nurse has informed the client's provider, who has discontinued the medication. What subsequent intervention should the nurse prioritize? Provide supportive care to manage fever and inflammation. Administer subcutaneous epinephrine as prescribed. Initiate emergency resuscitation measures. Administer naloxone as prescribed.
Provide supportive care to manage fever and inflammation.
A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this?
Psychological manifestation due to involvement of white matter of cerebral cortex
A client experiencing deep somatic pain would manifest which clinical symptoms? Select all that apply.
Radiation of pain, pain reproduced by stimuli
Following a car accident that has resulted in partial amputation of the lower limbs, the client's body has implemented a compensatory mechanism releasing antidiuretic hormone (ADH) into the blood stream, causing retention of water and vasoconstriction of blood vessels. This is accomplished as a result of:
Rapid axonal transport of ADH from the hypothalamus into the posterior pituitary
A client has started having uncontrolled seizures that are not responding to usual medications. Nurses working with the client must pay special attention to which priority aspects of this client's care? Assessment of:
Respiratory status and oxygen saturation
The nurse is preparing a medication that is new to the market and cannot be found in the nurse's drug guide. How should the nurse obtain the most reliable information about this medication? Read the package insert. Consult a clinical nurse specialist or an experienced nurse. Consult the FDA website. Consult the member of the care team who prescribed the drug.
Read the package insert
Nystagmus due to cerebellar dysfunction would most likely interfere with which activity?
Reading
Neurotransmitters exert their actions through specific proteins that are known as:
Receptors
A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following?
Recurrence of primary CNS lymphoma
A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following? a) Recurrence of primary CNS lymphoma b) Onset of early dementia c) Decrease in intracranial pressure d) AIDS-induced encephalopathy
Recurrence of primary CNS lymphoma Primary CNS lymphoma has a higher incidence in people who are immunocompromised and who also have a high rate of recurrence in spite of treatment. The most common symptoms include behavioral and cognitive changes that occur in about 43% of the cases. There is no information in the question to support any of the other options.
A client has started having uncontrolled seizures that are not responding to usual medications. Nurses working with the client must pay special attention to which priority aspects of this client's care? Assessment of:
Respiratory status and oxygen saturation Explanation: Tonic-clonic status epilepticus is a medical emergency and, if not promptly treated, may lead to respiratory failure and death. Treatment consists of appropriate life support measures. Airway/breathing is always the priority in this emergency situation.
What is not a responsibility of the nurse administering a controlled substance to a hospitalized client? Administering them only to people for whom they are prescribed Renewing expired controlled substance prescriptions Recording on agency narcotic sheets each dose given Reporting discrepancies to the proper authorities
Renewing expired controlled substance prescriptions Explanation: Only a health care provider or nurse practitioner can write prescriptions for medications, including controlled drugs. Additionally, controlled drug prescriptions must be rewritten; they cannot be renewed.
The nursing assistant reports to the registered nurse that a client with a brain tumor has a blood pressure of 180/100 mm Hg and a pulse of 50 bpm. Which action is the correct nursing intervention?
Report to physician the client's signs of increased intracranial pressure. Explanation: Hypertension, together with bradycardia and a widened pulse pressure make up the Cushing reflex, an indicator of increased intracranial pressure that should be reported to the physician.
The nurse observes a new nurse performing the test for Kernig's sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:
Resistance should be provided with the knee in a flexed position
The nurse observes a new nurse performing the test for Kernig's sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:
Resistance should be provided with the knee in a flexed position.
A nurse at a long term care facility provides care for an 85 year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIA's:
Resolve rapidly but may place the client at an increased risk for stroke. TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature and their effects are not normally cumulative. They may require treatment medically or surgically.
A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of:
Respiratory status and oxygen saturation Tonic-clonic status epilepticus is a medical emergency and, if not promptly treated, may lead to respiratory failure and death. Treatment consists of appropriate life support measures. Airway/breathing is always the priority in this emergency situation.
A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of: a) Ability to grasp hands and squeeze on command b) ECG for arrhythmias c) Respiratory status and oxygen saturation d) Urine output and continence
Respiratory status and oxygen saturation Tonic-clonic status epilepticus is a medical emergency and, if not promptly treated, may lead to respiratory failure and death. Treatment consists of appropriate life support measures. Airway/breathing is always the priority in this emergency situation
A patient with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the patient has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this patient's immediate care?
Respiratory support and protection of the patient's airway
A patient is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this patient will focus on which priority intervention for this patient?
Respiratory ventilation assessment and prevention of aspiration pneumonia
Which of the following afferent (sensory) neurons in the dorsal root ganglia innervate specialized gut-related receptors, such as taste buds and receptors of olfactory mucosa?
Special visceral afferents
A parent brought her 8-year-old child to the emergent care center to be examined following a fall off a playground set, resulting in a head injury. On discharge, the nurse explains to the parent that some symptoms may continue, including the inability to remember what happened before the fall. Which of the following terms best describes the diagnosis?
Retrograde amnesia The loss of memory following a concussion can be part of the postconcussion syndrome. The term for loss of memory before the accident is retrograde amnesia.
The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:
Rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet
The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:
Rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet Decerebrate (extensor) posturing results from increased muscle excitability. It is characterized by rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet.
The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:
Rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet.
A 45 year old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system, then the nurse can educate the patient that the venous blood supply to the penis is controlled by:
Sacral parasympathetic fibers.
Which types of cells are supporting cells of the peripheral nervous system?
Schwann cells
A 7 year old child had an emergency appendectomy during the night. When trying to assess their pain, the nurse should:
Show them a scale with faces of actual children and have them point to the picture that best describes how they are feeling.
A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which of the following abnormalities in the patient's gait?
Slow to start walking and has difficulty when asked to "stop" suddenly
The emergency department nurse is caring for a patient who fell and had a head injury. Which of the following assessments would be noted during the early stage of intracranial pressure increase?
Stable vital signs The vital signs remain unchanged in the early stage of increased intracranial pressure.
The emergency department nurse is caring for a patient who fell and had a head injury. Which of the following assessments would be noted during the early stage of intracranial pressure increase? a) Vomiting b) Hemiplegia c) Nonreactive pupils d) Stable vital signs
Stable vital signs The vital signs remain unchanged in the early stage of increased intracranial pressure. The remaining options are characteristic of late signs.
While sponging a client who has a high temperature, the nurse observes the client begins to shiver. At this point, the priority nursing intervention would be to:
Stop sponging the client and retake a set of vital signs
The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms?
Stupor
The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which symptom?
Stupor Explanation: The most frequent sign of brain dysfunction is an altered level of consciousness such as stupor. Pupils that react to light, wheezing, and chest pain are not symptoms of brain function.
The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms?
Stupor The most frequent sign of brain dysfunction is an altered level of consciousness such as stupor.
What term is used to describe a level of consciousness that sees a client responding only to vigorous and repeated stimuli and has minimal or no spontaneous movement?
Stupor Stupor is unresponsive except to vigorous and repeated stimuli; responds appropriately to painful stimuli; lies quietly with minimal spontaneous movement; may have incomprehensible sounds and/or eye opening.
The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms? a) Wheezing b) Chest pain c) Stupor d) Pupils that react to light
Stupor The most frequent sign of brain dysfunction is an altered level of consciousness such as stupor. Pupils that react to light, wheezing and chest pain are not symptoms of brain function.
The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms?
Stupor.
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following?
Subarachnoid hemorrhage
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with:
Subarachnoid hemorrhage Explanation: The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following?
Subarachnoid hemorrhage The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following? a) Encephalitis b) Subarachnoid hemorrhage c) Thrombotic stroke
Subarachnoid hemorrhage The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following?
Subarachnoid hemorrhage.
Which of the following are examples of drugs with local effects? Select all that apply. Sunscreen Cold sore medicine Antihypertensive Oral diabetes drugs Wart medicine
Sunscreen Cold sore medicine Wart medicine Explanation: Medications may be given for local or systemic effects. Drugs with local effects act mainly at the site of application. Those with systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventually eliminated from the body.
Neurons communicate with each other through which of the following structures?
Synapses
A nurse at a long-term care facility provides care for a client who has had recent transient ischemic attacks (TIAs). What significance should the nurse attach to the resident's TIAs?
TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke.
A client is experiencing acute pain. The nurse would anticipate the client to manifest:
Tachycardia
The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. Which strategies would be best for the nurse to implement? Select all that apply.
Television, music, games, Bubbles
Which of the following is the lobe of the brain with functions of perception, long-term memory, and recognition of auditory stimuli?
Temporal lobe
The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to non-pharmacologic therapy?
Tension
Since 1962, newly developed drugs have been extensively tested before being marketed for general use. What do drug companies do to test drugs initially? Test the drugs with animals. Test the drugs with humans. Test the drugs in a controlled laboratory experiment. Test the drugs on volunteers.
Test the drugs with animals.
Since 1962, newly developed drugs have been extensively tested before being marketed for general use. What do drug companies do to test drugs initially? Test the drugs with animals. Test the drugs with humans. Test the drugs in a controlled laboratory experiment. Test the drugs on volunteers.
Test the drugs with animals. Explanation: Since 1962, newly developed drugs have been extensively tested before being marketed for general use. Initially, drugs are tested in animals, and the FDA reviews the test results. Next, clinical trials in humans are done, usually with a randomized, controlled experimental design that involves selection of subjects according to established criteria, random assignment of subjects to experimental groups, and administration of the test drug to one group and a control substance to another group.
The nurse is aware that some drugs may be prevented from entering the brain as a function of:
The blood-brain barrier
The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be:
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid
The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be:
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.
The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be:
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Explanation: Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes.
The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be:
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space.
The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be: a) Normal physiologic circumstances result in decreased adsorption of CSF. b) There is a decrease in the amount of fluid volume in the brain. c) The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. d) There is an increase in the production of cerebral spinal fluid volume.
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes. (less
The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be: a) There is a decrease in the amount of fluid volume in the brain. b) There is an increase in the production of cerebral spinal fluid volume. c) Normal physiologic circumstances result in decreased adsorption of CSF. d) The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.
The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes.
An adult client has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which aspect of the client's history would be considered to have contributed to his stroke?
The client's blood pressure has historically been in the range of 150s/90s.
referred
pain that originates in a visceral organ but is perceived elsewhere in the body wall that is innervated by neurons entering the same segment of the nervous system
During class, the instructor asks students to explain the pathophysiology behind development of multiple sclerosis. Which student gave the most accurate description?
The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction
During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description?
The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction
A nurse is providing education to a client newly diagnosed with Guillain-Barre' syndrome. Which statement reflects accurate information about the course of the disease?
The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process
A drug is undergoing Phase III testing. During this phase, what activity will take place? The drug will be released for public use. The drug will be given to a large number of subjects. A few doses will be given to a small number of volunteers. The manufacturer will file an application with the Food and Drug Administration (FDA).
The drug will be given to a large number of subjects. Explanation: In Phase III, the drug is given to a larger and more representative group of subjects. In Phase II, a few doses are given to a certain number of subjects with the disease or symptom for which the drug is being studied, and responses are compared with those of healthy subjects. Public use follows Phase IV. The FDA is approached to review animal testing in preparation of human testing in Phase 0.
A nurse is teaching a client about the pharmacotherapeutics of the hormone replacement therapy that the client has been prescribed. What topic should the nurse address? The effect of the drug on the client's body The way that the client's body processes hormones The processes of absorption and elimination Safe and effective methods for drug administration
The effect of the drug on the client's body
The nurse is caring for a client who is receiving Gentamycin, 250 mg, and Diflucan, 500 mg at the same time. What effect should the nurse anticipate if these two drugs compete with each other for protein binding sites? Gentamycin will be metabolized faster than usual Risks of adverse drug effects will increase Potential positive benefits of each drug will cancel each other out The effectiveness of both drugs will be altered
The effectiveness of both drugs will be altered Explanation: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Metabolism will not be increased, and this does not mean the drugs' effects cancel each other out. Similarly, competition for binding sites does not result in an increased risk of adverse effects.
-Lumbar puncture Explanation: The diagnosis of bacterial meningitis is confirmed with abnormal CSF findings. Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The other options do not confirm the diagnosis.
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be: -Lumbar puncture -Blood cultures -CT of the head -Sputum culture
A nurse is discussing how vascular dementia differs from Alzheimer disease with a client. Select the most appropriate information. a) The main presenting symptom of vascular dementia is slow psychomotor function. b) Alzheimer disease most often presents with a rapid onset of memory loss followed by slowly progressive dementia that has a course of several years. c) Vascular dementia develops between the ages of 35 and 45. d) Vascular dementia is caused by neuritic (senile) plaques.
The main presenting symptom of vascular dementia is slow psychomotor function. The main presenting symptom of vascular dementia is slow psychomotor function. Alzheimer disease has been linked to neuritic plaque and has a slow onset. Vascular dementia usually manifests at age 50 or beyond.
-Assess for other signs/symptoms of increased intracranial pressure. Explanation: The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first? -Assess for other signs/symptoms of increased intracranial pressure. -Assess for signs/symptoms of cerebrovascular accident (stroke). -Contact physician for anti-nausea medication orders. -Document the finding as it is an expected symptom.
-The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Explanation: Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes.
The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be: -The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. -There is an increase in the production of cerebrospinal fluid volume. -Normal physiologic circumstances result in decreased adsorption of CSF. -There is a decrease in the amount of fluid volume in the brain.
-You may still regain use of this arm, and these exercises may help with this recovery. -These exercises help to prevent painful shoulder complications after a stroke. -We want to ensure your shoulder joint remains flexible while you recover. Explanation: Passive range-of-motion exercises help to maintain joint function and to prevent edema, shoulder subluxation, and muscle atrophy. They also may help to reestablish motor patterns. Recovery of motor function can continue over the first few months of stroke, so the level of disability is not yet known for this client. Telling the client to be positive is dismissive of the feelings being expressed. Arterial occlusion is not prevented by doing range-of-motion exercises.
The nurse is performing passive range-of-motion exercises with a client who suffered an ischemic stroke 2 weeks ago and has hemiparesis. The client says, "What is the point of doing these exercises if I will never be able to use that arm again?" What should the nurse include when responding to the client? Select all that apply. - You may still regain use of this arm, and these exercises may help with this recovery. - These exercises help to prevent painful shoulder complications after a stroke. - Doing these exercises helps to prevent blood clots from forming in the arteries of your arm. - It is important for you to keep a positive outlook as it will help with your recovery. - We want to ensure your shoulder joint remains flexible while you recover.
-Deep vein prophylaxis -Falls prevention -Swallowing precautions Explanation: Early hospital care for the client with ischemic stroke requires careful prevention of aspiration, deep vein thrombosis, and falls. Most clients with stroke are not disoriented. Stroke prevention education would be a priority closer to the time of discharge rather than in the acute phase of recovery.
The nurse is planning care for a client in the acute recovery phase after an ischemic stroke. What interventions will the nurse prioritize when planning care? Select all that apply. -Deep vein prophylaxis -Falls prevention -Swallowing precautions -Reorientation exercises -Stroke prevention education
What behavior demonstrates that a nurse is using knowledge for safe patient care under Quality and Safety Education for Nurses (QSEN) competencies when administering medications? The nurse keeps the computer printout of medications to refer to when pulling out medications that are due. Consults with the pharmacist about possible adverse reactions to a newly approved drug. Makes suggestion for feature to be included on a new drug dispensing system. Searches drug databases for effective patient education materials.
The nurse keeps the computer printout of medications to refer to when pulling out medications that are due. Explanation: QSEN delineates safe practices. The nurse should not rely on memory to administer medications, and should have strategies to reduce reliance on memory. The nurse engages in teamwork and collaboration when consulting the pharmacist. Appropriate use of technology is demonstrated when researching information and making suggestions relates to quality improvement.
-High dose irradiation exposure -polycinyl chlroide exposure Explanation: Risk factors for brain tumors include high-dose irradiation and acquired immune suppression and should be included by the nurse when discussing brain tumor prevention. Polyvinyl chloride exposure and head trauma have not been convincingly demonstrated to increase the risk of brain tumors.
The nurse planning a community education class on brain tumors and their prevention should include which risk factors in the presentation? Select all that apply. -High dose irradiation exposure -Acquired immune suppression -Polyvinyl chloride exposure -Head trauma
Which medication-related situation is not a result of the Durham-Humphrey Amendment? A nurse practitioner assesses a client prior to prescribing medication for a sinus infection. A nurse calls the client's health care provider to adjust the dosage of a prescribed analgesic. The nurse regularly follows the 5 rights of medication administration when caring for assigned clients. A pharmacist re-enforces information about possible side effects before dispensing a medication to a clinic client.
The nurse regularly follows the 5 rights of medication administration when caring for assigned clients Explanation: The Durham-Humphrey Amendment designates drugs that must be prescribed by a licensed physician or nurse practitioner and dispensed by a pharmacist. While an expected practice of medication administration, following the 5 rights is not associated with the Durham-Humphrey Amendment.
Following a spinal cord injury suffered in a motor vehicle accident, a 22 year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged?
The outer layer (neolayer)
The nurse is caring for a patient who is taking bisoprolol, a cardioselective beta blocker. She expects that the patient will have a drop in blood pressure, but during her assessment of the patient she notes the blood pressure to be 210/112, which is elevated. What is the explanation of this reaction? The patient did not take the medication as prescribed. The medication was metabolized too quickly, and therefore no response occurred. The patient had an idiosyncratic response to the medication, causing the opposite effect. The patient's genetic makeup causes the body to be unresponsive to this medication.
The patient had an idiosyncratic response to the medication, causing the opposite effect.
The spinal cord does not hang freely within the spinal column. What is it supported by?
The pia mater and the denticulate ligaments
A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items?
The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron
The nurse is assessing factors that may affect the absorption of a drug that the nurse will soon administer. What factor should the nurse prioritize? The client's blood urea nitrogen and creatinine levels The route of administration that has been prescribed The client's liver enzyme levels The date on which the client began taking the medication
The route of administration that has been prescribed Explanation: Drug absorption is influenced by the route of administration. IV administration is the fastest method; drug absorption is slower when given orally. Kidney function impacts excretion, liver function impacts metabolism. The length of time the client has been taking the drug has no appreciable effect on absorption.
"You should remind the patient to shower." Explanation: The patient should be reminded to shower because most likely he or she has difficulty remembering to do so. In the moderate stage of Alzheimer's disease, which can last for several years, it is not unusual for hygiene to be neglected because the person may just not remember if he or she did or did not shower. There is no information in the question to support the remaining responses.
The spouse of a patient diagnosed with Alzheimer's disease asks the nurse why the patient often neglects to take a shower. The spouse states that the patient was always diligent with hygiene in the past; however, over the past few months that has not been the case. Which of the following is the nurse's best response? "The patient just does not care anymore." "The patient would be fine without showering." "The patient is experiencing a temporary relapse." "You should remind the patient to shower."
The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as:
The withdrawal reflex is activated.
Drugs are classified according to what standard? Their effects on particular body systems, therapeutic uses, and chemical characteristics The manufacturer of the drug, as well as their impact on therapy regimens The effectiveness of the drug and the process of distribution Their historical and geographical origin
Their effects on particular body systems, therapeutic uses, and chemical characteristics Explanation: Drugs are classified according to their effects on particular body systems, therapeutic uses, and chemical characteristics. None of the other statements accurately describe the standards used to classify drugs.
Disorders of the pyramidal tracts, such as a stroke, are characterized by:
paralysis
Which are true of nonprescription drugs? (Select all that apply.) They require a prescription to obtain. They are referred to as over-the-counter drugs. They can be taken without risk to the client. They have certain labeling requirements. They should be taken only as directed on the label.
They are referred to as over-the-counter drugs. They have certain labeling requirements. They should be taken only as directed on the label.
Which are true of nonprescription drugs? (Select all that apply.) They require a prescription to obtain. They are referred to as over-the-counter drugs. They can be taken without risk to the client. They have certain labeling requirements. They should be taken only as directed on the label.
They are referred to as over-the-counter drugs. They have certain labeling requirements. They should be taken only as directed on the label. Explanation: Nonprescription drugs are often referred to as over-the-counter (OTC) drugs. They do not require a prescription but do not come without risk to the client. The federal government has imposed labeling requirements of OTC drugs and should only be taken as directed on the label unless under the supervision of a health care provider.
A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the healthcare team is preparing to administer a synthetic tissue plasminogen activator for which purpose?
Thrombolysis
A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which purpose?
Thrombolysis Explanation: Synthetic tissue plasminogen activators work with the body's natural tissue plasminogen activators to convert plasminogen to plasmin, which breaks down clots to allow for the reestablishment of blood flow. There are two causes of strokes: hemorrhagic and thrombotic, with thrombotic strokes occurring much more frequently. Thrombolytics play a large role in increased outcomes seen with thrombotic strokes.
A patient suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which of the following purposes?
Thrombolysis Synthetic tissue plasminogen activators work with the body's natural tissue plasminogen activators to convert plasminogen to plasmin, which breaks down clots to allow for the reestablishment of blood flow. There are two causes of strokes: hemorrhagic and thrombotic, with thrombotic strokes occurring much more frequently. Thrombolytics play a large role in increased outcomes seen with thrombotic strokes.
A patient suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which of the following purposes? a) Hemolysis b) Hemostasis c) Thrombolysis d) Thrombogenesis
Thrombolysis Synthetic tissue plasminogen activators work with the body's natural tissue plasminogen activators to convert plasminogen to plasmin, which breaks down clots to allow for the reestablishment of blood flow. There are two causes of strokes: hemorrhagic and thrombotic, with thrombotic strokes occurring much more frequently. Thrombolytics play a large role in increased outcomes seen with thrombotic strokes.
A patient suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which of the following purposes?
Thrombolysis.
The most common cause of an ischemic stroke is which of the following?
Thrombosis
The most common cause of an ischemic stroke is which of the following?
Thrombosis Thrombi are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels.
The most common cause of an ischemic stroke is which of the following? a) Thrombosis b) Cardiogenic embolus c) Intracerebral arterial vasculitis d) Vasospasm
Thrombosis Thrombi are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels.
The most common cause of an ischemic stroke is which of the following?
Thrombosis.
The most common cause of ischemic stroke is:
Thrombosis. Ischemic stroke includes those caused by large artery thrombosis (20%), small artery thrombosis (25%), cardiogenic embolism (20%) and cryptogenic (undetermined cause)(30%), making thrombosis the most common cause (45%).
Diagnosis of Carpal Tunnel:
Tinned sign--the development of tingling sensation radiating into the palm of the hand that is elicited by light percussion over the median nerve of the wrist.
Why does the nurse need to be alert for any indication of an allergic reaction in clients? To obtain early warning of noncompliance in drug therapy To increase the effectiveness of a specific medication To maintain the client's safety during drug therapy To reduce the risk of adverse effects during drug therapy
To maintain the client's safety during drug therapy
The sympathetic and the parasympathetic nervous systems are continuously at work in our bodies. This continual action gives a basal activity to all parts of the body. What is this basal activity referred to as?
Tone
A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing:
Transient Ischemic Attack (TIA)
A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing:
Transient ischemic attack (TIA) Explanation: Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.
A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing:
Transient ischemic attack (TIA) Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit.
A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: a) Transient ischemic attack (TIA) b) Lacunar infarct c) Cardiogenic embolic stroke d) Thrombotic stroke
Transient ischemic attack (TIA) Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.
A patient is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on:
UPPER and LOWER motor neurons
The nurse teaches a client about a new diagnosis of astrocytoma. Which statement indicates an accurate understanding?
Treatment is hard since glial cells support neurons and blood vessels in the brain.
A client comes to the emergency department stating she is having severe pain on the left side of her face. The client states that the pain started after being outdoors in the cold. The nurse observes lacrimation of the right eye. Which nerve does the nurse recognize is affected?
Trigeminal
A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain?
Trigeminal neuralgia
Global or diffuse brain injury is manifested by changes in the level of consciousness.
True
The arachnoid membrane is the middle layer of the three meninges.
True
The vertebral column provides protection for the spinal cord, spinal nerves, and supporting structures.
True
Global or diffuse brain injury is manifested by changes in the level of consciousness.
True Global brain injury nearly always results in altered levels of consciousness, ranging from inattention to stupor or coma.
Global or diffuse brain injury is manifested by changes in the level of consciousness. a) False b) True
True Global brain injury nearly always results in altered levels of consciousness, ranging from inattention to stupor or coma.
A client has experienced the α1-receptor stimulation. The nurse would assess the client for:
Vasoconstriction
Dopamine is an intermediate compound made during the synthesis of norepinephrine. It is the principal inhibitory transmitter of the internuncial neurons in the sympathetic ganglia. What other action does it have?
Vasodilates renal and coronary blood vessels when given intravenously
A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology?
Vasogenic edema Vasogenic edema occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and protein from the vascular into the interstitial space. It occurs in conditions such as tumors, prolonged ischemia, hemorrhage, brain injury, and infectious processes.
Autonomic dysreflexia (autonomic hyperreflexia) is characterized by which of the following?
Vasospasms and hypertension
The nurse has just completed an assessment on a client admitted with Guillain-Barré syndrome. The nurse determines that a priority of care will be:
Ventilatory assessment and support
A 21 year old male is brought to the ED following a night of partying in his fraternity. His friends found him "asleep" and couldn't get him to respond. They cannot recall how many alcoholic beverages he drank the night before. While educating a student nurse and the roommates in the fraternity, the nurse begins by explaining that alcohol is:
Very lipid soluble and rapidly crosses the blood-brain barrier.
Ion channels in nervous system cells generate action potentials in the cells. What are the ion channels guarded by?
Voltage-dependent gates
A patient has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this patients diagnosis?
Weakness in the muscular wall of an artery
In myasthenia gravis, periods of stress can produce myasthenic crisis. When does myasthenic crisis occur?
When muscle weakness becomes severe enough to compromise ventilation
What would the nurse identify as the desired response of the combination of codeine and acetaminophen rather than each given separately? The drugs will do the same thing given separately as they would with the combination. The analgesic effect of the drug will be decreased with the combined drugs. When the drugs are combined, the additive effect is better control of pain. The combination of the drugs will have an antagonistic effect, and the patient will have decreased pain control.
When the drugs are combined, the additive effect is better control of pain.
-Brudzinski sign and Kernig sign Explanation: Two assessment techniques can help determine whether meningeal irritation is present. Kernig sign is resistance to extension of the knee while the person is lying with the hip flexed at a right angle. Brudzinski sign is elicited when flexion of the neck induces flexion of the hip and knee.
When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present? -Kernig sign and Chadwick sign -Brudzinski sign and Kernig sign -Brudzinski sign and Chadwick sign -Chvostek sign and Guedel sign
Which of the following types of reflex is stimulated by a nociceptive stimulus?
Withdrawal reflex
first
______-order neurons & their receptors detect painful stimuli
second
______-order neurons in spinal cord process information & transmit it to reticular formation & thalamus
third
______-order neurons project pain information to somatosensory cortex where perception & subjective meaning of pain take place
A client's most recent laboratory result indicates an elevated potassium level. What drug in this client's medication regimen should the care team consider discontinuing? a diuretic a narcotic an antipsychotic an antianxiety agent
a diuretic
phantom limb pain
a neurologic pain that follows amputation of a limb
analgesia
absence of pain
analgesia
absence of pain on noxious stimulation or relief of pain without loss of consciousness
cluster headache
accompanied by conjunctival injection (redness) or lacrimation (tearing), ipsilateral nasal congestion, eyelid edema, or forehead/facial sweating
Myasthenia gravis is characterized by muscle weakness caused by antibody-mediated destruction of:
acetylcholine receptors
glutamate
acts quickly but lasts only a few sec
A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to:
administer IV tissue plasminogen activator (tPA). Explanation: tPA administration is the treatment of choice for an ischemic stroke after confirmation that it is not a hemorrhagic stroke. Monitor vital signs and provide pain relief to prevent complications.
cluster headache
affects men more than weomen
cluster (headache)
affects men more than women; episodic occurrences
primary (somatosensory) cortex
akapostcentral gyrus
Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?
altered level of consciousness
The route of medication administration can change dependent on client factors. Therefore, the route of medication administration is: Never included in the "five rights" of medication administration. Always included in the "five rights" of medication administration. Frequently included in the "five rights" of medication administration. Sometimes included in the "five rights" of medication administration.
always included in the "five rights" of medication administration.
proprioceptive receptors
are found in muscles, tendons & joint capsules
dermatome maps
are used to assess level/extent of damage to segmental nerves &/or spinal cord
PAG (periaqueductal gray) region
area of the midbrain with ↑[opioid receptors] & with descending connections to the brainstem & spinal cord
A patient with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:
arms
A client has not experienced the desired therapeutic effects of a medication. When considering factors that may affect the dynamic equilibrium that influences drug concentration, the nurse should: Assess for factors that may reduce absorption. Review the client's electrolyte levels. Educate the client about drug-drug interactions. Assess the client for adverse effects
assess for factors that may reduce absorption.
The spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should:
assess the client for additional signs/symptoms of increased intracranial pressure. Explanation: Since decreased alertness and/or drowsiness can be an early sign of increased intracranial pressure, the nurse should assess for additional signs/symptoms of increased intracranial pressure. Then, once the assessment is complete, the nurse should contact the physician as needed. There is no indication that the client will undergo EEG testing at this time and the spouse should not be instructed to keep the client awake.
pain threshold
associated with tissue damage & point at which stimulus is received
The nurse is caring for a client experiencing a seizure. During the seizure the nurse notes that the client repetitively rubs his/her clothing. When contacting the client's physician, the nurse notes that the client exhibited:
automatisms. Explanation: The nurse reports that the client exhibited automatisms, defined as repetitive nonpurposeful activities such as lip smacking, grimacing, patting and/or rubbing clothing.
The nurse is caring for a client experiencing a seizure. During the seizure the nurse notes that the client repetitively rubs his/her clothing. When contacting the client's physician, the nurse notes that the client exhibited:
automatisms. The nurse reports that the client exhibited automatisms, defined as repetitive nonpurposeful activities such as lip smacking, grimacing, patting and/or rubbing clothing.
thalamic neuron
axon reaches the somatosensory cortex of parietal lobe
thalamus
basic sensation of pain occurs at level of _______
(somatosensory) association area
behind primary somatosensory cortex
The cardinal symptoms of Parkinson disease include:
bradykinesia
nociceptors
bradykinin, histamine, serotonin, & K activate & sensitize
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:
brain death
An elderly patient has been brought to his primary care provider by his wife who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the patients gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This patient requires further assessment for which of the following health problems?
cerebellar disorders
The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:
cerebrospinal fluid
A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:
characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing. Explanation: Expressive or nonfluent aphasia is characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing. Conduction aphasia manifest as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency. Anomic aphasia is speech that is nearly normal except for difficulty with finding singular words. Wernicke aphasia is characterized by an inability to comprehend the speech of others or to comprehend written material.
A nurse determines that medications are known by different names.What are the different classifications of names assigned to medications? Select all that apply. chemical name generic name trade name metabolic name off brand name
chemical name generic name trade name
A nurse determines that medications are known by different names.What are the different classifications of names assigned to medications? Select all that apply. chemical name generic name trade name metabolic name off brand name
chemical name generic name trade name Explanation: Medications have several names assigned to them: a chemical name, a generic (nonproprietary, official) name, and a trade (or brand) name. Off-brand names or metabolic names are not used to classify medications.
unmyelinated
chemical or chronic mechanical/thermal stimuli
second-order neurons
communicate with spinal reflexes & ascending tract from spinal cord → thalamus
slower
conduction of thermal information is (faster/slower) than the rapid tactile tracts
The moderate stage of the progressive degenerative Alzheimer-type dementia is manifested by behaviors that include:
confusion
hyperpathia
continued stimulation causes pain
A client suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the client paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies:
decrease metabolic needs and increase oxygenation. Explanation: The general goal of treatment with global cerebral ischemia is to decrease metabolic needs and increase oxygenation to the injured cerebral tissue. Artificial ventilation provides appropriate oxygenation; keeping the client paralyzed decreases the body's metabolic needs.
The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis is the result of:
decreased oligodendrocytes
Hair follicle end organs
detect impending touch on skin surface
Pacinian corpuscles
detect tissue vibration
free nerve endings
detect touch & pressure
The patient has a traumatic complete spinal cord transection at the C5 level. Intact motor and somatosensory function will include ______ control.
diaphragm
Thermal sensation
discriminated by cold, warmth, & pain receptors
dyesthesia
distortions of somesthetic sensation
dyesthesia
distortions of somesthetic sensation (usually associated with a partial loss of sensory innervation)
A patients recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the patients levels of:
dopamine
FDA approval of a drug for OTC availability includes: Analysis of the cost of the drug to the consumer. Evaluation of evidence that the consumer can use the drug safely, using information on the product label. Studies involving the safe use of the medication by the consumer. Analysis of the diagnoses for which the medication may be used by the consumer.
evaluation of evidence that the consumer can use the drug safely, using information on the product label.
paresthesias
example: -pins-and-needles sensation following compression of a peripheral nerve
glutamate
excitatory NT in spinal cord
fast-conducting (neospinothalamic tract)
experienced as bright, sharp or stabbing pain
pain tolerance
extremely variable & depends on person's culture & previous experiences
trigeminal neuralgia
facial tics or grimaces characterized by stabbing, paroxysmal attacks of pain
myelinated
fast pain
dorsal column (medial lemniscal pathway)
fast-conducting
C pain
fibers release both glutamate & substance P
A nurse is caring for a client who has been receiving a drug by the intramuscular (IM) route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose? passive diffusion active transport glomerular filtration first-pass effect
first-pass effect
A sudden traumatic complete transection of the spinal cord results in _______ below the level of injury.
flaccid paralysis
Meissner corpuscles
found in nonhairy skin regions (lips, fingertips) -highly-developed sense of touch
somatosensory
four major modalities of _______ experience: 1. discriminative touch 2.proprioception 3.temperature 4.nociception
The nurse instructs the client that some drugs are no longer covered under patent and may be less expensive. What type of drug is the nurse describing? brand name generic orphan drug controlled drug
generic Explanation: Generic medications are those that are no longer covered by a patent, thereby allowing other companies to make the medication and charge less for the product. Brand name means the name of the drug given by the company that originally manufactured the drug, which may or may not still be under patent. Orphan medications are pharmaceuticals that have been developed to treat a rare disease or carry a high risk of harm and the pharmaceutical company is given an incentive to continue producing the drug. Controlled drugs are those with risk for abuse and dependence. Controlled drugs might be available in generic form, or they may still be under patent if they are drugs that were recently developed.
What term is used to describe drugs identified by their chemical or official name in order to be independent of any manufacturer's assigned name? brand generic prototype trade
generic Explanation: Individual drugs are known by the trade (brand) or generic names. Those designated and patented by manufacturers are trade (brand) name drugs. Generic drugs are independent of the manufacturer's trade or brand name. Prototype is the term used to identify the first drug of a particular drug class to be developed.
A new drug has been created by altering DNA. What process has been utilized to create this drug? genetic engineering pharmacodynamics organic chemistry pharmacotherapeutics
genetic engineering Explanation: Genetic engineering is the process of altering DNA in order to produce a chemical that is therapeutic and effective. Most often, the DNA is altered in a bacterium to create the new drug. Pharmacodynamics is one topic discussed in pharmacotherapeutics that addresses what the drug does to the body, but it does not specifically address the process of altering DNA. The drugs being used to treat, diagnose, and prevent disease are chemicals, but the study of chemistry includes far more than just those formed by altering DNA. Pharmacotherapeutics is a branch of pharmacology specifically focused on the use of drugs as therapy, to treat, prevent, and diagnose disease. DNA modification may be used on some drugs discussed by this branch of pharmacology, but there is a specific term for modifying DNA.
A client begins to exhibit signs and symptoms of a stroke at a community health fair. Emergency care for the client includes:
going to the nearest stroke center.
A client begins to exhibit signs and symptoms of a stroke at a community health fair. Emergency care for the client includes: a) going to an urgent care center. b) seeing his/her physician. c) going to the nearest stroke center. d) going to the nearest emergency room.
going to the nearest stroke center. Salvaging brain tissue, preventing secondary stroke, and minimizing long-term disability are the treatment goals for an acute ischemic stroke. The care of patients with stroke has shifted away from the "nearest hospital" to certified stroke centers. These are hospitals that have been certified by some external agency, most commonly the state or Joint Commission on Accreditation of Healthcare Organizations, the federal agency overseeing all facilities that care for Medicare patients.
primary (somatosensory) cortex
has a spatial orientation, the sensory homunculus
intracranial lesions
headaches that disturb sleep, are triggered by exertion, or are accompanied by drowsiness, visual or limb disturbances, or altered mental status suggest underlying ______ ______
Ruffini end organs
heavy continuous touch or pressure
A late indicator of increased intracranial pressure is:
high mean arterial pressure
A client has developed global ischemia of the brain. The nurse determines this is:
inadequate to meet the metabolic needs of the entire brain. Explanation: Global ischemia occurs when blood flow is inadequate to meet the metabolic needs of the entire brain. The result is a spectrum of neurologic disorders reflecting diffuse brain dysfunction.
The earliest signs of decreased level of consciousness include:
inattention
Metabolic factors that increase cerebral blood flow include:
increased carbon dioxide level
hyperalgesia
increased painfulness
prostaglandins
induce pain
The most common cause of C. botulinum in infants is:
ingestion of honey products containing C. botulinum spores
NSAIDs
inhibit production of PGs; inhibits COX 1/2 enzymes
receptor
innervates a certain area of the periphery
Which drug may be derived from an animal source? digitalis opium morphine insulin
insulin Explanation: Insulin for treating diabetes was obtained exclusively from the pancreas of cows and pigs, but now genetic engineering has allowed scientists to produce human insulin by altering Escherichia coli bacteria. Digitalis, opium, and morphine are derived from plant sources.
(somatosensory) association area
integrates sensory information with past learning to produce a meaningful experience
phantom limb pain
involvement of forebrain (site of pain integration) has also been suggested
An intracranial epidural hematoma causes focal symptoms that can include:
ipsilateral pupil dilation
cluster (headache)
is accompanied by conjunctival injection (redness) or lacrimation (tearing), ipsilateral nasal congestion, eyelid edema, or forehead/facial sweating
glutamate
is an excitatory NT released by the Aδ fibers within the spinal cord
somatosensory cortex
is needed to add precision/discrimination to the pain
substance P
is released more slowly & increases in concentration over seconds/minutes
What drug would the nurse discuss when educating a client about the prototype of opioid analgesics? morphine meperidine methadone hydrocodone
morphine Explanation: Individual drugs, often the first drugs of a particular group to be developed, are usually the standard with which newer, similar drugs are compared. While all the options are opioids analgesics, morphine is the prototype for opioids. Understanding morphine makes learning about other opioid analgesics easier because they are compared with morphine.
tension-type
most common type of headache
primary (somatosensory) cortex
most of surface concerns fingers, lips & tongue
proprioception
movement of limbs & joints
gate control theory
neural gating mechanism exists at the segmental spinal cord level to account for interactions between pain and the other sensations
substance P
neurotransmitter from C fibers -slow release
tension-type
not sufficiently severe to interfere with daily activities
neuralgia
occurs along the distribution of a cranial or spinal nerve
endorphins
opiod peptides that serve as endogenous
complex regional pain syndrome
pain & mobility problems that are more severe than the injury warrants
allodynia
pain after non-noxious stimulus
specificity theory
pain is a separate sensory modality evoked by specific receptors that transit information to the forebrain where pain is experienced
nociception
pain or itch
pattern theory
pain receptors share endings or pathways with the other senses but that different patterns of activity by the same neurons signal painful or nonpainful stimuli
allodynia
pain that follows a non-noxious stimulus to apparently normal skin
cutaneous
pain that is bright, sharp, burning pain with origin in skin or subcutaneous tissues
visceral (splanchnic)
pain that is diffuse, poorly-defined pain that results from stretching, distention, or ischemia of tissues in a body organ
acute
pain that is form from tissue damage; characterized by ANS responses (e.g., nausea)
Which phase of drug development is associated with continual evaluation of the drug? phase I study phase II study phase III study phase IV study
phase IV study Explanation: Phase IV study is a phase of continual evaluation in which prescribers are obligated to report to the Food and Drug Administration (FDA) any untoward or unexpected adverse effects associated with the drugs being used. A phase I study uses human volunteers for testing. A phase II study allows investigators to try out the drug in clients who have the disease that the drug is designed to treat. A phase III study involves the use of the drug in a vast clinical market.
Proprioception
position sense
pain
possesses an urgent, primitive quality
A patient has wrist inflammation causing compression of the median nerve in the carpal tunnel. Manifestations of this syndrome include:
precision grip weakness
More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by the ______ cortex in the frontal lobe.
premotor
TMJ (temporomandibular joint pain)
presents as facial muscle pain, headache, neck ache or earache
central axon
projects to the CNS
As the nurse is performing a physical assessment of a client, the client begins to have seizure activity including loss of consciousness and limb jerking. The nurse's first priority is to: a) preserve brain functioning. b) treat underlying disease. c) protect the patient from injury. d) stop the seizure.
protect the patient from injury. The first priority for the nurse when a client begins to experience seizure activity is to protect the client from injury during the seizure. -Stopping or preventing the seizure, preserving brain functioning and/or treating underlying disease are important goals of treatment but secondary to protecting the client from injury.
muscle spasm (guarding)
protective reflex rigidity to guard affected body part
proprioceptive receptors
provide information on stationary & dynamic (kinesthesia) aspects of movement
first-order neurons
receptor → CNS
complex regional pain syndrome
reflex sympathetic dystrophy
complex regional pain syndrome
regional post-traumatic pain problem affecting one or more limbs
tactile sensation
relays information about touch, pressure & vibration
The nurse observes a new nurse performing the test for Kernig's sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:
resistance should be provided with the knee in a flexed position. The test for Kernig's sign for meningeal irritation is performed by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle.
The nurse observes a new nurse performing the test for Kernig's sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that: a) the sign elicited was the Budzinski's sign. b) the sign elicited was the obturator sign. c) resistance should be provided with the knee in a flexed position. d) the client should be in a sitting position.
resistance should be provided with the knee in a flexed position. The test for Kernig's sign for meningeal irritation is performed by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle.
Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that:
resolve within one hour of onset
A patient with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the patient has gone into a myasthenic crisis on postoperative day one. Which of the following measures should the care team prioritize in this patients immediate care?
respiratory support and protection of the patients airways
pain receptors
respond to 'freezing cold', < 5°C or 'burning hot', > 45°C
cold receptors
respond to < 34°C
warmth receptors
respond to > 34°C
nociceptors
respond to mechanical, chemical, & thermal stimuli
The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:
rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. Explanation: Decerebrate (extensor) posturing results from increased muscle excitability. It is characterized by rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. Flexion of the arms, wrists, and fingers, with abduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities, would be a response of decorticate posturing. The other options are not specific to a diagnosis.
A nurse is administering a large number of medications to a diverse group of clients. What types of drugs will be excluded from these medications? schedule IV schedule III schedule II schedule I
schedule I Explanation: Schedule I medications have no accepted medical use and are not prescribed. Schedule II drugs are often prescribed and include medications such as narcotic analgesics. Schedule III drugs are often prescribed and include nonbarbiturate sedatives, nonamphetamines, stimulants, and non-narcotic analgesics. Schedule IV drugs are often prescribed and include sedatives, antianxiety agents, and non-narcotic analgesics.
A nurse is preparing to administer morphine and recognizes morphine as belonging to what classification of controlled substance? schedule II (C-II) schedule III (C-III) schedule IV (C-IV) schedule V (C-V)
schedule II (C-II) Explanation: Morphine is a schedule II (C-II) controlled substance with a severe risk of abuse and dependence. Schedule III drugs have a lower abuse potential and generally contain nonbarbiturate sedatives, nonamphetamine stimulants, and limited amounts of certain narcotics. Schedule IV drugs are those with less abuse potential than schedule III and limited dependence liability, including some sedatives, antianxiety agents, and nonnarcotic analgesics. Schedule V medications have limited abuse potential and are often found in small amounts in antitussives or antidiarrheals. Federal law allows purchase without a prescription directly from a pharmacist if the purchaser is over age 18 and furnishes suitable identification.
dermatome
segmental region of the body supplied by a single dorsal root ganglion
proprioception
sense of joint/limb position without visual cues
A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention? half-life analysis serum drug level monitoring regular changes to the administration route frequent administration of scheduled "drug holidays"
serum drug level monitoring Explanation: Measuring serum drug levels is useful when drugs with a narrow margin of safety are given because their therapeutic doses are close to their toxic doses. None of the other options are relevant to client safety regarding this drug characteristic.
neuralgia
severe, brief, often repetitive attacks of lightning-like or throbbing pain
cluster (headache)
severe, unilateral, supraorbital, or temporal pain lasting 15-180 minutes
cluster headache
severe, unilateral, supraorbital, or temporal pain lasting 15-180 minutes
Ruffini end organs
signal continuous states of deformation
unmyelinated
slow-wave pain
unmyelinated
slower onset, longer duration
paresthesias
spontaneous, unpleasant sensations
paresthesias
spontaneous, unpleasant sensations seen with severe irritation
hyperpathia
syndrome where sensory threshold is raised
third-order neurons
thalamus → somatosensory cortex (parietal lobe, postcentral gyrus)
While studying for the test, the nursing student encounters the drug papaverine (Pavabid). What does the nursing student identify the name Pavabid as? the generic name the chemical name the brand name the molecular name
the brand name Explanation: Several clues indicate the brand name including capitalization of the first letter in the name and the name being in parentheses. Generic names are not capitalized; chemical names are descriptions of the chemistry of the medication resulting in complicated names. The molecular name would include all the elements present in the drug.
A client has been referred for neurologic assessment because he has developed a tendency to have a back-and-forth tremor in his fingers as he reaches for an object. The client denies any changes to his cognition and his wife corroborates this. Assessment and diagnostic testing should focus on:
the client's cerebellar function
dorsal column (medial lemniscal pathway)
uses three neurons to transmit information: 1. primary dorsal root ganglion neuron → dorsal column neuron 2.the medial lemniscus → thalamic neuron
The client with a history of ischemic heart disease is taking aspirin 81 mg daily. The nurse should explain that less than 81 mg actually reaches target tissue due to: slow distribution. the first-pass effect. reduced absorption. adverse effects.
the first-pass effect
pain
theories include: specificity theory, pattern theory, gate control theory
nociceptive
these action potentials are transmitted through myelinated Aδ & unmyelinated C fibers
The most common cause of ischemic stroke is: a) vasospasms. b) cryptogenesis. c) arterial vasculitis. d) thrombosis.
thrombosis. Ischemic stroke includes those caused by large artery thrombosis (20%), small artery thrombosis (25%), cardiogenic embolism (20%) and cryptogenic (undetermined cause)(30%), making thrombosis the most common cause (45%).
trigeminal neuralgia
tic douloureux
slower conducting (paleospinothalamic tract)
transmits diffuse, dull, aching, & unpleasant sensations to brainstem
fast-conducting (neospinothalamic tract)
transmits sharp-fast pain to thalamus
A drug being tested is removed from testing during a phase II study. What would be the most likely reason for the drug being removed from testing? unacceptable adverse effects likelihood of prohibitive cost patent violation lack of participants for clinical trials
unacceptable adverse effects Explanation: A drug is removed from testing if it produces unacceptable adverse effects. Financial concerns, logistics of performing human trials, and patent issues are rarely the cause of the cessation of testing.
cluster headache
uncommon
trigeminal neuralgia
unilateral sensory distribution of one or more branches of CN V
hyperesthesia
unpleasant hypersensitivity
pain
unpleasant sensory & emotional experience associated with actual or potential tissue damage
dorsal column (medial lemniscal pathway)
used for transmission of discriminative touch & proprioception
pain threshold
~ same for all individuals
Hydrocephalus is caused by which of the following? Select all that apply.
• Decreased absorption of cerebral spinal fluid • Obstruction of cerebral spinal fluid Hydrocephalus is defined as an abnormal increase in cerebral spinal fluid volume. The two causes include decreased absorption and obstruction of cerebral spinal fluid.
Which of the following are the main neurotransmitters of the autonomic nervous system (ANS)? Select all that apply.
• Acetylcholine • Epinephrine • Norepinephrine
Which are functions of the frontal lobe? Select all that apply.
• Anticipation of consequences of behavior • Prediction of consequences of behavior
An 85-year-old patient with a medical history of diabetes, thrombocytopenia, and hypertension is on the cardiac step-down unit following the development of atrial defibrillation with a heart rate of 120-140. The atrial fibrillation was successfully cardioverted to a normal sinus rhythm and the patient was preparing to be discharged from the hospital when suddenly the patient developed right-sided hemiplegia and dysphasia. The nurse understands that this patient has many modifiable risk factors for stroke including which of the following? Select all that apply.
• Atrial fibrillation • Diabetes • Hypertension
A client may be at risk for the development of hypoxia. Select the conditions that would place a client at risk. Select all that apply.
• Carbon monoxide poisoning • Increased oxygenation by the lungs • Severe anemia
A client may be at risk for the development of hypoxia. Select the conditions that would place a client at risk. Select all that apply.
• Carbon monoxide poisoning • Increased oxygenation by the lungs • Severe anemia Hypoxia usually is seen in conditions such as exposure to reduced atmospheric pressure, carbon monoxide poisoning, severe anemia, and failure of the lungs to oxygenate the blood.
A client may be at risk for the development of hypoxia. Select the conditions that would place a client at risk. Select all that apply. a) Increased atmospheric pressure b) Increased oxygenation by the lungs c) Thrombocytopenia d) Age e) Severe anemia f) Carbon monoxide poisoning
• Carbon monoxide poisoning • Increased oxygenation by the lungs • Severe anemia Hypoxia usually is seen in conditions such as exposure to reduced atmospheric pressure, carbon monoxide poisoning, severe anemia, and failure of the lungs to oxygenate the blood. The other options will not alter oxygen levels.
When trying to explain the difference between vasogenic versus cytotoxic cerebral edema, the physiology instructor mentions that cytotoxic edema displays which of the following functions in the brain? Select all that apply.
• Causes ischemia to build up lactic acid due to anaerobic metabolism • Allows cells to increase volume to the point of rupture, damaging neighboring cells
In which phases of the action potential is there movement in and out of sodium and potassium? Select all that apply.
• Depolarization • Hyperpolarization • Repolarization
The nurse contacts the physician regarding a client's early signs of diminishing level of consciousness based on which of the following? Select all that apply.
• Disorientation • Blunted responsiveness • Inattention
When trying to explain the difference between vasogenic versus cytotoxic cerebral edema, the physiology instructor mentions that cytotoxic edema displays which of the following functions in the brain? Select all that apply. a) May cause herniation by displacing a cerebral hemisphere b) Impaired blood-brain barrier that allows water/proteins to leave vessels and go into the interstitial space c) Allows cells to increase volume to the point of rupture, damaging neighboring cells d) Mainly allows edema to form in the white mater of the brain e) Causes ischemia to build up lactic acid due to anaerobic metabolism
• Causes ischemia to build up lactic acid due to anaerobic metabolism • Allows cells to increase volume to the point of rupture, damaging neighboring cells Cytotoxic edema involves an increase in intracellular fluid. Ischemia results in the inadequate removal of anaerobic metabolic end products such as lactic acid, producing extracellular acidosis. If blood flow is reduced to low levels for extended periods or to extremely low levels for a few minutes, cellular edema can cause the cell membrane to rupture, allowing the escape of intracellular contents into the surrounding extracellular fluid. This leads to damage of neighboring cells. Vasogenic edema occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and proteins from the vascular into the interstitial space. It occurs primarily in the white matter of the brain, possibly because the white matter is more compliant than the gray matter. Vasogenic edema can result in displacement of a cerebral hemisphere and various types of brain herniation.
A patient has an abrupt onset of mental slowing and depression. Which of the following conditions in the patient's history would indicate vascular dementia as a cause of these changes? Select all that apply. a) Cigarette smoking b) Peptic ulcer c) Diabetes insipidus d) Cardiac dysrhythmias e) Cerebrovascular accident
• Cerebrovascular accident • Cardiac dysrhythmias • Cigarette smoking The hallmarks of vascular dementia are mental slowing and depression. They usually occur as a result of brain injury from hemorrhage or occlusion. Common disorders associated with this diagnosis are cerebrovascular accident, cardiac dysrhythmias, cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus, and autoimmune disorders.
The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply.
• Cognition • Level of consciousness • Motor function • Sensory function
The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply. a) Sensory function b) Level of consciousness c) Metabolic function d) Motor function e) Cognition
• Cognition • Level of consciousness • Motor function • Sensory function Brain injuries can cause changes in level of consciousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a patient with a traumatic brain injury should assess for changes in these areas.
There are several types of brain injuries that can occur. What are the primary (or direct) brain injuries? (Select all that apply.)
• Focal lesions of laceration • Contusion • Diffuse axonal • Hemorrhage
The nurse contacts the physician regarding a client's early signs of diminishing level of consciousness based on which of the following? Select all that apply. a) Stupor b) Inattention c) Disorientation d) Blunted responsiveness
• Inattention • Disorientation • Blunted responsiveness The earliest signs of diminution in level of consciousness are inattention, mild confusion, disorientation, and blunted responsiveness.
A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting and mental changes is likely located in which part of the brain? Select all that apply. a) Temporal lobe. b) Frontal lobe. c) Intra-axially. d) Brain stem. e) Extra-axially.
• Intra-axially. • Extra-axially. • Frontal lobe. Tumors within the intracranial (intra-axially) cavity is fixed and cause s/s of increased ICP like headache, n/vomiting, mental changes, papilledema, visual disturbances, alterations in sensory and motor function... Outside the brain tissue (extra-axially) but within the cranium, tumors may reach large sizes without producing s/s. After they reach a sufficient size, s/s of increased ICP appear. -Temporal lobe tumors often produce seizures as their first symptom. -Brain stem tumors commonly produce upper/lower motor neuron s/s such as weakness of facial muscles and ocular palsies. -Frontal lobe tumors also grow to a large size and cause s/s of increased ICP.
An older adult is being evaluated for dementia. Which of the following assessments do not indicate normal aging? Select all that apply.
• Is easily agitated when routines are not followed • Is unable to explain the meaning of a proverb • Needs cues to perform hygiene activities Normal aging often includes slower processing of short term memory, and intact long-term memory with recognition cues for recall. Dementia may inhibit cognitive function so the client is unable to perform normal activities such as bathing and dressing. They become agitated, experience difficulty in higher order thinking and problem solving, and may see things that are not there.
Huntington disease is a genetic disorder that does not usually manifest itself until the client is in his or her 40s or 50s. What are the most common early psychological changes that occur with Huntington disease? (Select all that apply.)
• Kernig's sign • Brudzinski's sign
Which symptoms would support the diagnosis of a stroke involving the posterior cerebral artery? Select all that apply.
• Loss of central vision • Repeating of verbal responses Posterior cerebral artery stroke would produce visual defects and the repeat of verbal and motor responses.
Which symptoms would support the diagnosis of a stroke involving the posterior cerebral artery? Select all that apply. a) Repeating of verbal responses b) Loss of central vision c) Contralateral hemiplegia d) Denial of paralyzed side e) Aphasia
• Loss of central vision • Repeating of verbal responses Posterior cerebral artery stroke would produce visual defects and the repeat of verbal and motor responses. -The other options are seen in middle cerebral artery strokes.
The nurse reading the results of a lumbar puncture cerebral spinal fluid analysis anticipates that the client's meningitis will be self-limiting in nature because of which of the following findings? Select all that apply.
• Lymphocytes • Moderately increased protein Viral meningitis, which presents with lymphocytes, moderately increased protein and normal glucose levels in the cerebral spinal fluid upon lumbar puncture, is self-limiting in nature.
Huntington disease is a genetic disorder that does not usually manifest itself until the client is in his or her 40s or 50s. What are the most common early psychological changes that occur with Huntington disease? (Select all that apply.)
• Moodiness • Impulsive behavior • Personality changes
Huntington disease is a genetic disorder that does not usually manifest itself until the client is in his or her 40s or 50s. What are the most common early psychological changes that occur with Huntington disease? (Select all that apply.)
• Moodiness • Impulsive behavior • Personality changes Depression and personality changes are the most common early psychological manifestations. Memory loss is often accompanied by impulsive behavior, moodiness, antisocial behavior, and a tendency toward emotional outbursts.
A nurse in the emergency room is assessing a client's level of consciousness. The client appears very drowsy but is able to follow simple commands and respond to painful stimuli appropriately. The nurse should document the client's level of consciousness as which of the following? a) Confusion b) Obtundation c) Lethargy
• Obtundation Characteristics of obtundation include responding verbally with a word, arousable with stimulation, responds appropriately to painful stimuli, follows simple commands, and appears very drowsy.
Following a car accident of a male teenage that did not have their seatbelt on; he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments corresponds to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply.
• Pupils fixed at ~ 5 mm in diameter. • Respiration rate of 40 breaths/min. • Decerebrate posturing following painful stimulation of the sternum. With midbrain involvement, pupils are fixed and midsize (5 mm in diameter), and reflex adduction of the eyes is impaired; pain elicits decerebrate posturing; and respirations change from Cheyne-Stokes to neurogenic hyperventilation.
The nurse is caring for a client who has received tissue plasminogen activator (tPA). The nurse's plan of care should include education relating to which of the following? Select all that apply.
• Reduction of risk factors • Signs and symptoms of occurrence • Warfarin (Coumadin) therapy
Select the actions of β2 receptors. Select all that apply.
• Respiration • Delaying labor
The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply.
• Sensory function • Motor function • Cognition • Level of consciousness Brain injuries can cause changes in level of consiousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a patient with a traumatic brain injury should assess for changes in these areas.
While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options.
• Thalamus • Dorsal root ganglion body • Dorsal root ganglion periphery • Axon • Cerebral cortex
The nurse is providing discharge instructions on the antiseizure medication valproic acid to a woman of childbearing age. Which of the following should the nurse include? Select all that apply. a) The medication may interact with oral contraceptives. b) The medication should be stopped in the third trimester of pregnancy c) The medication may predispose her to osteoporosis. d) The medication should be taken consistently. e) The client should also take a folic acid supplement daily.
• The client should also take a folic acid supplement daily. • The medication may predispose her to osteoporosis. • The medication should be taken consistently. • The medication may interact with oral contraceptives. The nurse should include in the teaching that the client should also take folic acid supplementation daily, that the medication may predispose the client to osteoporosis, and that it may interact with oral contraceptives. The nurse should also caution the client to take the medication on a consistent basis to prevent recurring seizures.
Which of the following types of sensation are transmitted via the discriminative pathway? Select all that apply.
• Two-point touch • Joint movement • Vibration
The nurse is caring for a client who has received tissue plasminogen activator (tPA). The nurse's plan of care should include education relating to which of the following? Select all that apply.
• Warfarin (Coumadin) therapy • Reduction of risk factors • Signs and symptoms of occurrence
The nurse is caring for a client who has received tissue plasminogen activator (tPA). The nurse's plan of care should include education relating to which of the following? Select all that apply. a) Warfarin (Coumadin) therapy b) Aspirin (ASA) therapy c) Reduction of risk factors d) Signs and symptoms of occurrence
• Warfarin (Coumadin) therapy • Reduction of risk factors • Signs and symptoms of occurrence Clients receive tPA as treatment for ischemic stroke. In her plan of care the nurse should include education related to: warfarin (Coumadin therapy), signs and symptoms of stroke recurrence (most likely in first week post-tPA administration) and ways for the client to reduce risk factors for another stroke.