P: 04/13
A pt who presents with a blank stare, clonic movements of their eyelids, and unresponsive is experiencing what? A. Absence Seizure B. Tonic Clonic Seizure C. Febrile Seizure D. Clonic Seizure
Answer: A CM expect see in absence seizure
Which IV solution will remain in the vascular space? A. Colloid B. Crystalloid C. Isotonic D. Hypertonic
Answer: A Colloid: proteins like albumin to keep it in vascular space; solutions with protein; stay in vasculature
Which of the following is the earliest indicator of increased ICP? A. Change in LOC B. Unilateral pupil dilation C. Bradycardia D. Abnormal respiratory pattern
Answer: A Earliest indicator is change in LOC: onset confusion, lethargy, inability recall facts, any change in LOC want check ICP; checking ICP via shunt; might do CT or something obvious causing swelling but first assessment is pupillary because quick and noninvasive
An epidural hematoma is caused by bleeding in the A. Arteries of the brain B. Veins of the brain
Answer: A Epidural Artery Tear Subdural - Subdued EAT: epidural artery tear; arteries high pressure fast bleed; veins low pressure slow bleed
Your patient's family is concerned because their mother forgets how to get home. What stage of Alzheimers is this? A. Early B. Advanced
Answer: A Forgetting fam routes are early signs of disease
Your patient is suffering from muscle weakness in the legs and moving up the body. Which disease would cause this? A. Guillian Barre Syndrome B. Amyotrophic Lateral Sclerosis C. Myasthenia Gravis D. Multiple Sclerosis
Answer: A GBS: Ground to Brain: start in LE and ascend up
What is your major concern with a brain stem injury? A. Loss of respiratory and cardiac function B. Loss of muscle control C. Loss of coordination and balance D. Loss of memory
Answer: A Major concern: what kill us first: brain stem responsible for autonomic funcs which means pat dead so very concerned about that
Which of the following is not true about ALS? A. Major cognitive deficits are often seen B. Death comes from cranial and respiratory involvement C. There is no cure D. Affects striated muscle only
Answer: A Not see cognitive deficits with ALS; cognition remain intact; know everything happening to them and can make their own decisions so can decide if want be put on ventilator and can guide their own treatment
Your pt presents with ptosis and dysphagia that worsen throughout the day. Which neurological disorder do you suspect? A. Myasthenia Gravis B. Multiple Sclerosis C. ALS D. Parkinson's Disease
Answer: A Ptosis: drooping of one eyelid; cardinal CM of MG: eye drooping and dysphagia (trouble swallowing) common CM for MG
Which disease is characterized by degeneration and death of UMN causing progressive paralysis? A. Amyotrophic Lateral Sclerosis B. Multiple Sclerosis C. Guillian Barre Syndrome D. Myasthenia Gravis
Answer: A UMN (upper motor neurons): patho for ALS
What manifestations of CKD lead to HTN? SATA A. Hypervolemia B. Increased RAAS system activation C. Decreased PVR D. Increased prostaglandins that promoted vasodilation
Answer: A, B Hypervolemia: kidneys fluid regulate and excrete and if not functioning not getting fluid out and if not functioning correctly increased RAAS activation leading to HTN; RAAS RAISES BP
What are the Nursing Responsibilities in regards to electrolyte and Fluid Imbalances? SATA A. Monitor Intake and Output B. Daily Weights C. Determine Best Treatment Method D. Constant Observation and Monitoring E. Prescribing proper medications
Answer: A, B, D Nursing responsibilities: daily weights best indicator fluid status; esp electrolyte small variations and cause very sig impacts; CE outside scope prac
What labs will be seen in a CKD diagnosis? SATA A. Proteinuria B. Decreased GFR C. Decreased Serum Creatnine D. Increased BUN
Answer: A, B, D Protein in urine one first things is slight amounts protein in urine - key finding of CKD - something going on in kidney because never should have in urine; kidneys not working so not filtrating; increased serum creatinine always look at kidney func; BUN: urea and nitrogen waste products usually filtered through the kidney but if kidney not func toxic build up in blood: Azotemia and Uremia (uremic state)
Define the pathophysiology of Parkinson's Disease. SATA A. Depleted Dopamine Stores B. Dopamine Dominates C. Acetylcholine Dominates D. Depleted Acetylcholine stores
Answer: A, C Dopamine: Inhibitory Acetylcholine: Excitatory AcH: depletion dopamine stores and see lot jerking that see in Parkinson's; dopamine inhibitory so inhibit involuntary movement; too much AcH and not enough dopamine then have jerking and involuntary movements seen
What CM would you see in a patient with hypoactive delirium? A. Lethargic B. Insomnia C. Decreased attention span D. Aggressive/Violent behaviors
Answer: A, C Hypoactive - everything slowed down
What CM would you see in a pt suffering from hyperactive delirium? SATA A. Decreased attention span B. Agression C. Hallucinations D. Inaccurate perception of the environment
Answer: B, C Hyperactive: hallucinations, aggressive and violent, insomnia, violent, restlessness; inaccurate - hypoactive and decreased attention is hypoactive
Which of the following people are at an increased risk of developing Bacterial Meningitis. SATA A. College student who lives in the dorms B. Single mom who lives at home with her infant C. Pt who is immediately post op neurosurgery D. Military personnel who live in the barracks E. Newlyweds back from their honeymoon
Answer: A, C, D Crowded spaces; post op neurosurgery increased risk because anytime have surgical incision at risk for infection so if surgery on brain that is infection of brain so surgery of brain at risk for the infection; crowded spaces/direct contact to brain: surgery/skull fracture/open injury in head
What is the function of the cerebellum and the basal ganglia? SATA A. Smooth movement B. Respirations C. Cardiovascular Function D. Posture
Answer: A, D Cerebellar func: think smooth movement and posture; damage to cerebellum or impaired cerebellar func: prob with smooth movement and posture
Which of the following would be seen with CKD? SATA A. Hyperphosphatemia B. Hypercalcemia C. Increased Vitamin D D. Hyperparathyroidism
Answer: A, D High phosphate and hyperparathyroidism in response to low Ca
Which of the following would you not expect to see during the late stages of Alzheimers? A. Motor impairment B. Increased ability to recall facts C. Behavior/Mood changes D. Loss of recognition of loved ones
Answer: B
If your patient is suffering from an acute confusion state that comes and goes what would you suspect? A. Dementia B. Delerium C. Late Stage Alzheimers D. UTI
Answer: B Acute and short term; not chronic; might be caused by UTI and common in older adults; delirium is the only one that comes and goes
What is the function of albumin in the blood? A. Releases fluid from vasculature B. Keeps fluid in vascular space C. Allows free movement of fluid between body spaces D. Forms charged particles in the body fluids
Answer: B Albumin: protein in blood that holds fluid in the vascular space; decrease in albumin CM expect to see: edema and third spacing; fluid leaking out of the vasculature
Which of the following is not true regarding Alzheimers? A. Neurons waste away B. Confusion state fluctuates and develops suddenly C. There is no cure D. Neuritic plaque and tangles form
Answer: B Chronic and slow onset and progressive; fluctuate at first but eventually go away and not come back
How does a brain tumor lead to hydrocephalus? A. Fluid leaks from the tumor and invades the brain cavity B. Blocks the normal flow of CSF causing a build up of fluid in the brain C. Reduces the ICP D. Casues microaneurysms in the brain cavity
Answer: B Hydrocephalus: hydro: water/fluid; cephalus: brain; water/fluid on the brain; cannot get out so build up on the brain
Glomerulonephritis is classified as which type of Acute Kidney Injury A. Pre Renal B. Intra Renal C. Post Renal
Answer: B Injury inside kidney so intrarenal: glomerulus inside kidney; prerenal injury causes/EX: GI bleed, hypo/hypertension, anemia, ischemia, anything between heart and renal artery; postrenal: kidney stone, UTI, BPH (not cancer - overgrowth, swelling of prostate gland), tumor, between kidney and urethral meatus
If your patient is wearing shorts and a tank top in the middle of winter what stage of Alzheimers would this indicate? A. Early B. Late
Answer: B Late - lost sense of judgment and reasoning in later stages
Which of the following is an autoimmune disorder in which the body attacks muscle receptors (AChR)? A. Multiple Sclerosis B. Myasthenia Gravis C. Guillian-Barre D. ALS
Answer: B MG: Patho: see that ptosis and dysphagia: remember AcH is excitatory so if blocking cannot func because there is no receptor to activate so if excitatory and not getting it so see drooping and trouble swallowing so affected; MS: think myelin sheath of upper motor neurons
What is the primary nursing consideration in an ALS patient? A. Cardiovascular Function B. Patency of Airway C. Muscle Wasting D. Patient's Pain Level
Answer: B Major causes of death of ALS pat is resp involvement so main nursing consideration is a patent airway
What is the function of a myelin sheath? A. Slow the transfer of signals between neurons B. Increases the speed of signal transfers between neurons C. Blocks the transfer of signals between neurons completely D. Works as the functional unit of a neuron
Answer: B Myelin sheath: see damage to this going to think signal transfers blocked; signals not transfer from one place to another
When aldosterone signals the Kidney to absorb Sodium, what happens to Potassium levels? A. Increase B. Decrease C. Stay the same
Answer: B Na and K have inverse relationship
Severe anemia or respiratory failure might cause which type of brain injury? A. Traumatic B. Hypoxic C. Ischemic D. Cerebral Edema
Answer: B Not enough O2 to brain because not carrying enough and not getting enough O2 in; getting blood flow but not enough O2
What is your major concern with Potassium imbalances? A. Neurological Deficits B. Cardiac Dysrhythmias C. Bone Pain D. Dehydration
Answer: B Potassium PUMPS the heart; irritating to heart so alterations up or down fatal arrythmias so on telemetry to monitor any changes
What is the major concern during a myasthenic crisis? A. Cardiac Involvement B. Compromised ventilation C. Loss of consciousness D. Loss of vision
Answer: B Think ABCs with primary or major concern or kill pat first; have dysphagia and decreased excitatory mechanism in throat so concerned about ventilation
If you notice a distended neck vein in a pt receiving IV fluids what would be your concern? A. Hypovolemia B. Hypervolemia C. Dehydration D. Hyponatremia
Answer: B Too much fluid: hypervolemia, high volume in the blood; hypovolemia: low volume in the blood; hyponatremia: low sodium below 135
A urinary obstruction increases risk for which of the following disorders? SATA A. Cancer B. Infections C. Hydronephrosis D. Polycystic Kidney Disease
Answer: B, C Cancer not caused by an obstruction, abnormal growth of cells; polycystic is genetic
What muscles are commonly involved in with myasthenia gravis? SATA A. Lower extremeties B. Facial Muscles C. Throat Muscles D. Upper extremeties
Answer: B, C Facial and ptosis muscle palsy; priority/primary nursing concern: respiratory muscle compromise
Which of the following are CM of Meningitis? SATA A. Pallor and diaphoresis B. Nuchal Rigidity C. Headache and Fever D. Dry mouth
Answer: B, C Nuchal rigidity: stiff neck/neck pain; classic CM of bacterial meningitis: stiff neck and headache and fever
What are typical cardinal signs of Parkinson's Disease? SATA A. Muscle Flaccidity B. Tremors C. Shuffling Gait D. Bradykinesia
Answer: B, C, D CM of Parkinson's Disease -Tremors -Pill Rolling -Rigidity -Bradykinesia -Postural Changes -Mask Like Face -Demential in later stages 3 cardinal signs: tremors, shuffling gait, slow body movement/bradykinesia; TRAMP B: tremor, rigidity, ANS dys func, mask like face, pill rolling, bradykinesia
Which two statements are true regarding knowledge? A. Implicit knowledge is how we process factual knowledge B. Implicit knowledge is our unconscious thought C. Explicit knowledge is our unconscious thought D. Explicit knowledge is how we process factual knowledge
Answer: B, D Implicit knowledge: just what know; explicit: working through something consciously
A pt comes in post MVC and presents unconsious with bilateral pupil dilation, where would you expect to see injury? A. Frontal Lobe B. Occipital Lobe C. Brain Stem D. Parietal Lobe
Answer: C Bilateral pupil dilation and unconscious = brain stem injury esp pupil dilation
How will an isotonic solution affect cell size? A. Cell will swell B. Cell will shrink C. No change in cell size
Answer: C Isotonic: no change; hypertonic: salt sucks so cell shrinks and pull fluid into ECF and cells shrink; hypotonic: more salt inside cell so more fluid inside cells and they will swell
Unilateral pupil dilation is the earliest sign of which of the following? A. Brain Stem Injury B. ICP C. Cerebral Herniation D. TBI
Answer: C Late sign of ICP; early sign of cerebral herniation unilateral pupil dilation; see this if know have ICP then need intervene before gets to brainstem
At which point of SCI would you need complete mechanical ventilation? A. C3-C5 B. C6-T8 C. C3 and above D. T1-T12
Answer: C Need mechanical ventilation each time: fracture or injury at C3 or above need mechanical ventilation 100% time, phrenic nerve is damaged; C3-C5 might need that might not but not for sure, diminished and lose diaphragmatic innervation - trouble breathing and resp distress but no mechanical ventilation yet
What would you suspect in a pt presenting to the ER with periorbital ecchymosis, Battle's Sign, and CSF otorrhea? A. Assault B. Domestic Violence C. Basilar Skull Fracture D. Concussion
Answer: C Periorbital ecchymosis: bruising around eyes; Battle's sign: bleeding behind ear; rhinorrhea or otorrhea; blood pooling in areas no direct trauma to face - fell and hit head but not fall on face blood pooling; CSF: coming out ears and nose; pretty bad head injury so want to intervene quickly
What is the most common inherited Kidney Disease? A. Renal Cell Carcinoma B. BPH C. Polycystic Kidney Disease D. Glomerularnephritis
Answer: C Polycystic most common inherited
Which of the following would be considered status epilepticus? SATA A. More than 3 seizures in a year B. Seizure precipitated by an acute increase in fever C. A seizure lasting more than 5-10 minutes D. 3 or more recurrent seizures without gaining consciousness in between
Answer: C, D Medical emergency; acute increase in fever: febrile seizure
What is the function of baroreceptors? A. Stimulates thirst response B. Adjust plasma osmolality C. Releases ADH D. Sense a change in circulating blood volume
Answer: D Barorecptors: in neck and senses change in circulating blood volume and where blood comes out heart and tell if not have enough blood and sense change in blood volume and activate response to increase/decrease; body senses change and tells body to compensate
Which body system do we focus our assessment with alterations in Sodium levels?
Neurological Assessments Na concerned about fluid shifts and salt sucks so worried about in brain; sig neuro impacts; concerned for ultimately seizures or impaired neuro func; might look for renal for cause but primary assessment is neuro
Crystalloids:
electrolyte solutions; shift between the vasculature
Cardiac arrest
is when heart stops beating so low Ca responsible for muscle contractions; Ca pumps heart and muscle contractions; low and stop beating; irritating to heart and dysrrythmia and can lead to fatal cardiac arrest; most concerned about cardiac arrest but also see muscle weakness
Compensatory mechanisms of CKD:
nephron hypertrophy: kidney not functioning and wants to filter but if cannot filter because nephrons dying off, working overtime will hypertrophy of ones that still functioning
Alterations in Na Level
primary intervention watch neuro func because main thing is seizure precautions
Hemorrhagic stroke:
skull not moving; active bleeding so increased ICP very quickly
K
super irritating to heart so if high or low so Na/K pump and any alterations in K concerned about heart muscle; telemetry monitoring read heart rhythm
Fibrosis - scar tissue and loss blood vessels as
tissues die and see inflammation and scar tissue builds see inflammatory process
