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Terms in this set [29]
which questions does the nurse ask when conducting an expanded assessment to determine patient orientation? select all that apply
A. what is your name?
B. what state are you in right now?
C. what floor are we on right now?
D. what are the names of your children?
E. what kind of place are we in right now?
B, C, D, E
the nurse is caring for a pt with a basiliar skull fracture and an intracranial pressure of 17mmHg, mean arterial pressure of 85 mmHg and a cerebral perfusion pressure of 68 mmHg. what is the priority intervention for this patient?
A. elevate the head of the bed to 30 degrees
B. encourage the pt to cough and deep breath
A. elevate the head of the bed to 30 degrees
the nurse is reviewing orders written for a pt returning from surgery to remove a spinal cord tumor. which order should the nurse implement immediately?
A. install a bed cradle
B. apply heel protection
C. Dexamethasone [Decadaron] 10 mg IVP now and every 8 hours x 2 doses
D. monitor bowel sounds; notify if unable to obtain or faint in any abdominal quadrant
C. Dexamethasone [Decadaron] 10 mg IVP now and every 8 hours x 2 doses
the nurse notes that a pt with low back pain is experiencing radiculopathy. what should the nurse expect when assessing this pt? select all that apply
A. pain
B. edema
C. weakness
D. numbness
E. inability to control motor movements
A, C, D, E
the nurse provides care for a pt who is prescribed a serum osmolality for the management of increased intracranial pressure [ICP]. which is an appropriate action by the nurse?
A. ensure the pt remains completely still during the test
B. inspect the pts head to ensure that all electrodes are in place
C. administer the prescribed benzodiazepine to decrease claustrophobia
D. draw the blood within one to two hours of osmotic diuretic administration
D. draw the blood within one to two hours of osmotic diuretic administration
when caring for a pt who has had a head injury, which assessment information requires the immediate action by the nurse?
A. a pt who is more difficult to arouse than she was 1 hour ago
B. a pt with slightly irregular pulse
C. a pt with a BP that increased from 120/54 to 136/60
D. a pt who complains of a headache with pain 5/10
A. a pt who is more difficult to arouse than she was 1 hour ago
the nurse is caring for a pt with a large epidural hematoma who is intubated and on the ventilator. the physician instructs the nurse to hyperventilation the pt. the nurse understands the best rationale for this action is which of the following?
A. increase the pts PaCO2 to lower intracranial pressure
B. decrease the pts PaCO2 to lower intracranial pressure
B. decrease the pts PaCO2 to lower intracranial pressure
After the emergency department nurse has received a status report on the following patients who have been admitted with head injuries, which patient should the nurse assess first?
a. A patient whose cranial x-ray shows a linear skull fracture
b. A patient who has an initial Glasgow Coma Scale score of 13
c. A patient who lost consciousness for a few seconds after a fall
d. A patient whose right pupil is 10
mm and unresponsive to light
d. A patient whose right pupil is 10 mm and unresponsive to light
a patient with multiple sclerosis is admitted for treatment of clinical manifestations. what should the nurse expect to be prescribed for this patient?
A. corticosteroids
B. beta interferons
C. muscle relaxants
D. immunosuppressive agents
C. muscle relaxants
your patient arrives after an MVA with a GCS of 8. the MD decides to intubate. what is the rational for intubation?
A. the level of consciousness is altered, and the patient may not be able to maintain a patent airway
B. all pts after an MVA must be sedated, and the ventilator will be placed to support being sedated
C. intubation is not appropriate for this pt because his GCS is greater than 3
A. the level of consciousness is altered, and the patient may not be able to maintain a patent airway
you are caring for a pt with a recent spinal cord injury. the pt develops a sudden, pounding headache and hypertension. what is your best first action?
A. administer metoprolol 5 mg IVP
B. elevate the head of the bed at least 45 degrees or place the pt in a sitting position
C. administer acetaminophen [Tylenol] 650 mg PO
B. elevate the head of the bed at least 45 degrees or place the pt in a sitting position
an unconscious pt has a nursing diagnosis of ineffective cerebral tissue perfusion r/t cerebral tissue swelling. which nursing interventions will be included in the plan of care?
A. elevated the head of the bed to 30 degrees
B. position the pt prone
C. encourage the pt to cough and deep breath to promote oxygenation
D.
incentive spirometer use Q1 hour
A. elevated the head of the bed to 30 degrees
why is a 3% sodium chloride ordered for a pt with increased ICP?
A. it is a hypotonic solution and will be used to decrease brain tissue swelling
B. it is an isotonic solution that will maintain hydration status for this pt
C. it is a hypertonic solution that will be used to decrease brain swelling
C. it is a hypertonic solution that will be used to decrease brain swelling
an 18 year old female is admitted to the ICU with a skull fracture after a motor vehicle accident. her nurse notices that the pt has what appears to be blood leaking from her nose and decides to test the fluid. what finding would indicate to the nurse that th pt has leakage of CSF?
A. battle's sign
B. periorbital ecchymosis
C. halo sign
D.
positive dolls eyes
C. halo sign
the nurse is assessing a patient's level of consciousness after a brain injury using the Glasgow Coma Scale. the patient's eyes open to painful stimuli only, but he does not respond verbally to the painful stimuli. he is also decorticate posturing. approximately what should the nurse rate his GCS score?
A. 2-3
B. 5-6
C. 7-8
D. 9-10
B. 5-6
a nursing student is helping care for a pt on the ventilator with positive brain swelling, which causes him to have an increased ICP. which action by the student would require intervention by the nurse?
A. the student positions the head of the patient's bed at 30 degrees
B. the student suctions the pt for 10 seconds, three times in a row to ensure all secretion have been cleared from the patient's airway
C. the student leaves the light
on in the room after she is finished giving a medication
D. the student repositions and turns the pt every 2 hours
B. the student suctions the pt for 10 seconds, three times in a row to ensure all secretion have been cleared from the patient's airway
Which parameter is best for the nurse to monitor to determine whether the prescribed IV mannitol [Osmitrol] has been effective for an unconscious
patient?
a. Hematocrit
b. Blood pressure
c. Oxygen saturation
d. Intracranial pressure
d. Intracranial pressure
the latest blood pressure reading for a pt with a spinal cord injury is 210/140 mmHg. what action should the nurse take first?
A. palpate for bladder distension
B. assess for a bowel impaction
C. re-measure the blood pressure
D. raise the head of the bed 45 degrees
D. raise the head of the bed 45 degrees
the patient is experiencing increasing flaccid upper arm while the lower extremities periodically cramp and contract. on which health problem should the nurse focus when assessing this patient?
A. brain tumor
B. spinal cord tumor
C. multiple sclerosis
D. amyotrophic lateral sclerosis [ALS]
D. amyotrophic lateral sclerosis [ALS]
the nurse provides care for a patient who is 4 hr post-op to correct a herniated nucleus pulposus. which assessment finding causes the nurse to notify the health-care provider?
A. the pt is drowsy but arousable
B. the pts respiratory rate is 9 bpm
B. the pts respiratory rate is 9 bpm
the nurse provides care to a pt who is diagnosed with increased intracranial pressure [ICP]. which finding indicates the need for intermediate intervention?
A. lethargy
B. confusion
C. contralateral hemiparesis
D. sluggish pupillary response to light
C. contralateral hemiparesis
pt is a 22 y/o female who has been on a 3 day party binge. her friends bring her to the ED after being unable to awaken her. assessment reveals shallow respirations with rate of 8/min,
diminished breath sounds, and decreased LOC.
what type of acid-base imbalance would you expect this pt to have? what is causing it?
respiratory acidosis due to hypoventilation
pt is a 22 y/o female who has been on a 3 day party binge. her friends bring her to the ED after being unable to awaken her. assessment reveals shallow respirations with rate of 8/min, diminished breath sounds, and decreased
LOC.
what type of compensation would expect or not expect?
renal system would increase bicarb level [make up for what respiratory could not do]
pt is a 22 y/o female who has been on a 3 day party binge. her friends bring her to the ED after being unable to awaken her. assessment reveals shallow respirations with rate of 8/min, diminished breath sounds, and decreased LOC.
what is the treatment?
mechanical ventilation
-secondary tx-
6 days after kidney transplantation from a deceased donor, a patient develops a temperature of 101.2 F [38.5C], tenderness at the transplant sit, and oliguria. the nurse recognizes that these findings indicate...
A. acute rejection, which is not uncommon and is usually reversible
B. hyperacute rejection, which will necessitate removal of the transplanted kidney
C. an
infection of the kidney, which can be treated with IV antibiotics
D. the onset of chronic rejection of the kidney with eventual failure of the kidney
A. acute rejection, which is not uncommon and is usually reversible
the nurse is administering 3.0% solution IV to a pt with severe hyponatremia. it is most important for the nurse to observe for what?
A. decreased HR and BP
B. prolonged QT interval and
facial flushing
C. SOB and increased RR
D. increased urine output and decreased urine specific gravity
C. SOB and increased RR
-bc can lead to intravascular volume overload and pulmonary edema
a pt is admitted with renal failure and an arterial blood pH of 7.29. which lab result would the nurse expect?
A. serum sodium 138 mEq/L
B. serum glucose 145 mg/dL
C. serum creatinine 0.4 mg/dL
D.
serum potassium 5.9 mEq/L
D. serum potassium 5.9 mEq/L
-acidosis accumulates in cell and potassium increases in ECF
a patient with an acid-base imbalance has an altered potassium level. the nurse recognizes that the potassium level is altered because...
A. potassium is returned to extracellular fluid when metabolic acidosis is corrected
B. hyperkalemia causes an alkalosis that results in potassium
being shifted into the cells
C. acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells
D. in alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate
C. acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells
a pt has the following ABG results: pH 7.48, PaO2 86 mmHg, PaCO2 44 mmHg, HCO3 28 mEq/L. when assessing the pt, the nurse would expect the pt to have?
A. muscle cramping
B. warm, flushed skin
C. RR of 36
D. BP of 94/52
A. muscle cramping
-metabolic alkalosis [muscle cramping and reduced RR]
-hypotension and warm, flushed skin may occur with respiratory acidosis
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