Exam 1

Question 1

What is the normal MAP? What happens when it is lowered?

Answer 1

70-110

if <68, blood starts to shut to the brain and kidneys

if <65 blood starts to shunt to heart with decreased perfusion to brain and kidneys

Question 2

What is cerebral perfusion pressure?

Answer 2

pressure needed to ensure blood flow to the brain

Question 3

What is the normal cerebral perfusion pressure? What happens when it is lower than normal?

Answer 3

60-100mmHg

<50, ischemia and neuron death

<30, ischemia and death

Question 4

What is the normal intracranial pressure?

Answer 4

5-15

Question 5

What happens when ICP increases?

Answer 5

MAP will need to increase to maintain CPP

Question 6

What are clinical manifestations of increased ICP for infants

Answer 6

fontanels are tense/bulging

cranial sutures are separated/split

increased occipital frontal head circumfrence

distended scalp veins

altered response to pain

Question 7

What are clinical manifestations of increased ICP for adults/adolexcents/children?

Answer 7

change in mental status (early sign)

headache

vomiting

change in pupils or vision

Question 8

What are later manifestations of increased ICP?

Answer 8

severely decreased LOC

decreased sensory response to painful stimuli

alterations in pupil size and reactivity (nonreactive, uneven, large/blown)

cheyne-stokes respirations

decreased/altered motor response to commands

decerbrate or decortiate posture

Question 9

What is the cushing’s triad? Why does this occur?

Answer 9

increased systolic bp with widening pulse pressure

bradycardia

altered respirations

body compensating to increased ICP

Question 10

What can occur when the brainstem is compressed?

Answer 10

hypothalamus produces and pituitary secretes ADH causing:

SIDAH: high levels of ADH causing hyponatremia and hypoosmolarity can lead to low urine output, increased body weight, muscle cramping, pain, weakness

Diabetes insipidus: deficiency of production or secretion of ADH or a decreased renal response to ADH resulting in fluid/electrolyte imbalances caused by increased urine output and plasma osmolarity

Question 11

What is herniation?

Answer 11

last stage of progression of increased ICP before death where the brain tissue is forcibly shifted downward (area of less pressure) causing death of brain stem

Question 12

What are nursing interventions for those with increased ICP

Answer 12

HOB at 30

temperature control

nutriton

eliminate or minimize noise

suction secretions prn

avoid activities that may increase ICP (hip flexion to decrease risk of increasing intrabdominal pressure)

Question 13

What medications can be given for increased ICP?

Answer 13

mannitol: IV osmotic diuretic which will cause 1. plasma expansion to reduce hematocrit and blood viscosity to increase CBF and cerebral O2
2. osmotic effect to cause fluid movement from tissues into blood vessels to decrease total brain fluid content

hypertonic saline solution: produces movement of water out of brain cells into vessels

both are often used together

Question 14

What is the nursing assessment for ICP?

Answer 14

mental status

glasgow coma scale (eye opening, best verbal response, best motor response)

pupil reaction (doll’s eyes (eyes stay fixated as the head moves))

cranial nerves

motor strength and response

vital signs

Question 15

What are the classifications of the glasgow coma scale?

Answer 15

mild = 13-15
moderate = 9-12
severe = 3-8

Question 16

What is a concussion? Typical signs?

Answer 16

sudden, transient mechanical head injury with disruption of neural activity

brief disruption in LOC (not always)
amnesia about the event
headache

Question 17

What medications can be given for concussion?

Answer 17

acetaminophen for headache

Question 18

What is focal injury?

Answer 18

localized area of injury consisting of lacerations, contusions, hematomas, and cranial nerve injuries that can be minor to severe

Question 19

What is latent TB versus TB disease?

Answer 19

latent: asymptomatic, +TST, CXR will be normal, sputum tests will be negative, not contagious

disease: symptomatic, +TST, CXR may be abnormal, sputum tests may be positive, contagious

Question 20

What are clinical manifestations of TB disease?

Answer 20

cough lasting 3 weeks or more

coughing up blood or sputum

angina

weakness and fatigue

Question 21

What are complications of TB?

Answer 21

miliary TB: widespread of TB bacteria to distant organs that will be fatal if not treated

pleural TB: unilateral, exudative pleural effusion, empyema (pus in pleural cavity)

organ involvement due to TB disease manifestations

Question 22

What diagnostic tests are there for TB?

Answer 22

mantoux TB skin test (TST): cannot distinguish between active and latent but can indicate presence of antibodies (if 10-15mm reading)

interferon-gamma release assays: measures immune response to TB, if negative would indicate no latent or active TB, can indicate presence of antibodies

sputum: collected over 3 consecutive days, only test to determine between latent and active

CXR: for visualization of active TB

Question 23

How can community spread of TB be prevented?

Answer 23

direct observation therapy where the nurse will directly observe the pt comply with medications

Question 24

What is bacille calmette-guerin (BCG) vaccine?

Answer 24

vaccine for TB that is recommended in countries or settings with high incidence of TB, may cause a false +TST

Question 25

What are the drugs used to treat active TB?

Answer 25

RIPE: rifampin, isoniazid, pyrazinamide, ethambutol

Question 26

How long is the treatment for active TB? for latent TB?

Answer 26

6 to 9 mo 3, 4, or 6-9

Question 27

What are the drugs used for latent TB?

Answer 27

rifampin and isoniazid

Question 28

What are the manifestations of osteoarthritis compared to rheumatoid arthritis?

Answer 28

OA: "wear and tear disease" can be seen asymmetrically NO systemic involvement pain is primary symptom and reason for seeking care, early stages: pain relief with rest, late stages: pain at rest and/or with barometric pressure, disability, joint stiffness after period of rest commonly involves weight-bearing joints Heberden's nodes (distal finger joints due to osteophytes and loss of joint space, red, swollen, and tender Bouchard's nodes (proximal finger joints are red, swollen, and tender) RA: chronic and systemic pannus formation is most common indicator fatigue, anorexia, weight loss general stiffness after activity and in the morning joint stiffness of especially small joints ("spindle fingers", "zig-zag", subluxation) has a precipitating event systemic manifestations: rheumatoid nodules, cataracts and vision loss, muscle fiber degeneration, nodules in heart and lungs, Sjogren's syndrome (diminished lacrimal or salivary secretions), felty syndrome (enlarged spleen with low WBC = risk of infection), hand deformities and decreased grasp strength, depression

Question 29

What are the nursing interventions for osteoarthritis?

Answer 29

rest and joint protection heat cold (for acute flare ups) nutrition exercise to reduce weight on joints avoid smoking transcutaneous electrical nerve stimulation (TENS) complementary and alternative therapies administer pain medications such as acetaminophen or topical applications, NSAIDs if necessary prepare client for corticosteroid injections into joints position joints in function position and avoid flexion of knees and hips immobilize the affected joint with a splint or brace until inflammation subsides encourage adequate rest

Question 30

What are nursing interventions for rheumatoid arthritis?

Answer 30

pharmacologic: DMARDs (cornerstone treatment to slow disease progression and decrease risk of joint erosion and deformity), biologic response modifiers (slows disease progression), tumor necrosis factor inhibitors (reduce inflammation and stop disease progression) physical mobility: preserve joint function, provide ROM exercises, balance rest and activity, splints may be used during acute inflammation to prevent deformity, prevent flexion contractures, apply heat or cold, encourage consistency with exercise, avoid weight-bearing on inflammed joints self care: assess need for assistive devices such as rasied toilet seats, work with OT, instruct pt in alternative strategies for providing ADLs fatigue: identify factors that may contribute to fatigue, monitor signs for anemia and administer iron, folic acid, and vitamins, monitor for medication related blood loss through stool, instruct pt to conserve energy by pacing activities and obtaining assistance when possible

Question 31

What are risk factors for osteoporosis?

Answer 31

increased age family hx low weight and BMI late menarche, early menopause, low endogenous estrogen levels lifestyle (smoking, inadequate amounts of weight bearing activity, excessive alcohol intake, nutrtional) ethnicity (highest to lowest risk): asians, native alaskan indian, native american white, non-hispanic women hispanic groups white men and african american women african american men

Question 32

What are manifestations of osteoporosis?

Answer 32

low BMD increase risk of fx

Question 33

What are the screening recommendations for osteoporosis?

Answer 33

hx of risk factors height: historical height loss of 6cm or more is consistent with diagnosis

Question 34

How can osteoporosis be managed?

Answer 34

calcium supplements (avoid usage with renal injury or risk of kidney stones) weight bearing exercise pharmacologic: calcitonin raloxifene (selective estrogen receptor modulator with common adverse effects: hot flashes and leg cramps and serious adverse effects; increase risk of blood clots) bisphosphonates: suppresses osteoclast bone reabsorption, DC does not result in cessation of action, must be taken with water and on an empty stomach, avoid taking with calcium

Question 35

What are the risk factors for breast cancer?

Answer 35

age 50 and older gender (predominantly women) genetic: BRCA1 and BRCA2 hormone usage, especially post-menopausal usage family hx personal hx menstrual hx: early menarche (before 12), late menopause (after 45) full term pregnancy after 30 nulliparity atypical epithelial hyperplasia of breast tissue breast denisty: more connective than fatty tissue makes it harder to see masses on mammograms weight and obesity after menopause due to fat cells storing estrogen ionizing radiation alcohol consumption

Question 36

What is inflammatory breast cancer? Pathophysiology?

Answer 36

rare rapid development of breast cancer making the affected breast red, swollen, tender occurs when cancer cells block lymphatic vessels and skin covering breast

Question 37

What is paget's?

Answer 37

rare breast cancer that starts at the nipple and extends to areolar

Question 38

What is phyllodes tumor?

Answer 38

breast tumor that rapidly grows in leaf-life pattern but rarely metastasize

Question 39

What are clinical manifestations of breast cancer?

Answer 39

nontender lump in breast that typically is found in upper outer quadrant abnormal nipple discharge rash around nipple area nipple retraction dimpling of skin change in nipple position usually painless Peau d'orange: skin becomes thick and pitted with a texture and appearance similar to orange peel infiltration, dimpling

Question 40

What is the nurse's role in the stages of end of life?

Answer 40

denial: be supportive and listen anger: don't take anger personally, help pt maintain autonomy as much as possible bargaining: listen, do not give false hope depression: listen, refer to spiritual leaders if wanted acceptance: honor wishes, simplify environment, peaceful environment

Question 41

What are nursing interventions for end of life care?

Answer 41

pain: proactively prevent respiratory: elevated HOB, pace activities throughout day, administer oxygen as needed constipation: proactively prevent with increase fluids, fiber, possible stool softener poor nutritional intake: may need to simulate appetite, at an increase fall risk

Question 42

What is left sided heart failure?

Answer 42

blood backs up into lungs likely to lead to right sided HF can be systolic or diastolic dysfunction: systolic leads to low ejection fraction and decreased perfusion to organs, diastolic leads to ventricle not filling completely (decreased stroke volume) with blood but with a normal ejection fraction

Question 43

What are the clinical manifestations of left sided heart failure?

Answer 43

DROWNING dyspnea rales (crackles) orthopnea (dyspnea upon lying down) weakenss nocturnal paroxysmal dyspnea increased HR nagging cough gaining weight

Question 44

What is right sided heart failure?

Answer 44

congestion of blood in the heart causing back up in the venous system and tissues

Question 45

What are the signs and symptoms of right sided heart failure?

Answer 45

SWELLING swelling of legs, hands, liver, abdomen weight gain edema (pitting) large neck veins (JVD) lethargy irregular HR (afib) nocturia girth of abdomen increased

Question 46

What are the major pharmaceutical therapies for heart failure? Side effects?

Answer 46

ACE inhibitors - prils side effects: dry, nagging cough, hypotension, hyperkalemia, renal insufficiency ARBs - sartans side effect: hyperkalemia

Question 47

How are diuretics used in heart failure?

Answer 47

symptom management by promoting excretion of sodium and water

Question 48

What are the classes of lupus drugs?

Answer 48

NSAIDs anti-malarial corticosteroids immunosuppressives anticoagulants B lymphocyte stimulator topical immunomodulators

Question 49

What is the pathophysiology of lupus?

Answer 49

multi-system inflammatory and autoimmune disease that affects the skin, joints, serous membranes (pleura, pericardium), renal, hematologic, and neurologic

Question 50

What are the clinical manifestations of lupus?

Answer 50

dermatologic: butterfly rash over cheeks, vascular skin lesions musculoskeletal: pain in multiple joints, morning stiffness cardiopulmonary: pleurisy (inflammation of pleural), tachypnea, inflammation of heart renal: glomerulonephritis progressing into end stage renal disease neurologic: peripheral neuropathy, cognitive problems, mood disorders, headache hematologic: thrombocytopnea (increased risk of infection)