Unit 2

Question 1

Serena Williams, an international tennis star underwent a series of serious health problems. It started in Fall, 2010 when she cut her foot on a piece of glass at a restaurant. She underwent 2 operations to repair the foot. She had limited movement for 20 weeks first with a cast, followed by a walking boot for 10 weeks. In February, 2011 she was hospitalized for pulmonary embolisms (PE) in both lungs.

Which part of Vichow’s triad put Serena at risk for a DVT and PE?

Answer 1

vascular wall injury

The most obvious answer is vascular wall injury due to the trauma that incurred that led to her injury and subsequent surgery. Surgery alone causes vascular wall injury. You could also argue for venous stasis due to the immobility that she had for the 20 weeks when she was in a cast.

Question 2

Symptom of a DVT?

erythema at the area of the thrombosis

Answer 2

yes

Question 3

Symptom of a DVT?

swelling in one leg

Answer 3

yes

Question 4

Symptom of a DVT?

severe pain (10 out of 10)

Answer 4

no

Question 5

Symptom of a DVT?

Temp of 100 F

Answer 5

no

Question 6

Symptom of a DVT?

maculopapular rash at the area of thrombosis

Answer 6

no

Question 7

WBC count of 11,000 cells/mm3

Answer 7

yes

Question 8

What is the most serious risk for a patient with a DVT?

Answer 8

pulmonary embolism

Patients with a DVT can have all of the items listed (pain, blood thinners, another DVT and a PE). The one with the biggest consequence is a PE, because it can be deadly if is large enough or if there are many PEs. A PE interferes with the ability for gas exchange in the lungs and can result in death.

Question 9

Which of the following patients has the highest risk of developing a DVT?

Answer 9

A pt who has a history of having a DVT

Question 10

True or False

A person with a PE can experience extreme shortness of breath, tachycardia, chest pain and a feeling of anxiety.

Answer 10

True

A patient has to have a DVT first before a PE develops. A PE is a DVT that has traveled (emboli) to the pulmonary arteries.

Symptoms of a PE include chest pain, fast heart rate, shortness of breathe, feeling of anxiety (or impending doom) and can be deadly if the pulmonary artery occlusion is large enough.

We treat patients with a DVT so that a PE is prevented. (We treat both DVT and PE.)

A way to prevent a DVT is through ambulation.

Question 11

Normal or hypertensive?

89 year old with a BP of 182/90

Answer 11

hypertensive

Question 12

Normal or hypertensive?

18 year old with BP of 118/72

Answer 12

normal

Question 13

Normal or hypertensive?

72 year old with BP of 145/92

Answer 13

Hypertensive

Question 14

Normal or hypertensive?

65 year old with BP of 145/92

Answer 14

normal

Question 15

The formula for arterial blood pressure is ____________X peripheral vascular resistance.

Answer 15

Cardiac output

Cardiac output X PVR= arterial pressure. You can take it a step further an look at what makes up cardiac output and what influences PVR.

Question 16

Modifiable Hypertension risk factors

Answer 16

Tobacco use, obesity, diet low in potassium, excessive alcohol use, oral contraceptive pill use

Question 17

Emily Sparks is a 39-year old female who has end stage renal disease (CKD stage 5) and is on dialysis. She was recently diagnosed with HTN. The nurse recognizes that she most likely has what type of HTN?

Answer 17

secondary

Emily most likely has secondary HTN as the end stage kidney disease can lead to HTN since the kidney is not functioning and can not eliminate wastes like it should.

Question 18

True or False

Dysfunction of the sympathetic nervous system, RAAS (renin, angiotensin, aldosterone system) adducin and naturietic peptides can result in increased peripheral vascular resistance and increased blood volume; two main causes of sustained hypertension.

Answer 18

True

Question 19

True or False

HTN can lead to blindness

Answer 19

True

HTN can lead to retinopathy, which can eventually lead to blindness.

Question 20

True or False

Kidney failure can cause HTN. HTN does not cause kidney failure.

Answer 20

False

Kidney failure can cause HTN because of fluid volume overload and HTN can cause nephropathy and increased pressure in the kidney causing dysfunction in the glomerulus and difficulty with filtration.

Question 21

Sustained hypertension for years can lead to ___________in the heart.

Answer 21

myocardial infraction, hypertrophy of left ventricle, heart failure, and angina

Question 22

Put the following in order from least pathogenic (1) to the most pathogenic (4).

1. fibrous plaque
2. fatty streak
3. foam cells
4. complicated lesion

Answer 22

3,2,1,4

The foam cells turn into fatty streaks, which develop into fibrous plaques, which have the potential to become a complicated lesion if the plaque ruptures.

Question 23

True or False

When a patient says “I was told I have 4 vessel occlusion” he is referring to atherosclerosis in his coronary arteries.

Answer 23

True

A plaque from atherosclerosis can result in:

1) progressive narrowing of the vessel resulting in occlusion (like in this example)

2) sudden vessel obstruction from plaque hemorrhage or rupture.

3) thrombois and formation of emboli

4) aneurysm formation caused by weak blood vessel walls.

Question 24

A patient complains of angina whenever he takes his morning walk with the dog. He tells his provider that his pain in his chest always come on when he reaches “Elm St”. The provider recognizes what is the underlying pathology in this situation?

Answer 24

Stable angina

This situation is characteristic of stable angina, which would be related to a fibrous plaque which is causing a decreased diameter in the blood vessel. It is predictable as the demand on the heart increases, the pain appears.. Stable angina is relieved by rest and/or nitroglycerin.

Question 25

John Jacob Jingleheimer Smidht is a 68 year old male. He presents to the outpatient clinic with complaints of occasional chest pain. He is concerned because his Dad died from heart problems at an early age. He has a history of hypertension and “sugar diabetes” but doesn’t take any medications for them because he doesn’t feel like he needs them. He smokes 1/2 pack a day of cigarettes and has since he was 12 years old. “Hard to quit, when I’ve been doing it for so long”. He was told he needs to watch what he eats as his cholesterol was high the last time it was checked. On physical exam, you note that he is considered “obese” based on his body mass index and he has a waist circumference of 44 inches.

What risk factors does John have for coronary artery disease?

Answer 25

Smoking, cigarettes, family history, diabetes mellitus, high cholesterol

John has a lot of risk factors (smoking, family history, DM, high cholesterol). He does have a 44 inch waist. Most men with a large waist are “apple” shaped. Apple shaped is a higher risk factor for cardiovascular disease than the typical pear shape of women. I know we haven’t discussed this yet—teachable moment.

Question 26

True or False

A foam cell is an oxidized LDL (low density lipoprotein) that is consumed by a macrophage. This occurs early in the process of atherosclerosis.

Answer 26

True

Question 27

Which of the following are some core components to atherosclerosis?

Answer 27

Narrowed blood vessels from the buildup of plaque

Behavioral and Genetic factors that lead to endothelial injury

High LDL levels. The LDLs become oxidized.

Plaque disruption can lead to a thrombus or an emboli which could mean a heart attack.

Question 28

True or False

Atherosclerosis occurs only in the coronary arteries of the heart.

Answer 28

False

Atherosclerosis can occur in every blood vessel in the body. Common places are the abdominal aorta, coronary arteries, femoral and popliteal arteries (leads to peripheral arterial disease), carotid arteries and the arteries in the brain.

It is the same process, it just occurs in different part of the body.

Question 29

When a patient develops peripheral arterial disease, are some expected findings?

Answer 29

history of dyslipidemia

shiny, pale skin

reports of intermittent claudication

PAD (peripheral arterial disease) is atherosclerosis in the peripheral arteries of the body.

Risk factors are the same for PAD as they are for coronary artery disease (CAD).

Symptoms include intermittent claudication, diminished or absent pulses, coolness of skin, pallor, and parathesias.

Question 30

If a person assigned female at birth has angina, how might they present?

Answer 30

Extreme fatigue, heavy pain in the chest and down the left arm, shortness of breath, and nausea and heartburn

Typical angina presents as heavy type pain that is steady and centered in the precordial or substernal area with radiation to jaw, shoulder or arm. Anginal equivalents is a description of non-typical presentations of angina which includes dyspnea, diaphoresis, feeling faint/dizzy, extreme fatigue and heartburn.

Those assigned female at birth can present with either.

Question 31

Put the following in the order from the least serious (1) to the most serious (4).

1. STEMI
2. unstable angina
3. non-STEMI
4. stable angina

Answer 31

4,2,3,1

stable angina–unstable angina—non-STEMI (non Q wave MI)——-STEMI (Q wave MI)

Question 32

A patient arrives in the emergency room with chest pain and is diagnosed with a STEMI. Which of the following findings are expected?

Answer 32

increased cardiac enzyme (troponin), EKG changes with ST elevation and eventually a Q wave, and necrosis of the myocardium transmural (from endocardium to epicardium)

Question 33

After _____________[x] minutes without oxygen, the cellular damage to the heart is irreversible.

Answer 33

20

Question 34

A client has been diagnosed as having unstable angina without an MI.

The nurse expects the symptoms of ______based on what pathological occurrence ______ ? The nurse expects ______ of cardiac enzymes like troponin.

Answer 34

chest pain at risk or minimal exertion

Plaque disruption that has caused occlusion of a blood vessel.

no elevation

Question 35

When a myocardial infarction occurs, what has happened?

Answer 35

necrosis of cardiac tissue

Ischemic death of cardiac tissue or necrosis of cardiac tissue occurs with an MI. That part of the cardiac muscle becomes noncontractile, necrotic and scarred leading to further problems.

Question 36

Which of the following are symptoms of an MI?

Answer 36

Intense feeling of anxiety

heavy, constricting chest pain

nausea

suddenly feeling sweaty

shortness of breath

Question 37

What happens to the heart after an MI?

Answer 37

After 2-3 months scar tissue has formed causing contraction and conduction issues.

There are a lot of complications immediately from an MI (chest pain, acidosis, electrolyte imbalances, contraction dysfunction, dysrhythmias and increase catecholemine affects).

After the MI, physiologically there are changes:

6 hours–blue and swollen (think hypoxia)

48 hours–grey with yellow streaks, neutrophils move in

8-10 days-granulation tissue

2-3 months–scar tissue and ventricular remodeling.

Question 38

In heart failure, the heart is likely to be ______, so that the diameter of the heart ______ .

Answer 38

overstretched, decreases

Question 39

The body tries to “fix” the problem of heart failure by compensatory mechanisms. How does the body compensate?

Answer 39

Increased heart rate

increased sympathetic nerve impulses

release of renin and aldosterone

The body tries a lot of compensatory mechanisms without any improvement. Strategies include: activating RAAS (water and Na retention), increased HR, increased peripheral vascular resistance.

Question 40

Systolic heart failure, the heart has a problem with _____ . As a result, the ejection fraction ______ . A normal ejection fraction (EF) is 65%.

Answer 40

ejection, decreases

Question 41

What is an example of high output heart failure?

Answer 41

Severe anemia

High output heat failure is not very common. Examples include severe anemia and thyrotoxicosis. Low output heart failure is much more common.

Question 42

Left or right heart failure symptom?

cough of pink frothy sputum

Answer 42

left

Question 43

Left or right heart failure symptom?

2+ ankle edema

Answer 43

right

Question 44

Left or right heart failure symptom?

shortness of breath

Answer 44

left

Question 45

Left or right heart failure symptom?

paroxysmal nocturnal dyspnea

Answer 45

left

Question 46

Left or right heart failure symptom?

anorexia

Answer 46

right

Question 47

Left or right heart failure symptom?

weight gain of 3 lbs overnight

Answer 47

right

Question 48

Left or right heart failure symptom?

orthopnea

Answer 48

left

Question 49

Left or right heart failure symptom?

dyspnea on exertion

Answer 49

left

Question 50

Left or right heart failure symptom?

hepatomegaly

Answer 50

right

Question 51

Which two pieces of information would be most important to know about a patient being admitted with heart failure?

Answer 51

BNP levels and ejection fraction

BNP is used for diagnosis of heart failure. The higher the number the worse the clinical situation. A BNP of 500 is diagnostic.

The EF of a patient tells you how decompensated their heart function is and gives a good idea of severity of the illness.

Question 52

True or False

A person who develops heart failure may have symptoms that are more indicative of failure on one side (right or left) but eventually will develop symptoms of both right and left sided heart failure.

Answer 52

True

Question 53

Which symptoms would the nurse expect to see in a patient with predominately right-sided heart failure?

Answer 53

loss of appetite or getting full easily

swollen feet and ankles

Signs of systemic congestion are much more common with right-sided heart failure and can include lower extremity edema, organ congestion (hepatomegaly) which can lead to abdominal fullness and anorexia and also jugular vein distention.

Pulmonary symptoms are much more common with left-sided heart failure (shortness of breath, PND, orthopnea, pink frothy sputum, crackles in the lungs).

Question 54

After an automobile accident a client who is unconscious and exhibiting decerebrate posturing is brought to the emergency department. When assessing the client, what does the nurse expect to observe?

Answer 54

Hyperextension of both the upper and lower extremities

Decorticate: inward

flexion of the arms, wrists, fingers with adduction of the upper extremities, internal rotation and plantar flexion of the LE.

Decerebrate: outward

results from increased muscle excitability. Rigidity of the arms with the palms of the hands turned away from the body and the stiffly extended legs with plantar flexion of the feet.

Both are POOR PROGNOSTIC SIGNS—usually happens in stage IV.

Question 55

A client is having a brain attack (CVA) is brought to the emergency department. The vital signs are P 78, R 16, BP 120/80. The change in this client’s vital signs that indicates increasing intracranial pressure (ICP) requiring notification of the practitioner is:

Answer 55

Pulse 50, Resp 20, BP 140/40

In stage 3, as the brain is beginning decompensation, vital signs start to change. Remember Cushing’s Triad: Increased systolic BP (up to 270 mmHg) with widened pulse pressure; irregular respirations and bradycardia. Widened pulse pressure is the difference between the systolic BP and the diastolic BP. Bradycardia occurs in a compensatory response because of the extremely elevated BP.

Question 56

Initially after a brain attack (CVA), a client’s pupils are equal and reactive to light. Later the nurse assesses that the right pupil is reacting more slowly than the left and the systolic blood pressure is beginning to increase. The nurse concludes that these signs are suggestive of:

Answer 56

Increased intracranial pressure

In stage 3, pupillary changes start to occur. Initially the pupils are slower to react or react differently from each other. They then progress to pinpoint size. In stage 4, one pupil becomes dilated and one is pinpoint then eventually both are dilated (usually called fixed and blown by practitioners). Systolic BP starts to rise in stage 3.

Question 57

The nurse is caring for a client with increased intracranial pressure. Which of the following assessment findings should the nurse report immediately?

Answer 57

Absence of pupillary response

Absence of pupillary response is always an abnormal finding and in someone with suspected IICP, this should be reported immediately. Vomiting tends to happen early, but it is usually not accompanied by nausea and tends to be projectile in nature.

Question 58

When increased intracranial pressure occurs in the brain, what is the relationship between ICP and arterial pressure?

Answer 58

ICP = arterial pressure

impacts blood flow and the exchange of oxygen. This first starts to happen in stage 3.

Question 59

Which of the following is options describe normal statements regarding intracranial pressure?

Answer 59

The first state of increased ICP, the body is able to compensate by displacing CSF and if often not even noticable.

Normal ICP is less than 15 mmgHg (5-15 mmHg is normal for testing purposes).

A decrease in level of consciousness is the earliest and most reliable sign of increased intracranial pressure.

The body compensates first by displacing CSF and is often not even noticeable.

During ICP, there is massive vasoconstriction to the point where the ICP equals the arterial pressure. Remember there is a increased blood pressure with a widened pulse pressure. Example 180/60 blood pressure.

Question 60

A client with a head injury is admitted to the nursing unit. The following is found on physical assessment:

BP 180/50, pulse 48 beats per minute. Client opens eyes but does not respond verbally. The pupils are slow to respond to light. The breathing is irregular in pattern and the client has decorticate posturing.

What is this client most at risk for?

Answer 60

Brain Herniation

This patient is very advanced in displaying signs of IICP and is very high risk of brain herniation if it has not happened already. The patient is in stage 3 and looks like they are moving toward stage 4 where herniation occurs.

Question 61

A ____ is an acute focal neurological deficit from an interruption of blood flow in a cerebral vessel due to thrombi or emboli or bleeding into the brain.

Answer 61

Stroke

A TIA can be described as a brief period of inadequate cerebral blood flow that has neurological deficits that usually resolve within hours (lasts no longer than 24 hours) and can be caused by platelets accumulating at the site of a thrombosis or from vasospasm.

Question 62

The nurse is admitting a client diagnosed to have a CVA involving left-brain damage. The nurse is told that the patient has aphasia. What does this mean?

Answer 62

Difficulty either understanding what is said to them or difficulty in speaking

Question 63

Which of the following factors put someone at increased risk for having a cerebral vascular accident (CVA)?

Answer 63

African Americans

Blood pressure readings consistently running 160/90 - 180/90

Alcohol use disorder

Afib

diabetes mellitus

Question 64

What pathological changes occur with a stroke?

Answer 64

creation of a necrotic core surrounded by a prenumbra

cerebral edema

creation of lactic acid from anaerobic metabolism

Question 65

A client is admitted with a hemorrhagic stoke. What does this mean?

Answer 65

The client had a cerebral artery rupture that led to bleeding

Question 66

What is a common cause of an embolic stroke?

Answer 66

Afib

Question 67

True or False

A person who has a seizure disorder always has convulsions. True or False

Answer 67

False

People with convulsions have seizures, but not all seizures have motor activity like convulsions.

Question 68

Define absence seizure

Answer 68

Client has no movement, staring off and is not responsive to stimuli.

Question 69

Define myoclonus

Answer 69

Brief muscle twitching of one part of the body. Often seen with a focal seizure.

Question 70

Define status epilepticus

Answer 70

Seizure that is prolonged or lasts more than 5 minutes

Question 71

Define Atonic

Answer 71

Person loose muscle control, muscles are weak or limp and ther person falls to the ground during a seizure.

Question 72

What term would we use to call her experience of smelling “burnt toast”?

Answer 72

aura

Question 73

What are some common etiologies (causes) of seizure disorders?

Answer 73

hypoglycemia, substance use disorder, epilepsy, stroke, and head injury

There can be a lot of causes of seizures:

unknown which is referred to as epilepsy as well as many secondary causes such as brain lesions, head injury, substance use disorder, metabolic imbalances, stroke, environmental stimuli, infections, Alzheimer’s disease, etc.

Question 74

The nurse is concerned about a patient presenting to the emergency room who has been seizing for 20 minutes and is in status epilepticus. The nurse expects which of the following findings in this patient?

Answer 74

Acidosis

In status epilepticus the patient doesn’t have normal respiration. It can lead to hypoxia, increased pCO2 and respiratory acidosis. This can eventually lead to severe brain damage and death. I mentioned metabolic acidosis in the recording, which eventually happens with prolonged seizing.

Question 75

True or false

All Alzheimer’s disease is hereditary

Answer 75

False

Early onset Alzheimer’s disease (diagnosed before the age of 50) has an inheritable genetic component, but this has not been found in all individuals with Alzheimer’s disease.

Question 76

which component of the Alzheimer’s pathology has the greatest significance and therefore the subject of new drug therapy strategies?

Answer 76

abnormal tau proteins

The presence of abnormal tau is where the focus is. There is a great statement by one of the researchers. Amyloid plaque pulls the trigger and tau protein is the bullet in the gun.

Question 77

Dementia or Delirium?

Patient becomes confused after being admitted to the hospital for hip surgery after falling at home.

Answer 77

Delirium

Question 78

Dementia or delirium?

Family notices that the patient is becoming more and more forgetful. He went to the grocery store and got lost coming home

Answer 78

Dementia

Question 79

Dementia or Delirium?

The patient was fine last week and now is hallucinating and seeing bugs crawling on the walls.

Answer 79

Delirium

Question 80

Dementia or delirium?

This problem is non-curable and will eventually result in the patient being bed-bound and requiring total care.

Answer 80

Dementia

Question 81

A nurse is performing the history and physical examination on a patient with Parkinson’s disease. Which assessments identified by the nurse support this diagnosis?

Answer 81

Low pitched monotonous voice, masklike facial expression, and nonintentional tremors

Question 82

Alzheimer’s disease, which is the most common type of dementia involves which of the following pathophysiological features?

Answer 82

apolipoprotien E4 mutation, presence of beta-amyloid plaques and neurofibrillary tangles made of tau, and decrease in acetylcholine

The presence of the apolipoprotien E4 mutation may be present, but is not always present in individuals with Alzheimer’s disease.

Question 83

The client with Parkinson’s disease has a nursing diagnosis of Risk for Falls, related to an abnormal gait documented in the nursing care plan. The nurse assesses the client, expecting to observe which type of gait?

Answer 83

Shuffling and propulsive

Question 84

Define bradykinesia

Answer 84

Slow, shuffling gait related to excessive inhibition of movement; difficulty initiating movements

Question 85

What are cog wheel movements?

Answer 85

Ratchet-like movements of arms; a form of rigidity

Question 86

What is a mask like face?

Answer 86

Lack of facial expression

Question 87

Define dysphagia

Answer 87

Difficulty swallowing

Question 88

Excessive sweating, salivation (with drooling), lacrimation, constipation, and impotence is defined as what?

Answer 88

Autonomic manifestations

Question 89

In Parkinson’s disease there is a lack of _____ being made by the substantia nigra of the basal ganglia. The symptoms result from acetylcholine not having an opposing neurotransmitter resulting in jerky movements.

Answer 89

dopamine

Question 90

What are the two pathophysiological processes that occur with Parkinson’s disease?

Answer 90

accumulation of alpha-synuclein protein in the form of Lewy bodies and loss of dopamine

We focused primarily on dopamine loss but we also know that there is an accumulation of alpha-synuclein protein in the brainstem, spinal cord and brain.

Question 91

What are the cardinal symptoms of Parkinson’s disease

Answer 91

bradykinesia, rigid movement, tremor at rest, postural/gait instability

Question 92

The two hallmark events that occur when a patient is having an asthma attack is:

Answer 92

Bronchoconstriction and inflammation

Question 93

True or false

Uncontrolled asthma with frequent attacks can lead to long term bronchial remodeling and chronic obstructive pulmonary disease (COPD).

Answer 93

True

This happens is a small population of people with asthma.

Question 94

Which of the following situations is ominous and is the worse case scenario of a patient with asthma?

Answer 94

patient with a silent chest (no wheezing) and a pCO2 of 70 mmHg

Normal symptoms of asthma attack include wheezing, dyspnea, chest tightness, tachypnea, tachycardia, anxiety, cough and accessory muscle use (intercostal muscle retractions). When they are hyperventilating, they are more prone to respiratory alkalosis, but when they tire out and their respirations slow down, they retain pCO2 can become acidotic. At that point, they are not moving air at all and their chest becomes silent (no breath sounds). Bad sign. Remember that people die from asthma attacks every day and we need to act quickly and recognize a serious condition.

Question 95

Chronic Bronchitis or Emphysema?

Patient has productive cough with a lot of thick tenacious sputum

Answer 95

Chronic bronchitis

Question 96

Chronic Bronchitis or Emphysema?

Respiratory rate on the low side (12-14/min)

Answer 96

Chronic bronchitis

Question 97

Chronic Bronchitis or Emphysema?

Works hard to breathe with higher respiratory rate (24/min) and pursed lip breathing

Answer 97

Emphysema

Question 98

Chronic Bronchitis or Emphysema?

Greater Ventilation/perfusion mismatch (VQ) resulting in more hypoxemia

Answer 98

Chronic bronchitis

Question 99

Chronic Bronchitis or Emphysema?

Barrel chested

Answer 99

Emphysema

Question 100

Chronic Bronchitis or Emphysema?

thin, low weight individual

Answer 100

Emphysema

Question 101

Chronic Bronchitis or Emphysema?

cyanosis common

Answer 101

Chronic bronchitis

Question 102

Chronic Bronchitis or Emphysema?

Assumes the tripod position to help breating

Answer 102

Emphysema

Question 103

Both emphysema and chronic bronchitis can result from cigarette smoking, but
_______ can be from a genetic deficiency in alpha-1 antitrypsin. In ___________hypertrophy of mucus glands, globlet cells and airway epithelium occurs. In
________ there is a last of elastin either from inflammatory cells (from cigarette smoking) or from lack of alpha-1 antitripsin. As patient with COPD advances, patients start to lose their normal respiratory drive that occurs from high pCO2 levels, so we have to be careful when giving them oxygen.

Answer 103

Emphysema, chronic bronchitis, emphysema

Both emphysema and chronic bronchitis can result from cigarette smoking, but emphysema can be from a genetic deficiency in alpha-1 antitrypsin. In chronic bronchitis, hypertrophy of mucus glands, globlet cells and airway epithelium occurs. In emphysema there is a last of elastin either from inflammatory cells (from cigarette smoking) or from lack of alpha-1 antitripsin. As patient with COPD advances, patients start to lose their normal respiratory drive that occurs from high pCO2 levels, so we have to be careful when giving them oxygen.

Question 104

What is Dead air space?

Answer 104

Situation where there is adequate ventilation, but poor perfusion (Ex: pulmonary embolism)

Question 105

What is a shunt?

Answer 105

Situation where there is adequate perfusion, but not ventilation (Ex:pneumonia, COPD)

Question 106

Define hypoxemia

Answer 106

Reduced oxygen in arterial blood

Question 107

Define hypoxia

Answer 107

decreased oxygen of cells in the tissues (could be related to problems with oxygenation, anemia or necrosis)

Question 108

Define hypercapnia

Answer 108

increased levels of carbon dioxide in the blood

Question 109

Define oxyhemoglobin dissociation curve

Answer 109

The ease that hemoglobin gives up oxygen and accepts carbon dioxide. (Ex: state of acidosis, hgb has decreased affinity for picking up oxygen).

Question 110

A patient is diagnosed with right lower lobe pneumonia, which is a type of _________pneumonia. Pneumonia is most often caused by
__________, but can also be caused by injurious agents like smoke, aspiration of gastric contents or respiratory suctioning. A patient who develops pneumonia in the hospital is said to have ________ pneumonia. This type of pneumonia is 90% of the time bacterial in origin and multi-drug resistant.

Answer 110

Lobar pneumonia, S. pneumoniae, nosocomial pneumonia

lobar: consolidation in a part of all of the lung of a lobe.

bronchopneumonia: patchy consolidation involving more than one lobe of the lung

S.pneumoniae is the most common infectious agent. Pneumonia can be cause by bacteria, viruses and fungi.

Community acquired pneumonia is referring to the types of organisms that are most often found in the community versus the hospital or nursing home.

Nosocomial refers to hospital acquired pneumonia and infections occur after 48 hours in the hospital and are usually bacterial and antibiotic resistant. VAP=ventilator associated pneumonia is an example.

Question 111

Why do patients with pneumonia have compromised gas exchange?

Answer 111

Inflammatory process leads to the accumulation of WBCs, causes capillary leak, edema and exudate in the alveoli.

These fluids collect in and around the alveoli and the alveolar walls thicken. Both events seriously reduce gas exchange and lead to hypoxemia interfering with oxygenation and tissue perfusion.

Question 112

The nurse recognizes which of the following as symptoms of pneumonia?

Answer 112

Resp 28/min, cough with productive purulent sputum, and pleuritic chest pain

Question 113

True or False

A person presents to the health department because she finds out that she was exposed to a person with active TB infection one week ago and is afraid that she has TB. The nurse correctly expects her purified protein derivative (ppd) test to be greater than 15mm in induration.

Answer 113

False

It takes time for the cellular immunity to kick in and mount a positive antibody response to this exposure (remember Hypersensitivity Type IV). This can take up to 10 weeks to happen and at the earliest is 2 weeks. Once that time has passed, her ppd should be positive. If she was a healthy individual with no known TB contacts, greater than 15 mm in induration would be considered positive. Because she had contact with a known active TB case, then greater than 5 mm induration is considered positive.

Question 114

When the tuberculosis bacilli enter the lungs, the body responds by:

Answer 114

phagocytes and macrophages engulf the bacilli and eventually wall it off by forming a granuloma. As the inside macrophages in granuloma die off, it develops a caseous (cheese like consistency) necrosis and it eventually forms a ghon complex, which can be seen on X-ray.

Question 115

True or False

TB is only found in the lungs.

Answer 115

False

TB is primarily a pulmonary infection, but can be found in lots of different areas in the body, such as the brain, prostate, intestine, etc.

Question 116

Which of the following individuals has active TB and is infectious?

Answer 116

positive ppd and positive sptutum culture and has had a 10 lb weight loss, chronic cough and low grade fevers in the afternoon.

Question 117

According to the Monro-Kellie hypothesis, if there is an increase in brain tissue, then what will occur in response as a means of compensation?

Answer 117

The blood volume and the CSP displace to accommodate the increased tissue volume.

Question 118

If a patient has IICP stage 3, the nurse expects what change in vital signs?

Answer 118

Blood pressure of 210/120 mmHg

There is an increase in the pulse pressure. The systolic blood pressure goes up in an attempt to perfuse the brain and the systolic pressure is lower.

Question 119

Which of the following symptoms should be reported to the provider for a patient with a head injury from playing football?

Answer 119

Patient’s conversation is not making sense.

Question 120

If a baby has increased ICP, what might the nurse see?

Answer 120

bulging fontanelles

Question 121

If a patient with IICP is having some strange positioning of the body with the flexion of extremities inward. What does this mean?

Answer 121

The patient is in stage 4 (herniation).

Question 122

A patient has stroke that comes on all of a sudden and cuts off blood supply to the brain. The patient has a history of irregular heart rhythm (atrial fibrillation). This patient most likely had what type of stroke?

Answer 122

Stroke from an emboli

Atrial fibrillation causes turbulent blood flow in the heart leading to the formation of clots in the heart. The clots can travel (emboli).

Question 123

A patient is having symptoms of a stroke. The patient reports the stroke symptoms came on suddenly and started with a very bad headache. This is most likely what type of stroke?

Answer 123

hemorrhagic stroke

Question 124

A patient had a TIA. Which statement by the patient needs further clarification?

Answer 124

Since all my symptoms went away, I am no longer at risk for a stroke.

Question 124

Which patient is most at risk for a stroke?

Answer 124

A 70-year-old man with a 10-year history of diabetes and hypertension.

Question 125

A patient came to the ED with a new onset CVA and underwent diagnostic testing that identified the area of the prenumbra. The nurse understands the significance of this as being:

Answer 125

If blood can be re-perfused to the prenumbra, this area of the brain can be saved from necrosis.

Question 126

A nursing student sees a person at Ingles who he suspects is having a stroke. Which of the following symptoms are suspicious of a stroke?

Answer 126

Inability to pick up a grocery bag, uneven smile, garbled speech, and arm drift

Question 127

A patient is said to have hemiparesis. What does this mean?

Answer 127

weakness on one side of the body

Question 128

When a stroke occurs, the nurse recognizes that the lack of perfusion causes which of the following pathophysiological changes?

Answer 128

Tissue injury from free radical formation and toxic metabolites build up.

Failure of the Na/K pump which results in cellular swelling and damage.

Localized acidosis due to lactic acid production that occurred from anaerobic metabolism.

Question 129

Which of the following statements is TRUE regarding the symptoms of a stroke?

Answer 129

The symptoms of a stroke are based on which artery has occlusion of blood flow.

Question 130

What does it mean if a patient has ipsilateral pupil dilation?

Answer 130

One pupil is large and the other one is small, and they don’t change with light.

Question 131

The nurse is caring for a patient in stage 4 IICP. What does the nurse expect to see?

Answer 131

Decerebrate posturing and Cheyne-Stokes breathing

Question 132

A patient has a seizure for the first time. What is the next step?`

Answer 132

Investigate any possible causes for the seizure.

Seizures can be primary (epilespsy) and have an unknown cause or can be secondary to something else. It is important to figure out why the person had the seizure and treat the cause first.

Question 133

The nurse is caring for a patient with a seizure disorder. What is a helpful question to ask the patient to help the nurse plan the care for this patient?

Answer 133

Do you have some type of aura before your seizures?

This is helpful for the nurse to know, so if the patient relays that he/she is having the aura (seeing, smelling or hearing something) then the nurse can prepare for the seizure and try to make sure the patient is safe. Just like in the video of “burnt toast” the man jumps in and catches her before she hits her head on the ground.

Question 134

If a patient is diagnosed as having a “focal” seizure, what does the nurse understand this to mean?

Answer 134

One side of the brain is affected.

Focal means one side of the brain; generalized means both sides of the brain are involved.

Question 135

A patient is determined to have a secondary seizure. Which of the following things can cause a seizure?

Answer 135

Low blood sugar, Na level of 120 mEq/L, glioblastoma, overexhaustion, and CVA

Question 136

A patient is in status epilepticus. What complication is expected?

Answer 136

hypotension

Question 137

What is the most common type of dementia?

Answer 137

Alzheimer’s

Question 138

What are the two essential pathologies related to Alzheimer’s disease?

Answer 138

Tau and amyloid

Amyloid plaque pulls the trigger and tau protein is the bullet in the gun

Question 139

Which tends to occur first in Alzheimer’s pathology?

Answer 139

Amyloid plaques

The plaques tend to happen before the tangles.

Question 140

What neurotransmitter is found in low levels in the brain with Alzheimer’s?

Answer 140

acetylcholine

This is because there is an enzyme (choline acetyltransferase) that results in a decrease in the amount of acetylcholine that is available.

Question 141

What seems to be the cause in people who have early onset Alzheimer’s?

Answer 141

Genetics

Question 142

One of the symptoms of Alzheimer’s disease is “sundown syndrome”. What is this?

Answer 142

increased confusion in the evening and night and clearer congnition during the day

Question 143

Which of the following individuals would be considered “delirious”?

Answer 143

A patient with acute confusion after being admitted to the hospital.

Question 144

A patient has Parkinson’s disease. The nurse recognizes that this patient should have what 3 cardinal symptoms?

Answer 144

Tremor at rest, shuffling gait, rigid movements

Question 145

Manipulation of what neurotransmitters are helpful to improve symptoms of Parkinson’s disease?

Answer 145

Increase dopamine and decrease acetylcholine

Question 146

Which symptom is common with Parkinson’s disease

Answer 146

masklike face, uncontrolled sweating and salivating, and short shuffling gait

Question 147

Which of the following describes what occurs with a seizure?

Answer 147

One or more parts of the brain becomes hyperexitable.

Question 148

What are typical clinical presentations of someone with dementia

Answer 148

Wandering or getting lost, Apraxia-difficulty performing familiar tasks such as getting dressed, Difficulty with abstract thinking, Difficulty with remembering to eat, Rapid mood changes such as becoming paranoid or scared for no apparent reason.

Question 149

What is one of the most consistent risk factors for delirium?

Answer 149

dementia

Question 150

If gas exchange occurs in the alveoli, which of the following can impact gas exchange?

Answer 150

pulmonary embolism, pneumonia, viral bronchitis, and pulmonary edema

Question 151

If a pulmonary embolism occurs, which definition best fits?

Answer 151

Ventilation without perfusion

Question 152

A patient has a high level of carbon dioxide on their ABG. What is this called?

Answer 152

Hypercapnia

Question 153

If a patient lives in a nursing home and gets pneumonia, what is this called?

Answer 153

community acquired pneumonia

There is not enough information in this stem to classify it any differently than just community acquired pneumonia.

Question 154

A patient is coughing up sputum that is thick and white in nature. The nurse understands what is in the sputum?

Answer 154

Inflammatory cells that have phagocytized the invader

Question 155

A patient has a RLL infiltrate. What does that mean?

Answer 155

The patient has pneumonia in his right lower lobe of the lung.

Question 156

What are expected symptoms in a patient with pneumonia?

Answer 156

cough, sputum production, fever, and pleuritic chest pain

Question 157

A patient tells you that he is “dyspneic” What does that mean?

Answer 157

short of breath

Question 158

A patient with active TB is admitted to the hospital. What type of isolation should he be placed on?

Answer 158

airborne

Question 159

How do we know that cellular immunity has started working in someone infected with TB?

Answer 159

They have a positive PPD test.

Cellular immunity helps to contain the bacilli in the lungs but it takes 2-10 weeks for this to occur. The production of antibodies against TB is what is seen with the positive PPD.

Question 160

The body works to contain a TB infection by forming a:

Answer 160

Granuloma

Question 161

A person has been exposed to someone with TB and gets infected. What is most likely going to happen?

Answer 161

latent TB infection

Most individual’s immune system can contain the infection and they don’t develop active disease. Only 5% develop active disease. More likely in those with an immune system that is not fully functioning (HIV, AIDS, young, old, sickly).

Question 162

Which of the following individuals who has latent TB is at risk of having reactivated TB?

Answer 162

HIV positive, 80 years old, and a Patient with rhuematoid arthritis who is on a TNF-alpha drug

Question 163

A patient received the BCG vaccination as a child. Which screening test is recommended for this patient to determine TB infection?

Answer 163

Quantiferon Gold blood test

Question 164

When a granuloma forms, what happens to the TB bacilli?

Answer 164

The bacilli become dormant

Question 165

What distinguishes asthma from COPD?

Answer 165

Asthma is a reversible lung disorder that is often triggered by an allergen.

Question 166

Which of the following would have the most VQ mismatch and therefore would have greater cyanosis?

Answer 166

Patient with primarily chronic bronchitis

Question 167

Which of the following symptoms are seen with patients with COPD with primarily emphysema symptoms?

Answer 167

Prolonged expiration, barrel chested, and pursed lip breathing