Managing Patients with Increased Intracranial Pressure & Chronic Neurological Diseases, Exams of Nursing

Download Managing Patients with Increased Intracranial Pressure & Chronic Neurological Diseases and more Exams Nursing in PDF only on Docsity! NUR 340 Exam Test Bank Exam 1, 2, and Final Exam New Latest Version with All Questions and Answers A patient with increased intracranial pressure (ICP) is being treated with corticosteroids. What actions should the nurse perform to avoid complications due to corticosteroid treatment? Select all that apply. A. Monitor fluid intake and sodium levels regularly. B. Monitor patient's sleep and diet routine regularly. C. Perform blood glucose monitoring at least every six hours. D. Avoid taking any antacids along with corticosteroid treatment. E. Start concurrent treatment with antacids or proton pump inhibitors. ------- Correct Answer --------- Answer: A,C,E Patients on corticosteroid treatment should be regularly monitored for fluid intake and sodium levels. Blood glucose monitoring should be performed at least every six hours until hyperglycemia is ruled out. Starting concurrent treatment with antacids or proton pump inhibitors is important to prevent gastrointestinal ulcers and bleeding, because complications associated with the use of corticosteroids include hyperglycemia, increased incidence of infections, and gastrointestinal bleeding. Regularly monitoring the patient's sleep and diet routine does not contribute to avoiding complications related to corticosteroid therapy. Antacids should be given along with corticosteroids to prevent gastrointestinal complications. Which disorders may cause peripheral neuropathy? Select all that apply. Fibromyalgia Osteoarthritis Dermatomyositis Rheumatoid arthritis Systemic lupus erythematosus (SLE) ------- Correct Answer --------- RA & SLE Peripheral neuropathy, or irritation of the nerves of the extremities, may occur in SLE and rheumatoid arthritis. Fibromyalgia is a musculoskeletal disorder that does not cause neuropathy. Osteoarthritis is a localized disease with a variable, progressive course; it does not cause neuropathy. Dermatomyositis is characterized by muscle changes along with significant skin changes, but not peripheral neuropathy. A patient is to be started on adalimumab (Humira) for management of rheumatoid arthritis. Which of the following statements by the patient demonstrates accurate knowledge about the drug? A. "My husband will be giving me intramuscular injections of the medication in the sides of my thighs." B. "The drug must be stored in a warm place like my bathroom medicine cabinet." C. "I have been taught how to administer the medication to myself in the fatty tissues of the top of thighs and abdomen." D. "The drug is more likely to cause allergic reactions when administered orally." ------- Correct Answer --------- Answer: C Adalimumab (Humira) is administered subcutaneously in the anterior thighs or abdomen by the nurse, patient, or caregiver. Adalimumab is for subcutaneous administration only. It should be stored cold at 36° to 46° F (2° to 8° C). Adalimumab is not available for oral administration. A patient is being treated with immunomodulators for relapsing-remitting multiple sclerosis. Which information about this drug will the nurse include in patient education? A. Use this drug only when you are having a relapse. B. This drug should always be taken by mouth. C. Continue this drug indefinitely unless otherwise ordered. D. Take this drug only if attacks last more than 1 week. ------- Correct Answer --------- Answer: C Treatment should begin as soon as possible after diagnosis and continue indefinitely. If therapy is stopped, symptom progression will return to pre-treatment rate. Immunomodulators are typically injectable with only fingolimod available in an oral form. The nurse is caring for a patient with increased intracranial pressure. Which actions should the nurse perform to promote optimal outcomes for the patient? Select all that apply. Maintain fluid balance and assess osmolality. Maintain intubation and mechanical ventilation. Lower the head of the bed and turn the patient to one side. Wait for the respiration to improve before beginning with ventilation. Elevate the head of the bed to 30 degrees with the head in a neutral position. ------- Correct Answer --------- Intubation and mechanical ventilation, maintenance of fluid able to assess for all adverse effects from the drug. The pharmacist would provide counseling about the drug. Since RA is not an endocrine disease, an endocrinologist would not be needed. A patient wants to use medication rather than surgery for gall stones. The nurse explains that drugs used to dissolve gallstones are most effective for which gall stones? are located within the gallbladder consist of cholesterol are located within the bile duct can be seen on an X-ray ------- Correct Answer --------- consist of Cholesterol Chenodiol and Ursodiol, bile acids used to dissolve gallstones in carefully selected patients, promote dissolution of stones that are composed of cholesterol rather than those composed mainly of calcium. Gallstones composed of calcium are radiopaque and show up on X-ray. Those composed of cholesterol are radiolucent, so are not visible on X-ray. See Lehne p 1023 The nurse is caring for a patient with ulcerative colitis who is being treated with azathioprine (Imuran). Which laboratory test result should be monitored periodically? Microscopic urine examination Complete blood count (CBC) with differential Serum albumin Immunoglobulin survey ------- Correct Answer --------- The nurse should monitor the CBC, because neutropenia is a major adverse effect of azathioprine (Imuran). Another major adverse effect is pancreatitis. Microscopic urinalysis is not indicated. The immunoglobulin and serum albumin levels do not require monitoring in relation to this drug. The health care provider prescribes methotrexate (Rheumatrex) for a 28-year-old woman with stage II moderate rheumatoid arthritis (RA). What information about the patient would be the most important information for the nurse to communicate to the health care provider? a history of infectious mononucleosis as a teenager family history of age-related macular degeneration of the retina uses large doses of vitamins and health foods to treat the RA discontinued taking birth control pills 8 weeks ago ------- Correct Answer --------- Discontinued taking BC pills around 8 weeks ago Methotrexate is teratogenic (causes birth defects), can lead to fetal death; the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy. The health care provider left an order to discontinue prednisone. What will the nurse do next? ------- Correct Answer --------- Ask the health care provider for instructions to taper the prednisone dose Prednisone must be tapered according to physician order to avoid adrenal insufficiency. Dosage adjustments are not within the pharmacist's or nurse's scope of practice unless there is a standing protocol or order. The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine (Azulfidine). What statement by the patient best demonstrates understanding of the action of sulfasalazine? "Azulfidine ------- Correct Answer --------- reduces the inflammation." Sulfasalazine reduces the inflammation associated with ulcerative colitis; this statement indicates understanding. Although similar to sulfonamides, sulfasalazine is not used to treat infections; further teaching is needed. Sulfasalazine does not enhance the immune response or increase the reabsorption of fluid; further teaching is needed. The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse expects the prescriber to order that the drug be administered at what time? ------- Correct Answer --------- 0800 Early morning administration mimics the burst of glucocorticoids normally released by the adrenal glands at dawn (circadian rhythm). Patients on alternate-day therapy or who take one daily dose should receive this medication before 0900. Therefore, 0800 is the only time listed that matches this criterion. A patient who has taken glucocorticoids for 3 years tells a nurse, "I've lost my job. I don't know how I'm going to support my family and pay all the bills." Which glucocorticoid dosage adjustment would the nurse expect? ------- Correct Answer --------- Increased dosage At times of physiological stress, the adrenals secrete large amounts of glucocorticoids and epinephrine (which maintain blood pressure and plasma levels of glucose). If glucocorticoid levels are insufficient, hypotension and hypoglycemia occur. The dose should be increased to compensate for the increased levels of stress. Reducing the dosage would put the patient at risk for glucocorticoid insufficiency. Alternate-day dosing results in decreased drug levels, which would put the patient at risk for glucocorticoid insufficiency. The dosage needs to be increased, but without knowledge of the current dose, doubling the dose may result in an inappropriately high dosage A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing an adverse effect of the medication? DEXA scan that indicates osteoporosis increased erythrocyte sedimentation rate (ESR) no improvement in symptoms a recent 5-pound weight loss ------- Correct Answer --------- DEXA scan that indicates osteoporosis Osteoporosis is an adverse effect of corticosteroid use. Weight gain, not weight loss, is seen with corticosteroid use. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication. The nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex). Which information is most important to communicate to the health care provider? serum potassium is 5.1 mEq/L. platelet count is 149,500/mm3 blood glucose is 110 mg/dL white blood cell count (WBC) is 1500 mm3 ------- Correct Answer --------- The highest priority is the very low WBC count. Bone marrow suppression is a possible side effect of methotrexate, and the patient's resulting low WBC count places the patient at high risk for infection. The low platelet count is close to normal, and will need to be addressed because the patient is on methotrexate. However, the WBC count is a higher priority. The other laboratory values are also abnormal but are not far from normal values and would not have any immediate serious consequences. A nurse is teaching a patient who is ordered to take oral NSAIDs for an ankle sprain. Because a common side effect of NSAIDs is gastrointestinal distress, how does the nurse instruct the patient to take this medication? with milk at bedtime after an antacid only as needed ------- Correct Answer --------- To reduce the risk of GI distress, NSAIDs can be taken with milk or food. Taking these medications at bedtime would increase the risk of gastritis because the patient would be in a flat position during the night. Antacids reduce absorption. Pain medications work best if taken before the pain is severe. The nurse is caring for a patient taking high-dose glucocorticoids and is creating a plan of care for the patient. This medication places the patient at greatest risk for which nursing diagnosis? disturbed sensory perception, auditory. infection. fluid volume deficit. inflammation. ------- Correct Answer --------- Patients taking glucocorticoids are at risk for infection, because glucocorticoids increase the susceptibility to infection by suppressing host defenses. Glucocorticoids do not disturb sensory perception. Glucocorticoids do not put the patient at risk for fluid volume deficit, but rather for fluid volume retention. Glucocorticoids can be used to treat inflammation; they don't put the patient at greater risk for inflammation A patient with systemic lupus erythematosus (SLE) asks the rheumatology nurse about belimumab (Benlysta), a new drug for SLE. How does the nurse respond? ------- Correct Answer --------- Belimumab has modest benefits and may contribute to mortality. benlysta, while promising, demonstrated only modest benefits to a limited population of patients with SLE. It has significant side effects and, in clinical trials, there was a slightly higher mortality rate with this drug than with the placebo. A nurse works with clinic patients who have chronic neurological diseases. Which goal is the priority for all patients with chronic neurological disease? a. bowel and bladder control b. independent functional ability c. adequate nutritional status d. maintenance of skin integrity ------- Correct Answer --------- Answer: B What is the body's second line of defense? ------- Correct Answer --------- Inflammatory response, pyrogens, interferons, and complement proteins ________________________ always causes an inflammation response ------- Correct Answer --------- Infection What are the functions of the inflammatory response? ------- Correct Answer --------- Neutralize and dilute an inflammatory agent Remove necrotic materials - phagocytosis Establish an environment suitable for healing and repair What are the local responses to inflammation? ------- Correct Answer --------- Redness Heat Pain Swelling Loss of function What are the systemic effects of inflammation? ------- Correct Answer --------- Increased WBC count with a shift to the left increased neutrophil production particularly with infection "bands" (immature cells) and "segs" (mature cells) Increased pulse and respiration Nausea and anorexia Fever What cellular mediators trigger local reactions? ------- Correct Answer --------- Histamine (stimulates vasodilation) Prostaglandins What are prostaglandins? ------- Correct Answer --------- Proteins that circulate in an inactive state Activated by antibodies or infectious organisms. Also active in autoimmune diseases Considered to be pro-inflammatory Potent vasodilators Sensitize pain receptors Stimulate hypothalamic temperature regulating area leading to fever What is the complement system? ------- Correct Answer --------- Works in tandem with inflammatory process Group of inactive proteins in circulation that, when activated, stimulate the release of other chemical mediators, promote inflammation, chemotaxis, and phagocytosis. Major mediator of the inflammatory response through an enzyme cascade (C1 - C9) Enhanced phagocytosis Increased vascular permeability Chemotaxis Movement of cells in response to chemical signals. Cellular lysis What _____________ circulate to hypothalamic temperature-regulating center & promote synthesis of PGE2? ------- Correct Answer --------- cytokines PGE2 increases thermostatic set point ANS causes heat conservation & generation so core temp increases to new set point How does a fever help the body fight infection? ------- Correct Answer --------- Creates unfavorable environment for bacteria Increases metabolism which accelerates phagocytosis Severe fever (>105 degrees) is life threatening Destroys enzymes needed for biochemical reactions What is a sign of infection in an immunosuppressed patient? ------- Correct Answer ------ --- Will present with "just not feeling well." What does RICE stand for? ------- Correct Answer --------- RICE: to treat inflammation associated with soft-tissue injury Rest Ice Compression - observe circulation & sensation distal to compression Elevation What are the drug classes used to treat chronic inflammation? ------- Correct Answer ---- ----- Immunomodulators Immunosuppressants Corticosteroids What does the complement system do? ------- Correct Answer --------- Causes cell death by rupturing of cell membrane (cellular lysis) Also activated in autoimmune diseases Damages healthy tissue in combination with inflammatory process. What is hypovolemic shock? ------- Correct Answer --------- Loss of intravascular fluid Absolute hypovolemia -External fluid loss Relative hypovolemia -Third-spacing - fluid moves into extravascular space Symptoms reflect affected organs Hypotension and tachycardia Cool, clammy and pale skin - tissue perfusion Low output - renal perfusion Change in mental status - cerebral perfusion What is septic shock? ------- Correct Answer --------- Systemic inflammatory response to infection Hypotension despite fluid resuscitation Pathophysiology Vasodilation Maldistribution of blood flow Myocardial depression Symptoms Fever, hypotension, tachycardia, tachypnea What is appendicitis? ------- Correct Answer --------- Infection and inflammation of the appendix Typically begins with periumbilical pain, followed by anorexia, nausea, and vomiting Pain persistent and continuous shifting to lower right quadrant localizing at McBurney's point (halfway between umbilicus and right iliac crest) What is some of the important nursing management regarding patients with appendicitis? ------- Correct Answer --------- Place in position of comfort Patient should remain NPO until evaluated by HCP in case surgery is needed. Ice bag to right lower quadrant (RLQ) to reduce inflammation Heat may cause appendix to rupture! Anticipate pre-operative IV fluids and IV antibiotics What is peritonitis? ------- Correct Answer --------- Results from localized or generalized inflammatory process of peritoneum ruptured ulcer or appendix contamination from fistulas traumatic injury Inflammatory process leads to massive fluid shifts and adhesions What is the most common symptom of peritonitis? ------- Correct Answer --------- Pain Assessment of pain, including location, very important in determining cause Oral care What is meningitis? ------- Correct Answer --------- Acute inflammation of meningeal tissues surrounding brain and spinal cord Caused by infection of arachnoid layer and CSF Inflammatory process increases CSF production and intracranial pressure Purulent secretions spread to other areas of brain through CSF and can affect cranial nerves. Which type of meningitis is more severe? ------- Correct Answer --------- bacterial meningitis It is a medical emergency. If untreated, mortality rate is near 100% What causes bacterial meningitis? ------- Correct Answer --------- S. pneumoniae or Neisseria meningitidis What causes viral meningitis? ------- Correct Answer --------- enterovirus, arbovirus, HIV, or herpes simplex (HSV) What causes encephalitis? ------- Correct Answer --------- Epidemic Viruses transmitted by ticks & mosquitoes (i.e. West Nile) Non-epidemic Measles, mumps or chickenpox HSV Protozoa What are the clinical manifestations of meningitis? ------- Correct Answer --------- Decreased level of consciousness (LOC) Coma has poor prognosis. Occurs in 5% to 10% of bacterial cases Increased intracranial pressure Fever Severe headache Nausea/vomiting Nuchal rigidity Photophobia Seizures in 1/3 of cases What are the diagnostic studies for meningitis? ------- Correct Answer --------- Blood cultures, CT scan Rule out obstruction of foramen magnum Do before lumbar puncture to prevent brain stem herniation Lumbar puncture for CSF Send for culture to differentiate bacterial & viral infection CSF is purulent and turbid in bacterial meningitis; it may be the same or clear in viral meningitis. Sputum and nasopharyngeal specimens for culture Head X-rays & CT scans If encephalitis suspected Blood tests for viral RNA - best test for W. Nile Polymerase chain reaction (PCR) for HSV or W. Nile viruses What are the clinical manifestations of ICP? ------- Correct Answer --------- Change in level of consciousness Change in vital signs (Cushing's triad) Ocular signs Decreased motor function Headache Vomiting What is the most sensitive and reliable indicator of ICP? ------- Correct Answer --------- Change in level of consciousness is the most sensitive and reliable indicator of increased ICP result of impaired CBF to cerebral cortex and reticular activating system (RAS) range from decreased attention level to coma What is Cushing's triad? ------- Correct Answer --------- Systolic hypertension with widening pulse pressure Bradycardia with full and bounding pulse Altered respiratory pattern Caused by Increasing pressure on thalamus, hypothalamus, pons, and medulla What do ocular signs mean in ICP? ------- Correct Answer --------- NEUROLOGIC EMERGENCY Indicates herniation Fixed, unilaterally dilated pupil What is decorticate posturing? ------- Correct Answer --------- Decorticate posture is an abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest. This type of posturing is a sign of severe damage in the brain What is decerebrate posturing? ------- Correct Answer --------- Decerebrate posture is an abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward. The muscles are tightened and held rigidly. This type of posturing usually means there has been severe damage to the brain Which posturing is worse? ------- Correct Answer --------- While decorticate posturing is still an ominous sign of severe brain damage, *decerebrate* posturing is usually indicative of more severe damage at the rubrospinal tract, and hence, the red nucleus is also involved, indicating a lesion lower in the brainstem. What is a health promotion option for preventing meningitis? ------- Correct Answer ------ --- Vaccination against respiratory infections Early treatment of respiratory infections Prophylactic antibiotics for those exposed to meningitis What is a health promotion option for preventing encephalitis? ------- Correct Answer ---- ----- Mosquito control for disease prevention How is bacterial meningitis treated? ------- Correct Answer --------- Antibiotic therapy started as soon as specimens collected Critical for bacterial meningitis Can be discontinued if etiology is viral Ex.: ampicillin, cefuroxime, ceftriaxone Corticosteroids if bacterial Dexamethasone associated with lower mortality rate and reduced incidence of hearing loss How do you prevent ICP? ------- Correct Answer --------- Monitor LOC Elevate HOB to 30 degrees Minimize suctioning and coughing Carefully treat anxiety, fear, and pain What is cyclosporine used for? ------- Correct Answer --------- Immunosuppressant Mechanism Suppresses the production of interleukin-2, interferon gamma, and other cytokines Therapeutic uses Drug of choice for organ rejection (kidney, liver, and heart) of an allogenic transplant Some autoimmune diseases Pharmacokinetics Oral (preferred) or IV Intensive hepatic metabolism Excreted through bile What are the adverse effects of cyclosporine? ------- Correct Answer --------- Adverse effects -Nephrotoxicity Infection What do non-aspirin first generation NSAIDs do? ------- Correct Answer --------- Inhibit COX-1 and COX-2 pathways Used to treat inflammatory disorders (rheumatoid arthritis, osteoarthritis, bursitis) Alleviate mild to moderate pain Suppress fever Relieve dysmenorrhea Suppress inflammation but have risk of serious harm *No protection against MI or stroke* What is celecoxib used for? ------- Correct Answer --------- Second-Generation NSAID Just as effective as traditional NSAIDs in suppressing inflammation and pain Somewhat lower risk for GI side effects Can impair renal function and cause hypertension and edema *Increase risks for MI and stroke* Adverse effects and drug interactions: Gastroduodenal ulceration Risk may be reduced by short-term use and combining with a proton pump inhibitor (PPI) Cardiovascular events - MI and stroke Increased vasoconstriction combined with normal platelet aggregation leads to vessel obstruction. Reduce risk - use lowest effective dose for shortest period of time May enhance effects of warfarin Last-choice drug for long-term management of pain What is acetaminophen used for? ------- Correct Answer --------- Therapeutic uses: Analgesic, antipyretic *No anti-inflammatory or antirheumatic actions* Not associated with Reye's syndrome Action Inhibits prostaglandin synthesis in central nervous system Adverse effects Very few at normal doses Hepatotoxicity at doses > 4 gm daily toxicity at 2 gm if history of alcoholism Caution clients to check OTC products or opioid/acetaminophen for amounts of acetaminophen How do you manage an overdose of acetaminophen? ------- Correct Answer --------- Overdose: hepatic necrosis Early symptoms: nausea and vomiting, diarrhea, sweating, abdominal pain Signs and symptoms of hepatic failure, coma, death *Treatment for overdose: acetylcysteine* Drug interactions Alcohol Warfarin What are Glucocorticoids? ------- Correct Answer --------- Also known as corticosteroids and nearly identical to steroids produced by the adrenal cortex Anti-inflammatory and immunosuppressant effects Multiple mechanisms to suppress inflammation More powerful than NSAIDs Therapeutic uses in nonendocrine disorders *Rheumatoid arthritis, Systemic lupus erythematosus, Inflammatory bowel disease* Miscellaneous inflammatory disorders Allergic conditions, Asthma, Dermatologic disorders, Neoplasms, Suppression of allograft rejection, Prevention of respiratory distress syndrome Physiologic effects (low doses) Modulation of glucose metabolism in adrenocortical insufficiency (Addison's disease) Pharmacologic effects (high doses) Suppression of immune response and subsequent inflammation What are the metabolic effects of corticosteroids? ------- Correct Answer --------- Metabolic effects Primary effect on carbohydrate metabolism: *elevation of blood glucose levels* What are the cardiovascular effects of corticosteroids? ------- Correct Answer --------- Increased number of circulating RBCs and polymorphonuclear leukocytes Decreased number of lymphocytes and other white cells What are the fluid and electrolyte effects of corticosteroids? ------- Correct Answer -------- - Some have higher mineralcorticoid action Similar to effect of aldosterone on kidneys Net result - hypernatremia, hypokalemia, edema What are the adverse effects of glucocorticoids? ------- Correct Answer --------- *Adrenal insufficiency* *Osteoporosis and resultant fractures Infection* *Glucose intolerance* Myopathy manifesting as weakness of proximal muscles of arms and legs Fluid and electrolyte disturbances Psychologic disturbances Cataracts and glaucoma Peptic ulcer disease Iatrogenic Cushing's syndrome Use in pregnancy and lactation Cross placenta and enter breast milk What are the drug interactions of glucocorticoids? ------- Correct Answer --------- Interactions related to potassium loss Particularly when combined with loop diuretic or digoxin Nonsteroidal anti-inflammatory drugs Increased risk for gastric ulceration Insulin and oral hypoglycemics May need increased doses or addition of insulin Vaccines *No immunization during glucocorticoid use* Decreased antibody reaction to immunization Live vaccine increases risk of developing virus What are some contraindications for glucocorticoids? ------- Correct Answer --------- Patients with systemic fungal infections Those receiving live virus vaccines Use with caution in pediatric patients and in pregnancy/breast-feeding What drugs are used for MS symptom management? ------- Correct Answer --------- Fluoxetine, Oxybutynin, Dalfampridine, Gabapentin, Amantadine, Psyllium What drugs are immunomodulators? ------- Correct Answer --------- Interferon beta preparations Glatiramer acetate What drugs are immunosuppressants? ------- Correct Answer --------- cyclosporine, hydroxycholoroquine, methotrexate, mitoxantrone, adalimumab, etanercept, infliximab What kind of drug is Prednisone? ------- Correct Answer --------- Corticosteroid/glucocorticoid What is SLE? ------- Correct Answer --------- Systemic Lupus Erythematosus Chronic multi-system inflammatory autoimmune disease Results from interactions among genetic, hormonal, environmental, and immunologic factors What systems does SLE affect? ------- Correct Answer --------- Skin What drugs are used for mild symptoms of RA? ------- Correct Answer --------- DMARDs - mild symptoms Methotrexate Sulfasalazine Hydroxychloroquine What drugs are used for moderate to severe RA? ------- Correct Answer --------- Biologic/targeted drugs: moderate to severe disease Etanercept - inhibits TNF What is a sprain? ------- Correct Answer --------- injury to tendons/ligaments surrounding joint Graded by degree of ligament tearing What is a strain? ------- Correct Answer --------- excessive stretching of muscle and its fascial sheath Graded by degree of muscle damage What is IBD? ------- Correct Answer --------- Characterized by chronic, recurrent inflammation of the intestinal tract Periods of remission are interspersed with unpredictable periods of exacerbation and occur over years Ulcerative colitis and Crohn's disease are immunologically related autoimmune diseases Collectively referred to as inflammatory bowel disease Cause is unknown What is Sulfasalazine used for? ------- Correct Answer --------- Mild or moderate IBD Treat exacerbation and maintain remission Reduce inflammation What type of drugs is used to treat mild to severe IBD? ------- Correct Answer --------- Glucocorticoids Mild to severe IBD Induction of remission Reduce inflammation Immunomodulators May be used early in treatment to induce remission quickly and maintain remission longer *Used for moderate to severe IBD* Monoclonal antibodies that inhibit TNF TNF is key immuno-inflammatory modulator Infliximab, adalimumab, natalizumab Approved for Crohn's and/or ulcerative colitis Also approved for other inflammatory conditions. Immunosuppressants Long-term therapy for patients who have not responded to traditional therapy (refractory) - maintain remission Why is methotrexate used in IBD? ------- Correct Answer --------- Used in Crohn's disease to promote short-term remission and decrease need for glucocorticoids Why is cyclosporin used in IBD? ------- Correct Answer --------- Reserved for acute, severe IBD that hasn't responded to glucocorticoids The use of antibiotics help which type of IBD? ------- Correct Answer --------- Help control symptoms of Crohn's disease, but NOT ulcerative colitis Metronidazole Ciprofloxacin What nutritional therapy is recommended for patients with IBD? ------- Correct Answer -- ------- Overall dietary approach: Balanced diet -Supplementation with cobalamin (Crohn's), zinc, --Vitamin D Avoid triggers: lactose, high-fat, high-fiber, smoking Acute exacerbation Avoid irritation of GI tract Enteral feedings rather than parenteral feedings to maintain gut function What is the surgical treatment for Crohn's disease? ------- Correct Answer --------- Most patients will require surgery -High recurrence rates Strictureplasty is most common procedure Widens obstructions caused by strictures Bowel resection with anastomosis Disease reoccurs at suture site Complication - short bowel syndrome Not enough short bowel (either from disease or surgery) to maintain life Parenteral nutrition required for rest of life What is the surgical treatment for ulcerative colitis? ------- Correct Answer --------- Removal of colon is curative *Total proctocolectomy with ileoanal anastomosis Two-step procedure with temporary ileostomy and formation of ileal pouch 2nd step reconnects ileum and allows for eventual continence* OR permanent ileostomy What are chronic neuro diseases? ------- Correct Answer --------- Impact the central nervous system Most are progressive & uncurable All are life-altering for patient and family Treated collaboratively as indicated Drugs, PT/OT, counseling, social work, occupational training Some surgeries available What lab tests are used to help diagnose MS? ------- Correct Answer --------- No definitive test History and physical examination Adjuncts to exam CSF: ↑ lymphocytes and monocytes MRI: sclerotic plaques & white matter lesions over time (advanced sign of MS) What drugs are used as the first line of therapy for MS? ------- Correct Answer --------- Immunomodulators Started ASAP after diagnosis of MS *Continued indefinitely* Injectable or po po have more adverse effects & are reserved for pts who can't tolerate injectable or haven't responded to first-line drugs. What immunomodulators are used to treat MS? ------- Correct Answer --------- Interferon -1a Avonex: IM weekly Rebif: subcutaneous 3x/week Interferon -1b subcutaneous every other day Glatiramer Subcutaneous daily Natalizumab IV monthly when inadequate response to others *Also used for Crohn's disease* Risk for progressive multifocal leukoencephalopathy (PML) What is mitoxantrone used for? ------- Correct Answer --------- Immunosuppressant used for MS Helps prevent relapse developed psychosis. Which medication should the nurse suspect may be causing this symptom? ------- Correct Answer --------- If a person with SLE develops psychosis, it may be due to the disease itself or may be due to side effects of *corticosteroids*. Hence corticosteroids may need to be discontinued. Some patients with SLE may not tolerate antimalarial drugs, but these drugs do not cause psychosis. Long term use of corticosteroids is reduced with immunosuppressants. Nonsteroidal antiinflammatory drugs are used for polyarthritis or polyarthralgias. These drugs may cause gastrointestinal and renal effects, not psychosis. Identify characteristics of professionals [professional nurses] -------- Correct Answer ----- ----- requires an extended education, body of knowledge, provides specific service, has autonomy, incorporate a code of ethics Explain the scope and standards of practice; recognize examples -------- Correct Answer ---------- to improve health and well being of all individuals, communites, and populations through the significant and visible contributions of RNs examples: assessment, disgnosis, planning, implementation Explain the purpose of the code of ethics for nurses -------- Correct Answer ---------- a code of ethics is the philosophical ideals of right and wrong that define principles used to provide practice it is important to incorporate your own values and ethics Define autonomy and accountability. Recognize examples -------- Correct Answer -------- -- autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. Example: implement deep breathing exercises for a patient who recently had surgery accountability: you are responsible, professionally and legally for the type and quality of nursing care provided. Differentiate between the levels of competency in Benner's Novice to Expert Model ------ -- Correct Answer ---------- • Novice o Beginning nursing student • Advanced beginner o Nurse with some level of experience with the situation • Competent o Nurse who has been in the same clinical situation for 2-3 years o Understands organization and specific care required by the patients • Proficient o More than 2-3 years experience with the same clinical position o Can assess patient as an entire situation o Remember info from past experiences and apply now • Expert o Nurse with diverse experience o Has intuitive grasp of potential or existing problem o Skilled Explain the purpose of the nurse practice acts -------- Correct Answer ---------- regulate scope of nursing practice and protect public health, safety, and welfare Differentiate between roles of the nurse. Recognize examples: caregiver, advocate, educator, communicator, manager -------- Correct Answer ---------- • Caregiver o Helps patients maintain and regain health • Advocate o Protects patients human and legal rights • Educator o Explain facts about health • Communicator o Allows you to know your patients including strengths and weaknesses, and their needs • Manager o Establish an environment for collaborative patient centered care to provide safe quality care with positive outcomes Be familiar with the QSEN competencies and recognize examples: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, informatics -------- Correct Answer ---------- • Quality and Safety Education for Nurses • Safety aka min harm to patient • Evidence based practice • Quality improvement • Collaboration • Informatics • Patient centered care o To respond to reports about safety and quality patient care by IOM o Prepares nurses with competencies needed to improve quality of work o Patient centered care, quality improvement, safety, informatics, evidence based practice, teamwork Understand the Health Services Pyramid -------- Correct Answer ---------- five levels of care for which health care providers offer services for disease prevention, health promotion, primary/secondary/ tertiary care. Differentiate between health care settings and services -------- Correct Answer ---------- the health care setting ensure that patients receive care in the most appropriate places to reduce duplication Identify examples of preventive and primary care, secondary care, and tertiary care, restorative care, continuing care, respite care -------- Correct Answer ---------- • Tertiary health care o Intensive care o Subacute care • Secondary health care o Emergency care o Acute medical surgical care o Radiological procedures for acute problems ( x-rays) • Primary health care o Prenatal and well baby care o Nutrition counseling o Family planning o Exercise classes • Restorative care o Cardiovascular and pulmonary rehabilitation o Sports medicine o Spinal cord injury programs o Home care • Continuing care o Assisted living o Psychiatric older adult care Explain the focus of community-based nursing -------- Correct Answer ---------- Takes place in community settings such as home or a clinic where the focus is on the needs of the individual or family Define prevention, health promotion, and restorative care. Recognize examples -------- Correct Answer ---------- prevention: preventing illness, promoting health, to avoid the need for primary/sec/teri care health promotion: activities such as routine exercise/ food nutrition that help patients maintain or enhance their present level of health and reduce risk of developing disease restorative care: health care settings/ services in which patients who are recovering form illness or disability receive rehabilitation and supportive care Interdisciplinary theories: understand differences -------- Correct Answer ---------- systems theory: input to nursing process to output to feedback basic human needs: maslow's hierarchy of basic needs developmental: human growth and development are orderly predictive processes that begin with conception and continue through death psychosocial: focus on helping us to understand context of patient tertiary: when a defect or disability is permanent and irreversible Identify caring behaviors -------- Correct Answer ---------- Caring: universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another Identify examples of caring in nursing practice relative to: o Presence o Touch o Listening o Knowing the patient o Spiritual caring o Relieving pain and suffering o Family caring -------- Correct Answer ---------- presence: person to person encounter touch: contact(skin) and non-contact touch (eye) listening:listener is present and engages the patient in a nonjudgemental and accepting manor knowing: nurses understanding of a specific patient and his or her subsequent selection of interventions spiritual: connectedness / interpersonally relieving: giving patient comfort, dignity, respect, and peace family: nurse must know family as well at patient, important resource Differentiate between culture and ethnicity -------- Correct Answer ---------- culture: thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethic, religious, or social groups ethnicity: shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics Define key cultural concepts: culture, subculture, emic worldview, etic world view, enculturation, acculturation, assimilation, biculturalism -------- Correct Answer ---------- subculture:maintain unique life patterns, values, and norms ethnic and religious groups with characteristics distinct from dominant culture emic: insider/ native perspective etic: outsider perspective enculturation: socialization into ones primary culture as a child acculturation:second culture learning that occurs when culture of a minority is gradually displaced assimilation: members of an ethnocultural community are absorbed into another community and loose their unique characteristics such as lang, customs, and ethnicity biculturalism: multiculturalism occurs when an individual identifies equally with two or more cultures Identify differences in selected cultures and how they impact life transitions -------- Correct Answer ---------- ... Define family -------- Correct Answer ---------- a set of relationships that the patient identifies as a family or as a network of individuals who influence one another's lives whether or not there are actual biological or legal ties Define family forms -------- Correct Answer ---------- are patterns of people considered by family members to be included in the family Define family structure and function -------- Correct Answer ---------- structure: ongoing membership of the family and the pattern of relationships which are often numerous and complex - womans relationships wife son wife husband function: what the family does the way a family reproduces Identify factors that may influence the health of the family -------- Correct Answer ---------- relative positon in society, economic reduces, geographical boundaries Understand differences in viewing the family as context, family as system, and family as patient -------- Correct Answer ---------- context:primary focus is on the health and development of an individual member existing within a specific environment: patients family system: elements from both of the previous perspectives : based on assessment you determine family is not eating right patient: family processes and relationships are the primary focus of nursing care: parenting or family caring Apply the concepts of health promotion and prevention to the family -------- Correct Answer ---------- the primary focus on health promotion has traditionally been on individuals promoting healthy, positive, support Recognize caregiver concerns -------- Correct Answer ---------- ... What is an example of a caring response by a nurse to the parent of a child diagnosed with schizophrenia? ---------- Correct Answer --------- "Schizophrenia is a biological illness. You are not to blame for your child's illness." Using Maslow's when planning care for a psychotic patient, priority is: ---------- Correct Answer --------- Eating and Bathing A nurse prepares to administer an antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring of the medication's effects and side effects will be most important if the patient is also diagnosed with which health problem? ---------- Correct Answer --------- Diabetes due to weight gain. A patient underwent psychotherapy weekly for 3 years. The therapist used free association, dream analysis, and facilitated transference to help the patient understand unconscious processes and foster personality changes. Which type of therapy was used? ---------- Correct Answer --------- Psychoanalysis (Freud) Clozapine (Clozaril) ---------- Correct Answer --------- Antipsychotic. - CE: Report sore throat and fever immediately due to Agranulocytosis ( ↓ granulocytes). How do SSRIs lift depression? ---------- Correct Answer --------- Make more serotonin available in the synaptic gap. What can happen with first-generation antipsychotics? ---------- Correct Answer --------- EPS Acute Dystonia ---------- Correct Answer --------- Severe spasms of tongue, neck, face, and back. - NA: Report muscle stiffness. A patient is hospitalized for major depressive disorder. The nurse can expect to provide the patient with medication teaching about: ---------- Correct Answer --------- An SSRI - Fluoxetine. What permits someone to be involuntary committed? ---------- Correct Answer --------- Danger to self, danger to others, or gravely disabled. Which nursing intervention demonstrates false imprisonment? ---------- Correct Answer - -------- A patient has been irritating and attention-seeking much of the day. A nurse escorts the patient down the hall saying, "stay in your room, or you'll be put in seclusion." Which action by a nurse constitutes a breach of a patient's right to privacy? ---------- Correct Answer --------- Releasing information to the patient's employer without consent. A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority? a. Risk for injury. b. Ineffective coping. c. Impaired social interaction. d. Ineffective therapeutic regimen management. ---------- Correct Answer --------- a. Risk for injury. A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine (Zyprexa). The addition of olanzapine to the medication regimen will: ---------- Correct Answer --------- Bring hyperactivity under rapid control. Lithium ---------- Correct Answer --------- Treatment of bipolar disorders and mania episodes. - TR: 0.8 - 1.4 mEq/L - CE: Maintain diet of adequate sodium and water. A nurse reviewing the laboratory results for a patient diagnosed with bipolar disorder notes the lithium level as 1 mEq/L. How will the nurse interpret this information about the medication level? ---------- Correct Answer --------- It requires no additional nursing intervention. A patient is scared that someone is trying to destroy them. Select the nurse's most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help you if you will let them." d. "Staff members are health care professionals who are qualified to help you." ---------- Correct Answer --------- b. "Feeling that people want to destroy you must be very frightening." A nurse works with a patient with Schizophrenia, the patient says, "I don't like taking the pills." What other option can we give? ---------- Correct Answer --------- Use of a long- acting antipsychotic injection. (once a month). A patient diagnosed with schizophrenia says, "Two staff members I saw talking were plotting to assault me." Based on data gathered at this point, which nursing diagnoses relate? ---------- Correct Answer --------- Risk for other-directed violence. A patient with a history of daily alcohol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak? ---------- Correct Answer --------- Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped). A woman whose husband is terminally ill says, "I don't want to cry in front of him. I don't want him to know how soon death will occur or how sad I am." Which response by the nurse would be most therapeutic? ---------- Correct Answer --------- "He might be more comforted than disturbed by your tears." An individual was killed during a store robbery 2 weeks ago. The widowed spouse, who was diagnosed 6 years ago with schizoaffective disorder, cries spontaneously when talking about the death. What is the nurse's most therapeutic response? ---------- Correct Answer --------- "The unexpected death of your husband is very painful. I'm glad you're able to talk about your feelings." As death approaches, a patient says, "I don't want to see a lot of visitors anymore. Just my parents and my sibling can come in for a while each day." What action should the nurse take? a. Ask the patient to reconsider the decision because many interested and caring friends can be sources of support. b. Discuss the request with the parents and siblings. Suggest that they explain the patient's decision to friends. c. Place a "no visitors" sign on the patient's door. ---------- Correct Answer --------- b. Discuss the request with the parents and siblings. Suggest that they explain the patient's decision to friends. A widow grieving her husband's sudden death tells the nurse, "Yesterday, I saw my husband walk through the door and he just faded away." Which is the nurse's most appropriate action? ---------- Correct Answer --------- Counsel the widow that visualizations are a normal part of grieving. Psychotherapy for individuals at risk for complicated grief focuses on which goals? Select all that apply. a. Identifying ways to break bonds with the deceased. b. Exploring emotional responses to a loss. c. Solving problems related to moving forward in life. d. Learning about the stages and symptoms of grieving. e. Using antipsychotic medications for dysfunctional grief. ---------- Correct Answer ------- -- b. Exploring emotional responses to a loss. c. Solving problems related to moving forward in life. d. Learning about the stages and symptoms of grieving. The spouse of a patient in hospice care angrily tells the nurse, "The care provided by the aide and other family members is inadequate, so I must do everything myself. Can't anyone do things right?" The palliative care nurse should: ---------- Correct Answer ------- -- Provide teaching about anticipatory grieving. Children of a widowed parent confer with the nurse; their surviving parent repeatedly relates the details of finding the deceased parent not breathing, performing CPR, going to the hospital by ambulance, and seeing the pronouncement of death. The family asks, "What can we do?" The nurse should counsel the family: a. Retelling the story should be limited to once daily to avoid unnecessary stimulation. b. They should share their feelings with the surviving parent and ask for the retelling to stop. c. That repeating the story is a helpful and a necessary part of grieving. ---------- Correct Answer --------- c. That repeating the story is a helpful and a necessary part of grieving. A terminally ill patient tells the nurse, "Life has been good. I am proud of being self- educated. I overcame adversity with willpower. I always gave my best and expected things to turn out well. I intend to die as I lived: optimistically." The nurse planning care for this patient recognizes a critical need to: a. Support the patient's use of personal resources to meet challenges. b. Help the patient reassess and explore existing conflicts. c. Assist the patient to focus on the meaning in life and death. ---------- Correct Answer -- ------- a. Support the patient's use of personal resources to meet challenges. For borderline personality disorder, what kind of medication would you give? ---------- Correct Answer --------- Antidepressant (SSRI) What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects? ---------- Correct Answer --------- Risk for other-directed violence. When a patient diagnosed with a personality disorder uses manipulation to get needs met, the staff applies limit-setting interventions. What is the correct rationale for this action? ---------- Correct Answer --------- External controls are necessary due to failure of internal control. A nurse is caring for a client who has a substance use disorder. Which of the following statements by the nurse is an example of patient-centered care? A. "Let's review the goals you set today and see what your priority is this week." B. "Although you have mentioned wanting to talk today about your past abuse, lets discuss this handout I have with new coping skills." C. "I would like to focus on what I believe are the best goals for you to work on." D. " I am going to have to change our meeting time because I need to go get lunch." ---- ------ Correct Answer --------- A. "Let's review the goals you set today and see what your priority is this week." A nurse is caring for a client who was admitted to the emergency department with a blood alcohol content of 0.15 mg/dL. Which of the following conclusions should the nurse make about the client's blood alcohol content? ---------- Correct Answer --------- The client ingested enough alcohol to cause them to experience acute cognitive impairment. A nurse is caring for a client and notes that the client appears disheveled, frightened, and seems to be talking to someone who is not there. The nurse should identify that this is an example of which of the following steps of the nursing process? ---------- Correct Answer --------- Assessment Client has OCD, what's a common comorbidity? ---------- Correct Answer --------- Anorexia A nurse is teaching a newly licensed nurse about the importance of therapeutic communication. Which of the following statements should the nurse include in the teaching? ---------- Correct Answer --------- Key component of mental health nursing and the therapeutic nurse-client relationship that improves the emotional well- being of the client. A nurse is discussing relapse potential with a group of patients and their families. What should the nurse educate them on? ---------- Correct Answer --------- Relapses should be expected and be looked at an opportunity. in the shift change of report, an off going nurse criticizes a patient who wears heavy makeup; which comment by the nurse who received the report best demonstrates advocacy --------- Correct Answer ----------- our patients need our help to learn behaviors that will help them get along in society which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community with serious and persistent mental illness; within 2 months, the patient will --------- Correct Answer ----------- report a sense of well-being a staff nurse completes orientation to a psychiatric unit; the nurse may expect an advanced practice nurse to perform which additional assessment --------- Correct Answer ----------- prescribe psychotropic medication which assessment finding most clearly indicates that a patient may be experiencing a mental illness --------- Correct Answer ----------- reports a consistently sad, discouraged mood which indicates that the goal "demonstrate mentally healthy behavior" was acheived ---- ----- Correct Answer ----------- sees self as capable of achieving ideals and meeting demands a nurse encounters an unfamiliar psychiatric disorder; which resource should the nurse consult to determine criteria used to establish the diagnosis --------- Correct Answer ------ ----- diagnostic and statistical manual of mental disorders (DSM5) a nurse wants to find a description of diagnostic criteria for anxiety disorders; which resource would have the most complete information --------- Correct Answer ----------- diagnostic and statistical manual of mental disorders (DSM5) which individual is demonstrating highest level of resilience; an individual who --------- Correct Answer ----------- takes a temporary job to maintain financial stability after the loss of a job which Western cultural feature may result in establishing unrealistic outcomes for patients of other cultural groups --------- Correct Answer ----------- direct confrontation to solve problems a Haitian patient with depression tells the nurse "there's nothing you can do; this is punishment"; what does this tell the nurse --------- Correct Answer ----------- the patient may believe the distress is the result of a curse or spell a person diagnosed with schizophrenia has had difficulty keeping a job because of arguing with coworkers and accusing them of conspiracy; today the person shouts "they're all plotting to destroy me"; select the nurse's most therapeutic response --------- Correct Answer ----------- feeling that people want to destroy you must be very frightening a newly admitted patient diagnosed with schizophrenia is hyper-vigilant and constantly scans the environment; he states "I saw two doctors talking in the hall; they were plotting to kill me"; the nurse may correctly assess this behavior as --------- Correct Answer ----------- an idea of reference a patient diagnosed with schizophrenia begins to talk about "cracklomers" in the local shopping mall; the term should be documented as --------- Correct Answer ----------- a neologism a patient's care plan includes monitoring for auditory hallucinations; which assessment findings suggest he may be hallucinating --------- Correct Answer ----------- darting eyes, tilted head, and mumbling to self a patient diagnosed with schizophrenia tells the nurse "I eat skiller; tend to end; easter; it blows away; get it?"; select the nurse's best response --------- Correct Answer ----------- I am having difficulty understanding what you are saying when a patient diagnosed with schizophrenia was discharged six months ago, haldol was prescribed; he now says "I stopped taking those pills; they made me feel like a robot"; what common side effects should the nurse validate with the patient --------- Correct Answer ----------- sedation and muscle stiffness according to the WHO, palliative care is an approach that improves quality of life for patients and their families who face problems associated with life-threatening illnesses; what are some specific goals of palliative care --------- Correct Answer ----------- regard dying as a normal process; provide relief from symptoms, including pain; affirm life and neither hasten nor postpone death; support holistic patient care and enhance quality of life; offer support to patients to live as actively as possible until death; offer support to the family during the patient's illness and their own bereavement the husband and daughter of a hispanic woman dying from pancreatic cancer refuse to consider using hospice care; what is the first thing the nurse should do --------- Correct Answer ----------- assess their understanding of what hospice care services are list the two criteria for admission to a hospice program --------- Correct Answer ----------- patient must desire services and agree in writing that only hospice care can be used to treat the terminal illness (palliative care); patient must meet eligibility, which is less than six months to live, certified initially by two physicians what are some physical manifestations that the nurse would expect to see in a patient approaching death --------- Correct Answer ----------- Cheyne-Stokes respiration; death rattle (inability to cough and clear secretions); increased, then slowing, respiratory rate; irregular breathing; terminal gasping; mottling on hands, feet, and legs that progresses to the torso; cold, clammy skin; cyanosis on nose, nail beds, and knees; waxlike skin; slowing of the GI tract with accumulation of gas and abdominal distention; loss of sphincter control with incontinence; bowel movement before imminent death or at time of death; loss of muscle tone with sagging jaw; difficulty speaking; difficulty swallowing; loss of ability to move or maintain body position; loss of gag reflex a terminally ill patient is unresponsive and has cold, clammy skin with mottling on the extremities; the patient's husband and two grown children are arguing at the bedside about where the patient's funeral should be held; what should the nurse do first --------- Correct Answer ----------- take the family members aside and explain that the patient may be able to hear them a 20-year-old patient with a massive head injury is on life support, including a ventilator to maintain respirations; what three criteria for brain death are necessary to discontinue life support --------- Correct Answer ----------- coma, absent brainstem reflexes, apnea a patient with end-stage liver failure tells the nurse, "if I can just live to see my first grandchild who is expected in five months, then I can die happy"; the nurse recognizes that the patient is demonstrating which of the following stages of grieving --------- Correct Answer ----------- Kübler-Ross's stage of bargaining a terminally ill man tells the nurse, "I have never believed there is a God or an afterlife, but now it is too terrible to imagine that I will not exist; why was I here in the first place?" what does this comment help the nurse recognize about the patient's needs --------- Correct Answer ----------- he is experiencing spiritual distress in most states, directives to physicians, durable power of attorney for health care, and medical power of attorney are included in which legal documents --------- Correct Answer ----------- natural death acts when teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump --------- Correct Answer ----------- tight glycemic control can be maintained a patient taking insulin has recorded fasting glucose levels above 200 mg/dL on awakening for the last five mornings; what should the nurse advise the patient to do first --------- Correct Answer ----------- monitor the glucose level at bedtime, between 2 and 4am, and on arising which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose --------- Correct Answer ----------- biguinide the patient with type 2 diabetes is being put on acarbose (precose) and wants to know why she is taking it; what should the nurse include in this patient's teaching --------- Correct Answer ----------- take it with the first bite of each meal; effectiveness is measured by 2-hour postprandial glucose; it delays glucose absorption from the gastrointestinal tract the nurse is assessing a newly admitted diabetic patient; which observation should be addressed as the priority by the nurse --------- Correct Answer ----------- rapid respirations with deep inspiration individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to --------- Correct Answer ----------- eat regular meals at regular times what should the goals of nutrition therapy for the patient with type 2 diabetes include ---- ----- Correct Answer ----------- normal serum glucose and lipid levels to prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise --------- Correct Answer ----------- about 1 hour after eating when blood glucose levels are rising the nurse assesses the diabetic patient's technique of self-monitoring of blood glucose three months after initial instruction; which error in the performance of self-monitoring of blood glucose noted by the nurse requires intervention --------- Correct Answer ----------- cleaning the puncture site with alcohol before the puncture a nurse working in an outpatient clinic plans a screening program for diabetes; what recommendations for screening should be included --------- Correct Answer ----------- FPG for all individuals at age 45 and then every three years a patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms; which advice form the nurse will be the best for this patient --------- Correct Answer ----------- administer the usual insulin dosage the nurse should observe the patient for symptoms of ketoacidosis when --------- Correct Answer ----------- glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss what are manifestations of diabetic ketoacidosis (DKA) --------- Correct Answer ----------- thirst; ketonuria; dehydration; metabolic acidosis; kussmaul respirations; sweet, fruity breath odor what describes the primary difference in treatment for diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome --------- Correct Answer ----------- hyperosmolar hyperglycemic syndrome requires greater fluid replacement to correct the dehydration the patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech; what should the nurse suspect is happening --------- Correct Answer ----------- hypoglycemia the patient with diabetes has a blood glucose level of 248 mg/dL; which manifestations in the patient would the nurse understand as being related to this blood glucose level --- ------ Correct Answer ----------- headache, abdominal cramps, increase in urination, weakness and fatigue a diabetic patient is found unconscious at home and a family member calls the clinic; after determining that a glucometer is not available, what should the nurse advise the family member to do --------- Correct Answer ----------- administer glucagon 1 mg intramuscularly or subcutaneously the patient with diabetes is brought to the emergency department by his family members, who say that he is not acting like himself and he is more tired than usual; what would be the order of the nursing actions for this patient --------- Correct Answer --- -------- ensure patent airway; check blood glucose; establish IV access; administer 0.9% NaCl solution at 1L/hr; begin continuous regular insulin drip; establish time of las food and medication(s) two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL; which is the best response by the nurse --------- Correct Answer ----------- "that is a good range for your glucose levels" which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes --------- Correct Answer ----------- it occurs with a higher frequency and earlier onset than in the nondiabetic population what disorders and diseases are related to macrovascular complications of diabetes ---- ----- Correct Answer ----------- coronary artery disease, ulceration and amputation of the lower extremities the patient with diabetes has been diagnosed with autonomic neuropathy; what problems should the nurse expect to find in this patient --------- Correct Answer ----------- erectile dysfunction, vomiting undigested food, painless myocardial infarction following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient makes which statement --------- Correct Answer ----------- "I'll know if I have sores or lesions on my feet because they will be painful" a 72-year-old woman is diagnosed with diabetes; what does the nurse recognize about the management of diabetes in the older adult --------- Correct Answer ----------- it is more difficult to achieve strict glucose control than in younger patients in planning community education for prevention of spinal cord injuries, what group should the nurse target --------- Correct Answer ----------- adolescent and young adult men a 70-year-old patient is admitted after falling form his roof; he has a spinal cord injury at the C7 level; what findings during the assessment identify the presence of spinal shock --------- Correct Answer ----------- tetraplegia with total sensory loss which syndrome of incomplete spinal cord lesion is described as cord damage common in the cervical region resulting in greater weakness in upper extremities than lower ------- -- Correct Answer ----------- central cord syndrome the patient is diagnosed with Brown-Séquard syndrome after a knife wound to the spine; which description accurately describes this syndrome --------- Correct Answer ----------- spinal cord damage resulting in ipsilateral motor paralysis and contralateral loss of pain and sensation below the level of the lesion what causes an initial incomplete spinal cord injury to result in complete cord damage -- ------- Correct Answer ----------- infarction and necrosis of the cord caused by edema, hemorrhage, and metabolites a patient with spinal cord injury has spinal shock; the nurse plans care for the patient based on what knowledge --------- Correct Answer ----------- resolution of spinal shock is manifested by spasticity, hyperreflexia, and reflex emptying of the bladder two days following a spinal cord injury, a patient asks continually about the extent of impairment that will result from the injury; what is the best response by the nurse --------- Correct Answer ----------- "the extent of your injury cannot be determined until the secondary injury to the cord is resolved" with other drugs used for MS is what --------- Correct Answer ----------- it has a lifetime dose limit because of cardiac toxicity a patient with MS has a nursing diagnosis of self-care deficit related to muscle spasticity and neuromuscular deficits; in providing care for the patient, what is most important for the nurse to do --------- Correct Answer ----------- promote the use of assistive devices so the patient can participate in self-care activities a patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease; following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what --------- Correct Answer ----------- "when I begin to feel better, I should stop taking the prednisone to prevent side effects" a patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness; when is a diagnosis of cholinergic crisis made --------- Correct Answer ----------- administration of edrophonium (tensilon) increases muscle weakness during care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient --------- Correct Answer ----------- respiratory function when providing care for a patient with ALS, the nurse recognizes what as one of the most distressing problems experienced by the patient --------- Correct Answer ----------- retention of cognitive function with total degeneration of motor function in providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward --------- Correct Answer ----------- maximize neurologic functioning for as long as possible in promoting health maintenance for prevention of strokes, the nurse understands that the highest risk for the most common type of stroke is present in which people --------- Correct Answer ----------- individuals with hypertension and diabetes a thrombus that develops in a cerebral artery does not always cause a loss of neurologic function because --------- Correct Answer ----------- circulation via the circle of Willis may provide blood supply to the affected area of the brain a patient comes to the emergency department immediately after experiencing numbness of the face and an inability to speak but while the patient awaits examination, the symptoms disappear and the patient requests discharge; why should the nurse emphasize that it is important for the patient to be treated before leaving --------- Correct Answer ----------- the patient has probably experienced a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease what are characteristics of a stroke caused by an intracerebral hemorrhage --------- Correct Answer ----------- carries a poor prognosis, caused by rupture of a vessel, creates a mass that compresses the brain which type of stroke is associated with endocardial disorders, has a rapid onset, and is unrelated to activity --------- Correct Answer ----------- embolic what primarily determines the neurologic functions that are affected by a stroke --------- Correct Answer ----------- the brain area perfused by the affected artery is aphasia, a manifestation of a stroke, more likely to occur with right brain damage or left brain damage --------- Correct Answer ----------- left brain damage is impaired judgement, a manifestation of a stroke, more likely to occur with right brain damage or left brain damage --------- Correct Answer ----------- right brain damage is quick, impulsive behavior, a manifestation of a stroke, more likely to occur with right brain damage or left brain damage --------- Correct Answer ----------- right brain damage is an inability to remember words, a manifestation of a stroke, more likely to occur with right brain damage or left brain damage --------- Correct Answer ----------- left brain damage is left homonymous hemianopsia, a manifestation of a stroke, more likely to occur with right brain damage or left brain damage --------- Correct Answer ----------- right brain damage is neglect of the left side of the body, a manifestation of a stroke, more likely to occur with right brain damage or left brain damage --------- Correct Answer ----------- right brain damage is hemiplegia of the right side of the body, a manifestation of a stroke, more likely to occur with right brain damage or left brain damage --------- Correct Answer ----------- left brain damage the patient has a lack of comprehension of both verbal and written language; which type of communication difficulty does this patient have --------- Correct Answer ----------- receptive aphasia a patient is admitted to the hospital with a left hemiplegia; to determine the size and location and to ascertain whether a stroke is ischemic or hemorrhagic, the nurse anticipates that the health care provider will request a --------- Correct Answer ----------- MRI a carotid endarterectomy is being considered as treatment for a patient who has had several TIAs; what should the nurse explain to the patient about this surgery --------- Correct Answer ----------- it involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke the incidence of ischemic stroke in patients with TIAs and other risk factors is reduced with the administration of which medication --------- Correct Answer ----------- daily low- dose aspirin what is the priority intervention in the emergency department for the patient with a stroke --------- Correct Answer ----------- maintenance of respiratory function with a patent airway and oxygen administration a diagnosis of a ruptured cerebral aneurysm has been made in a patient with manifestations of a stroke; the nurse anticipates which treatment option that would be considered for the patient --------- Correct Answer ----------- surgical clipping of the aneurysm during the acute phase of a stroke, the nurse assesses the patient's vital signs and neurologic status every four hours; what is a cardiovascular sign that the nurse would see as the body attempts to increase cerebral blood flow --------- Correct Answer --------- -- hypertension during the secondary assessment of the patient with a stroke, what should be included - -------- Correct Answer ----------- gaze, sensation, facial palsy, proprioception, distal motor function what is a nursing intervention that is indicated for the patient with hemiplegia --------- Correct Answer ----------- having the patient perform passive range of motion of the affected limb with the unaffected limb a newly admitted patient diagnosed with a right-sided brain stroke has a nursing diagnosis of disturbed visual sensory perception related to homonymous hemianopsia; early in the care of the patient, what should the nurse do --------- Correct Answer ---------- - place objects on the right side within the patient's field of vision four days following a stroke, a patient is to start oral fluids and feedings; before feeding the patient, what should the nurse do first --------- Correct Answer ----------- check the patient's gag reflex what is an appropriate food for a patient with a stroke who has mild dysphagia --------- Correct Answer ----------- scrambled eggs a patient's wife asks the nurse why her husband did not receive the clot busting medication (tPA) she has been reading about; her husband is diagnosed with a hemorrhagic stroke; what is the best response by the nurse to the patient's wife --------- Correct Answer ----------- "the medication you are talking about dissolves clots and could cause more bleeding in your husband's brain" the rehabilitation nurse assesses the patient, caregiver, and family before planning the rehabilitation program for this patient; what needs to be included in this assessment -----