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NUR 508 Elaborated Final Exam Sure Pass A Graded, Exams of Nursing

Jacksonville State University (JSU)Nursing

A comprehensive review of key concepts and clinical applications in neurological and burn care, focusing on essential nursing knowledge and skills. It covers a wide range of topics, including stroke management, spinal cord injuries, head injuries, shock, and burn care. Questions and answers, highlighting critical assessment findings, interventions, and complications related to these conditions. It is a valuable resource for nursing students and professionals seeking to enhance their understanding of neurological and burn care.

Typology: Exams

2024/2025

Available from 12/10/2024

CESSLYN
CESSLYN 🇺🇸

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NUR 508 Elaborated Final Exam Sure Pass A
Graded
What is the number one risk factor for a stroke?
hypertension
Which interventions are appropriate for a TIA?
-give aspirin
-education: TIA is temporary but needs immediate medical attention
What is the gold standard diagnostic test for a stroke?
noncontrast head CT
What is the #1 assessment finding with a hemorrhagic stroke?
"thunderclap" headache: comes on suddenly with no warning
What are the safety concerns with R sided vs L sided strokes?
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NUR 508 Elaborated Final Exam Sure Pass A

Graded

What is the number one risk factor for a stroke? hypertension Which interventions are appropriate for a TIA?

  • give aspirin
  • education: TIA is temporary but needs immediate medical attention What is the gold standard diagnostic test for a stroke? noncontrast head CT What is the #1 assessment finding with a hemorrhagic stroke? "thunderclap" headache: comes on suddenly with no warning What are the safety concerns with R sided vs L sided strokes?
  • R: impulsive or safety problems, such as impaired judgment
  • L: emotional dysregulation What are the main complications of hemorrhagic strokes (that she mentioned at least)?
  • homonymous hemianopsia: unilateral neglect (teach about looking around + caring for both sides of body)
  • watch for stent occlusion or retroperitoneal hemorrhage What is considered appropriate delegation for strokes?
  • PCAs can help with Pts who had a stroke a while ago & are stable now
  • PCA should not be assigned to Pt who may have new symptoms What is the relationship between ischemic strokes and permissive HTN?
  • HTN is body's attempt to maintain cerebral perfusion
  • therefore, only give BP meds if SBP > What is the purpose of the ventriculostomy system?
  • gold standard for measurement of ICP
  • decerebrate: all 4 extremities are rigid = very bad!! What are the two key indications that a patient may have a CSF leak?
  • CSF otorrhea: there is a ring on the Pt's pillow
  • fluid tests positive for glucose Which nursing action is contraindicated with a basilar skull fracture? placement of an NG tube Which assessment findings relate to a thoracic spinal cord injury?
  • paraplegia
  • paralysis from chest down Which assessment findings relate to a cervical spinal cord injury?
  • paralysis from neck down
  • impaired respiratory** What are the manifestations of spinal shock?
  • flaccid paralysis
  • loss of sensory and motor fxn
  • incontinence What are the manifestations of autonomic dysreflexia?
  • hypertension + bradycardia
  • HA
  • flushing/diaphoresis
  • blurred vision Which GCS scores correspond to minor, moderate, and severe injuries?
  • minor: 13- 15
  • mod: 9- 12
  • severe: 3- 8 Which education points should be made for a concussion patient?
  • watch for lethargy or behavior changes within 2 weeks to 2 months after-
  • watch for decreased short-term memory
  • no driving, hot baths, or sports

Which interventions are appropriate for a Pt with facial burns?

  • monitor respiratory closely**
  • may need high O
  • intubate if wheezing or hypoxia
  • eye care for burns or edema What are some interventions to prevent cross contamination in burn patients?
  • change gloves between care for different body parts
  • wear full PPE What are some interventions to prevent infection in burn patients?
  • debridement in cart shower/bed
  • done after ABCs and adequate fluids
  • give aggressive pain meds before** Which analgesic is best for burns? morphine: helps pain & perfusion/oxygenation

What is the nutritional intake during emergent phase of burns?

  • fluids take precedent
  • start a small bore IV for enteral feedings to preserve GI function
  • need 5000 kcal/day d/t hypermetabolic state What is a circumferential burn and what is the priority intervention?
  • entire circumference of a limb is burned
  • monitor for decreasing pulses or sensations = notify MD immediaely Which interventions are appropriate for chemical burns?
  • prolonged washing is better than neutralizing
  • remove clothing and jewelry asap Which vaccine is important for burn patients? tdap How do you intervene & then evaluate fluid resuscitation in burn patients?
  • 2 large-bore IVs for >15% TBSA burned

What are the indications for norepinephrine use in shock patients?

  • CVP is WNL
  • Pt not responding to fluid resuscitation
  • want MP >60- 65
  • monitor kidney w/ creatinine and liver with ALT/AST What is important to know about admin of vasopressors through a PIV?
  • it causes necrosis in extremities over time
  • watch for decreased pulses or cap refill What are some interventions to avoid during acute DIC?
  • needle sticks
  • invasive procedures
  • anything that causes injury What are the assessment findings that proceed developing MODS?
  • 2+ organ failure
  • usually, respiratory system is 1st
  • CV changes, neuro changes, AKI, DIC, GI changes

What are the common organs affected by shock?

  • respiratory is commonly affected
  • kidneys: decreased urine
  • GI tract: paralytic ileus
  • skin changes What is the main goal of therapy in shock patients? maintain/correct tissue perfusion to prevent MODS What is the pathophysiology of shock? structural problems > decreased stroke volume > decreased CO > decreased oxygenation

decreased perfusion What is a contraindication of using LR in shock patients? avoid in shock patients because it contains lactate What are some risk factors for septic shock?

  • pale skin
  • rapid, weak heartbeat
  • orthostatic hypotension What is the first-line treatment for anaphylactic shock? epinephrine injection What is the purpose of trickle feeds in shock patients?
  • start within 24h
  • maintain GI function because they can't handle full nutrition What are some assessment findings r/t inadequate tissue perfusion d/t shock?
  • decreased pulses or cap refill
  • pallor
  • cool, clammy skin
  • mottling Which indicators are most helpful in evaluating fluid resuscitation in hypovolemic shock patients?
  • signs of increased fluid volume: BP comes up, HR goes down
  • Hgb and Hct decrease d/t dilution
  • increased signs of perfusion How do vasodilators relate to systemic vascular resistance?
  • SVR is a measure of afterload
  • afterload decreases with use of vasodilators
  • decreased afterload = increased CO What is the main manifestation of cardiogenic shock? increased pulmonary artery wedge pressure What are the key interventions to prevent complications in shock patients?
  • ensure airway
  • volume expansion**
  • maintain spO2 > 90%
  • give blood products
  • give antibiotics w/in first hour = decreased mortality
  • prevent ulcers with famotidine or pantoprazole

What is atropine used to treat? bradycardia What are some manifestations of ventricular tachycardia?

  • ventricular rate of 150-250 bpm
  • no P waves
  • QRS is wide/distorted
  • hypotension
  • might be talking for now, but will decline rapidly! What might cause a high pressure alarm during mechanical ventilation?
  • Pt biting on tube
  • clog in tubing (such as d/t mucous)
  • bronchospasm
  • "fighting" the ventilator What are some main complications of ARDs?
  • pneumonia
  • barotrauma: absent lung sounds, crepitus, tracheal deviation
  • stress ulcers
  • AKI: decreased urine What are the values for a normal ABG? pH: 7.35-7. PaCO2: 35- 45 HCO3: 22- 26 Why is proning used in ARDs?
  • can help increase oxygenation
  • used in refractory hypoxemia: not responsive to increased O What are some indications for CRRT?
  • if they have AKI + volume overload or K >6 or BUN >
  • if they have end stage renal disease: BUN >120 or GFR <15 mL/min or encephalopathy or uncontrolled hyperkalemia What is a main indicator for hemodialysis? hyperkalemia (>6) = need emergent HD
  • ammonia decreases
  • s/s of metabolic encephalopathy decrease Why are acute pancreatitis patients NPO? NPO = decreased pancreatic secretions = decreased pain What is important to know about laparoscopic cholecystectomies?
  • Tx of choice for gallbladder issue
  • return to work in a week
  • gradual introduction of fats into diet
  • no baths for weeks