Download NSG 211 Final Exam Questions: Acute Neurologic Disorders and Renal System and more Exams Nursing in PDF only on Docsity!
NSG 211 FINAL EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
Acute Neurologic Disorders Wernicke's Area correct answer: damage to the Wernicke's area causes RECEPTIVE DYSPHASIA "the understanding and receiving" Brocca's Speech Area correct answer: damage to Brocc'a Speech Area causes EXPRESSIVE APHASIA or DYSPHASIA "can't express in meaningful ways" Left Hemisphere Damage correct answer: -impaired logic -impaired ANALYTICAL SKILLS -impairs LOSS OF INTELLECT (intelligence) -impaired/loss of communication skills Right Hemisphere Damage correct answer: -impaired art/music appreciation -BEHAVIORAL PROBLEMS -SPATIAL ORIENTATION (self neglect & impairs mobility) LEVEL OF CONSCIOUSNESS (alterations in cognitive states) correct answer: gradient of persons mental status from ALERT -> COMA elevated by: BREATHING PATTERNS, EYE RESPONSES, MOTOR RESPONSES
GLASGOW COMA SCALE · 3-15 Level of consciousness (glascoma scale) FULL CONSCIOUSNESS (alterations in cognitive states) correct answer: state of awareness both of ones self and one's environment -AROUSAL (wakefulness) how awake are you? -AWARENESS (content of though processes) how aware are you? VEGETATIVE STATE (alterations in cognitive states) correct answer: loss of awareness of the environment and cognitive function brainstem function continues (RESPIRATORY, CIRCULATORY, CARDIOVASCULAR, AUTONOMIC INTACT) all of these are INTACT but completely loss of awareness LOCKED IN SYNDROME (alterations in cognitive states) correct answer: loss of motor function and communication, EXCEPT eye movement the individual is AWARE BUT PARALYZED
-Receptive (Wernicke's area) -Global (both Broca's and Wernicke's) Alexia correct answer: impaired reading ability Agraphia correct answer: impaired writing ability Agnosia correct answer: impaired pattern recognition Confusion Disorders correct answer: disruption of neural network involving RAS, BRAINSTEM, THALAMUS, CORTEC can be acute and chronic Delirium correct answer: HYPERACTIVE STATE overactivity of ANS most common(EXCITED, AGGITATED, aggressive) signs & symptoms: AGGRESSIVE, COMBATIVENESS, altered mental status, high heart rate, increased pain tolerance (drug/sleep deprivation, loss of servacadem rhythm presents in hyperactive and excitement STRONG, still confused but not in a slumber) quick onset, can recover Dementia correct answer: an ACQUIRED, PROGRESSIVE DETERIORATION OF MENTAL FUNCTION which decreases intellect, orientation, memory, judgement, language language: often manifests as ALTERATIONS IN BEHAVIOR
signs and symptoms: SHORT-TERM MEMORY LOSS, anger, agitation, wandering, poor decision making manifestations (loss of cognition, loss of judgment, loss of memory, SLOW manigestations) Pyelonephritis correct answer: · Upper urinary tract infection, inflammation of the kidney (infra renal) · Signs and symptoms: URINARY CASTS (inflammation) mac n cheese, FLANK PAIN, CLOUDY URINE -at risk for hydronephorsis(backup of kidney that's supposed to be draining but clogged and back up in kidneys and can lead to ischemia and lead to kidney injury ACUTE KIDNEY INJURY which is post renal) Glomerulonephritis: signs symptoms correct answer: - Glomerulonephrisits is infra renal (IN THE KIDNEY) · DUMPING TONS OF PROTEIN in urine · Strep throat · Strep not being treated can cause serious complications and affect kidneys, PSGN (post streptococcal glomerulonephritis) which causes dumping of protein · When kidneys start to shut down, elevated BUN and creatine, , EDEMA, HYPERKALEMIA, metabolic acidosis, , decreased GFR
acute kidney injury is the sudden decrease in glomerular filtration rate (GFR) correct answer: · Pre-renal: o Decrease GFR, DECREASED RENAL ARTERIAL BLOOD FLOW TO KIDNEYS (hypotension, cardiac rest, a severe bone that causes massive inflammation and hypotension) = all of these things that can REDUCE renal artery blood flow going across the kidney that reduces GFR to nothing and shock it -problem came BEFORE the kidney/glomerular apparatus (most common cause of acute kidney injury) · Intra-renal: o ex: glomerulonephritis, pelonephritis it accumulates IN THE KIDNEY and damages the kidney causing a nephrotic syndrome/allergic reaction and DESTROY THE INSIDE OF THE KIDNEY (inside the kidney or glomerulus) · Post-renal: o Kidney stones causes ex: hydronephrosis, pyelonephritis and clogging the kidney "log jam", even prosteitis can cause there to be problems AFTER KIDNEY/GLOMERULAR (large prostate can block urine) (cause is after the glomerular apparatus) -Chronic renal failure from renal ischemia, etiology is CAD, diabetes, peripheral, polisistic disease
Dialysis correct answer: · Hemodialysis: quicker and MORE EFFECTIVE than perinteral dialysis, need AV shunt puts which ultimately puts the patient at risk for SEPSIS cause you introduce it to the blood · Perinteral dialysis: you have independence you can do it at home -you need abdominal catheter port which goes to PERITONEUM, complication is PERITONITIS(where getting bacteria in the peritoneum) ALL TYPES OF RENAL FAILURE correct answer: GFR DROPS!!! BUN AND CREATINE GOES UP, POTASSIUM GOES UP (HYPERKALEMIA), METABOLIC ACIDOSIS, EDEMA fluid overload in body because you have (decrease urine output) OLIGURIA Normal GFR correct answer: is greater than 60 depends on ethnicity Brain dead correct answer: NO reflexes NO brainstem function, NO spontaneous respirations (can organ donate) Decorticate correct answer: -cortex and arms go in RIGID FLEXION in the upper limbs, adducted arms "flexion to the CORE of body"
-Components of cushings triad is: HYPERTENSION, BRADYCARDIA, DECREASED RESPIRATORY RATE Even before you suffer you can recognize in a pt they have cerebral ischemia you see DECREASE OF LOC (you see this before cushings triad) ex: they might be confused, sleepy, not responsive. That's why you use Glasgow Comas scale because it measures and assesses eye response and motor response to commands Meningitis correct answer: Much uglier is bacterial meningitis because how do you treat bacteria with antibiotics and antibiotics don't go to brain because you have blood brain barrier and have to have antibiotic go to brain have to have NASTY medications to get there(bacterial or viral) · What do you see in BOTH meningitis? i. Photophobia (light hurts your eyes) ii. Headache iii. Fever iv. Chills v. Stiff neck (lucre rigidity) · Bacterial meningitis · Do spinal tap to see if its bacterial or viral · You see CLOUDY in spinal tap if its bacterial because has pus (purulent) probably low sugar since bacteria is eating sugar
· You see CLEAR in tap viral tap because white blood cells don't attack in virus in the tissue, you have high PROTEIN Autonomic dysreflexia: Causes, process, dangerous complications correct answer: · What type of patient do you typically have for autonomic dysreflexia? -They have spinal cord injuries or paralyzed/paralysis Signs and symptoms: -DISTENDED BLADDER DISTENDED BOWEL DIAPHORESIS (SWEATING) VASOCONSTRICTION HIGH BP HYPERTENSION, BRADYCARDIA -high blood pressure activates the PNS to stimulation of the vagus nerve then the SA node is stimulated to lower the heart rate and thats why we get bradycardia (if you don't fix can have a stroke mi etc (because pushing fluid to lungs) iii. Check with bladder scan and bowel hygiene program (stool softners etc) Multiple Scelorsis correct answer: Manifestations: start with (parasthesia) numbness and tinging to paralysis leading to muscle weakness,
-3-5 years, no known cause, no cure Myasthenia Gravis correct answer: -Type 2 hypersensitivity and get an antibody binding to something inapporirate and causes inappropriate response -Autoimmune impairs ACH receptor meaning that ACH cannot bind to receptor and our muscles weaken, without ACH you have no muscle contraction LOSES STRENGTH -Weakness STARTS IN THE FACE (flatt affect) pace things throughout the day and at risk for aspirating Huntington Disease correct answer: -Loss of GABA"in charge or calming down the nerves" -chloreaform is a NON repetitive dance moves, necks get twisted around -Autosomal dominant to children (50-50) -Depends if you inherit the gene, no treatment TIA / CVA: types, etiology, differences, signs and symptoms, sequelae of each correct answer: Risk factors of TIA/CVA= hypertension, Coronary Artery Disease , peripheral artery disease, history of smoking, diabetes
· TIA- transient don't always stick around, patient recovers , always ischemia, important to know because they look like strokes and CVA, they are GREAT WARNINGS for patients' being at risk for CVA, symptoms FADE AWAY after couple of days may LOC or may NOT · CVA- you can have CVA that's ischemic which leads to infarction (part of brain dies) and probably have symptoms first 24 hours, hemorrhagic and blood actually goes to brain "LOC" · Symptoms: HYPERTENSION BRADYCARDIA DECREASE RR REALLY BAD HA (WORST EVER!!) BLOWN PUPILS bleeding in the brain so increase IVP leading to decreased LOC and leads to Cushing's triad (hypertension, bradycardia, decreases respiratory rate uncle herniations, comas, blown pupils, worst headache of their lives, increased ICP, seizures, if blood mixes with meninges) from bleeding in brain What type of head bleed is venous and a little slower correct answer: Subdural "venous" brain bleed How does someone know they are having a cerebral aneurisms head bleed? correct answer: 1. They don't,
- Circle of Willis is affected in cerebral aneurisms
· Exercise and estorgen encourages osteoblasts??? · Osteoclasts break it down (hyperparathyroidism increase osteoclasts activity because the bones are being broken down and take the calcium) · Osteoblasts make new bone (exercising) Smokers increase osteoclasts, thin women/mean, immobility, women because they lost their estrogen, light hair, light eyes, postmenopausal Osteoporosis: Risk factors, etiology, pathophysiology, manifestations and complication correct answer: · People who are not using their bones (use it or lose it) decrease in bone desnity and mass -hollow bone smokers, thin people, loss of estrogen, and people who arent active T score(bone density test) Osteoarthritis: Risk factors, etiology, pathophysiology, manifestations and complications correct answer: · Wear and tear of the joint · Osteoarthritis is wear and tear of joint (obese people, hip,knee) · Because you are knicking the bones worn down the soft tissue and cartilage doing the "fracture healing process "making new
bone and keep growing bigger and bigger in joint space and close it up and get bone on bone" Rheumatoid arthritis: etiology, pathophysiology, manifestations and complications correct answer: · Autoimmune (3 or 4) · T cells involves, systemic and affects and destroys the joints and destroys all aspects of the joint, cartilage, bone, completely destroys the joint space and can affect other organs, have inflammatory fluid too ·how to screen for it RA: Rf factor (in blood) signs of inflammation, increased esr, low grade fever, abnormal lab results, Gout: etiology, pathophysiology, dietary considerations correct answer: · High Uric acid crystalizes, activinating leukocytes · Walking a lot, using joints ex: camping stay away from high in purine diets (red wine, aged cheese, ages juices, sardines, smoked meats, worchestire sauce) STRAIN correct answer: Injury muscle and bone what is it called= EFFECTS TENDON "tear in a tendon" SPRAIN correct answer: tear in a ligament injury bone to bone Tendonitis correct answer: swelling/inflammation of a tendon
Rabies correct answer: virus from animal change of LOC, seizures, death, etc can cause nervous irritability, HA, fever, respiratory deatha and failure Guillain barre syndrome correct answer: idiopathic, adverse vaccination reaction · Ascending from distal to proximal (to peripheral nerves) · Can be regenerated and muscles can be rebuilt during recovery Osteoporosis Test? correct answer: you know someone has it by the T score (bone density tests) Herniated disk correct answer: no medical emergency found in people all the time but we worry when cuadia equina (hurting the spinal cord) medical emergency when saddle anesthesia (numbness down there) loss of bowel or bladder, the patient can't lift their legs (dragging) there's so much compression on the spinal cord that if you have compression you have ischemia which ischemia can turn into necrosis and if we kill the CNS it doesn't come back and lead to paralysis Cushing triad is correct answer: what happens with cushing reflex it occurs with cerebral ischemia, associated with hemorgahic stokres, ruptured cerebral aneuryms, traumatic brian injury, tumors, bleeding in brain
-cushings reflex (vasoconstriction,(squeezing toothpaste harder) up blood on brain allowing cerebral perfusion its temporary so it has to keep increasing the blood pressure higher and higher The high blood pressure increases carotid sinuses that say bp is wayyyy too high and brain wont vasodilate to lower bp, the high blood pressure stimulates vagus nerve causing sa to and we see bradycardia and slowing of respiratory rate Generalized Seizure correct answer: affects both cerebral(sides) hemispheres of the brain, loss of consciousness can be a petit/grand mal and have tonic clonic contractions, Partial correct answer: unilateral affecting one side of the brain may or may not have LOC oliguria correct answer: low urine output < CUSHINGS TRIAD correct answer: INCREASED BP DECREASED HR DECREASED RR Lyme Disease correct answer: bacteria dsseminates through circulation and leads to neurological injury causing immunological reactions -transmitted by brown deer tick -bullzeye rash -can cause cardiac arrythmias, meningoencephalitis facial nerve paralysis, pain swelling of joints, autoimmune reactions
