Download NURS 487 WEEK 4 MIDTERM 1 LATEST 2025 EXAM STUDY GUIDE QUESTIONS WITH ANSWERS and more Exams Nursing in PDF only on Docsity!
NURS 487 WEEK 4 MIDTERM 1
LATEST 2025 EXAM STUDY GUIDE
QUESTIONS WITH ANSWERS
Cardiac Output •what's coming out of the heart in one minute (5 L/min) Stroke volume •amount of blood in one beat in ml) (preload, afterload, contractility) x HR bpm •Ventricles fill with blood (end diastolic volume), the ventricles don't eject out all the blood during systole, some amount is always left in the ventricle after contraction (end systolic volume). The amount ejected is the stroke volume (EDV - ESV). Preload •EDV or how much fluid is going in, also described as how stretched the myocytes are when the ventricle is full of blood (think of a balloon full of air - when its full of air it has a lot of force, when its not full of air, not as much force) Afterload the resistance the ventricle must overcome to eject blood. If there is a lot of pressure it takes a lot of force to open valves. This may reduce the amount of blood ejected. Stenotic (narrowed) valves reduces blood output = low CO. contractility •how much squeeze the heart has, the more force the more it ejects
•Heart rate is increased if CO is reduced; if heart rate is decreased this may also decrease CO if the SV doesn't increase Fatty Streak lipids accumulate and migrate into smooth muscle cells fibrous plaque
- collagen covers the fatty streak
- vessel lumen is narrowed
- blood flow is reduced
- fissures can develop complicated lesion
- plaque rupture
- thrombus formation
- further narrowing or total occlusion of vessel collateral circulation circulation by secondary channels after obstruction of the principal channel supplying the heart (grows new vessels to bypass blockage) Embolus travelling clot that occludes an artery (atrial fibrillation, infective endocarditis, PCI)
What causes pain with angina? anaerobic metabolism creates lactic acid = pain Ischemia Lack of blood supply unstable angina rupture of thickened plaque, exposing thrombogenic surface •UA: New onset, occurs at rest (different from stable angina that goes away at rest), worsening pattern •Unpredictable and requires immediate attention •Easily provoked (minimal to no exertion) •Common symptoms in females include fatigue, SOB, indigestion, anxiety •Remember in UA there is no ST elevation and cardiac enzymes are normal (There may be ST depression or T wave inversion which indicates ischemia but not infarct) A 65 y/o female presents with chest pain with activity and is diagnosed with chronic stable angina. The pain occurs when myocardial oxygen supply has fallen below the demand Acute Coronary Syndrome sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction Myocardial Infarction (NSTEMI or STEMI)
•Interruption of blood supply to the cardiac muscle resulting in sustained ischemia and irreversible myocardial cell death •Location of the infarction correlates with the involved coronary circulation •The longer the area is deprived of oxygen the greater chance of cell death •Causes altered contraction and heart function •Sub-endocardium is affected first and necrosis will progress through entire thickness of the heart muscle in 4-6 hrs NSTEMI non-ST elevation myocardial infarction
- partial occlusion to vessel STEMI ST elevation MI, real-time ongoing death of heart tissue due to ischemia
- complete occlusion to heart vessel
- reflected by reduced CO ECG changes and ruse in troponins Infarct Area of dead tissue after a lack of blood supply - gets worse and worse Troponin blood test Test is performed to determine if chest pain is due to a heart attack These proteins are elevated when the heart muscle has been damaged
Osler nodes/Janeway lesions endocarditis manifestations pericarditis inflammation of the pericardium pericardial effusion accumulation of fluid in the pericardial cavity over time - pericardium stretches w/o compressing heart acute pericardial tamponade
- sudden fluid accumulation
- pericardium cannot adjust
- causes: chest trauma, ruptured aorta, ventricle rupture(MI) Beck's triad for cardiac tamponade. Hypotension, muffled heart sounds, distension of jugular veins What is the hallmark assessment finding in acute pericarditis? pericardial friction rub pericardiocentesis surgical puncture to aspirate fluid from the sac surrounding the heart
sinus rhythm normal heartbeat triggered by the SA node Asthma •Inflammatory disorder of the bronchial mucosa •Bronchial hyper-responsiveness (inflammation) •Bronchoconstriction •Varying degrees of airway obstruction •Asthma occurs in all ages •Both genetic and environmental factors What is asthma thought to be caused by? interactions between genetic and environmental factors pulsus paradoxus drop in blood pressure >10 mmHg with inspiration somnolence sleepiness What is airway hyper-responsiveness in asthma related to? Exposure to an allergen causing mast cell degranulation
PRAM score Pediatric Respiratory Assessment Measure Classifying severity of Asthma treatment for asthma oxygen ventolin and atrovent dexamethasone Acute exacerbation of COPD •sustained (>48h) worsening of respiratory symptoms, such as dyspnea, cough, or sputum production •Cause is usually infection (mostly viral but also bacterial), purulent needs ax, could be exposure to allergens •Pneumonia is a frequent complication of COPD •No specific diagnostic tests to define AECOPD •ABG should be done if SPO2 is low •CXR (check for pneumonia, HF, pneumothorax) A 60-year-old with a 25-year history of smoking is diagnosed with emphysema. Assessment shows an increased anterior-posterior chest diameter. What does the nurse attribute this finding to? air trapping
cor pulmonale right ventricular hypertrophy and heart failure due to pulmonary hypertension embolism the sudden blockage of a blood vessel by an embolus emboli a blood clot, air bubble, piece of fatty deposit, or other object that has been carried in the bloodstream A 70-year-old is hospitalized and develops a pulmonary embolism. What would this embolus likely be composed of? Blood Clot A 50-year-old male is diagnosed with pulmonary embolism (PE). Which of the following symptoms most likely occurred before treatment is initiated? Chest pain and shortness of breath what is high d-dimer indicative of? likely to have a blood clot - send to CT scan for definitive diagnosis Which assessment finding would be expected in pulmonary embolism (PE)? (Select all that apply.)
•Ischemia, hypoxia, microhemorrhage, and edema Central Cord Syndrome Sensory - Variable Motor- Upper extremity weakness, distal > proximal Brown-Sequard Syndrome Sensory- Ipsilateral position and vibration sense loss Contralateral pain and temp sensation loss Motor- Motor loss Ipsilateral to cord lesion Anterior Cord Syndrome Sensory - Loss of pain and touch sensation Vibration, position sense preserved Motor- loss of voluntary motor function below cord level Transverse cord Syndrome - Complete sensory - Loss of sensation below level of cord injury Motor - Loss of voluntary motor function below cord level Clinical Manifestations SCI - Respiratory c3,c4,c5 keeps the diaphragm alive - loss of phrenic nerve - diaphragm is immobilized and will need to be mechanically ventilated
Clinical Manifestations SCI - Cardiovascular injuries above t
- hypotension
- bradycardia because it disrupts sympathetic nervous system Clinical Manifestations SCI - GI
- if the injury is above T5 problems r/t hypomotility
- neurogenic bowel
- T12 or below = decreased sphincter tone; areflexic bowel
- potential for paralytic ileus Neurogenic Shock a state of shock (hypoperfusion) caused by nerve paralysis that sometimes develops from spinal cord injuries (think vasodilation- low BP, low HR) usually t5-t6 effects sympathetic nervous system Spinal Shock physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury. ( not vascular think cord dysfunction)
Diffuse (Concussion) •A sudden transient mechanical head injury with disruption of neural activity and a change in LOC •Brief disruption in LOC •Amnesia •Headache •Short duration Diffuse Axonal •Widespread axonal damage following mild, moderate, or severe traumatic brain injury (TBI) •altered LOC to unconsciousness •increased ICP •Decortication, decerebration •Global cerebral edema basilar skull fracture Fracture at the base of the skull, can cause CSF drainage in nose / ears, ecchymosis behind the ear (battles sign)
- indicates dura has been disrupted halo sign blood stain surrounded by a yellowish stain; highly suggestive of a cerebrospinal fluid leak what should you consider with basilar fractures meningitis
intercerebral hematoma a hematoma located inside the brain usually frontal or temporal, often due to fractures, progressive rapid decline in consciousness subdural hematoma pertaining to below the dura mater, tumor of blood - ipsilateral issues Epidural Hematoma a hematoma located on top of the dura - more dangerous, associated with fractures, bleeds over time rapid rise in ICP and decreased secondary blood flow
- ipsilateral pupil dilation subarachnoid hemorrhage Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates. - results from traumatic injury to vascular structors - sensitivity to light nausea and vomiting - WORST HEADACHE OF MY LIFE The CT scan shows patient has sustained a large epidural hematoma. What is the most concerning complication the nurse needs to watch for? Increased intracranial pressure Cerebral blood flow interruption •Cell death occurs within 5 minutes of interrupted blood flow
- left sided neglect
- spatial perceptual deficits
- tends to deny or minimize problems
- rapid performance short attention span
- impulsive
- impaired judgement
- impaired time conception left brain damage
- paralyzed right side
- impaired speech language (aphasia)
- impaired right-left discrimination
- slow performance, cautious
- aware of deficits, depression, anxiety
- impaired comprehension related to language and math what is the most common stroke ischemic stroke 80% thrombotic stroke type of stroke caused by a blood clot caused by injury blocking an artery in the brain embolic stroke a type of ischemic stroke that causes a clot to travel to the brain, mostly from the left side of the heart
Broca's asphasia production of speech (frontal lobe) Wernicke's aphasia inability to comprehend speech What term describes a compensatory alteration in the diameter of cerebral blood vessels in response to increased intracranial pressure Autoregulation A 20-year-old experiences a severe closed head injury as a result of a motor vehicle accident. Which of the following structures is most likely keeping the patient in a vegetative state (VS)? Brainstem Which does the Glasgow Coma Scale assess? Eye-opening, verbal, and motor responses A patient is experiencing an increase in intracranial pressure. What does this increase result in? Brain tissue hypoxia A patient is admitted to the neurological critical care unit with a severe closed head injury. All four extremities are in rigid extension, the forearms are hyperpronated, and the legs are in plantar extension. How should the nurse chart this condition?
