SN/CVA exam 4 questions

Question 1

how would a patient present with AMD

Answer 1

loss of central vision

Question 2

how would a patient present with glaucoma

Answer 2

peripheral vision loss

Question 3

how would a patient present with cataracts

Answer 3

opacity of lens – can be bilateral or unilateral

Question 4

what medications treat symptoms of glaucoma by lowering IOP

Answer 4

cholinergic
prostaglandin analogs
beta blockers
alpha-adrenergic agonists
carbonic anhydrase inhibitors

Question 5

there is no cure for glaucoma so the medications treat symptoms and prevent ___ ____ _____

Answer 5

optic nerve damage

Question 6

SE/CI of cholinergics

Answer 6

• expire after 2 months at room temp
• tell pt to avoid dimly lit areas
• side effects = pain and blurred vision

Question 7

prostaglandin side effects

Answer 7

darkening of iris

Question 8

beta blocker contraindications

Answer 8

COPD, asthma, heart blocks, bradycardia

Question 9

alpha agonists side effects

Answer 9

redness of eyes, dry mouth, dry nasal passages

Question 10

carbonic inhibitors important infor

Answer 10

avoid with sulfa allergy and watch for electrolyte imbalances

Question 11

signs/symptoms of retinal detachment

Answer 11

Sudden floaters, flashes, blurred vision, reduced peripheral vision, curtain-like shadow over field of view

Question 12

type of conjunctivitis associated with a history of URI

Answer 12

viral (adenovirus, H. simplex)
very contagious!!!

Question 13

how to instill eye drops or ointment for conjunctivitis

Answer 13

Apply drops to inner canthus

Question 14

What side effects can occur with someone who is having cerumen impaction irrigation?

Answer 14

Vertigo/dizziness
Perforation of tympanic membrane

Question 15

what condition can cause tympanic membrane perforation

Answer 15

acute and chronic otitis media

Question 16

Meniere’s disease has what 3 symptoms

Answer 16

vertigo, tinnitus, hearing loss

Question 17

medical treatment for Meniere’s

Answer 17

Antihistamines (Antivert)
Tranquilizers (valium)
Antiemetics (Phenergan)
Diuretics
Shunting of the fluid or vestibular nerve suctioning (surgical)

Question 18

nonmedical treatments for Meniere’s disease

Answer 18

Low salt diet (1000-1500 mg daily)
Increase water intake
Avoid caffeine
Limit alcohol intake
Avoid aspirin and MSG

Question 19

Describe a patient who is at high risk for CVA. Age/race/medical conditions

Answer 19

African American
Male
Over the age of 55
History of HTN
HLP
Diabetes
Atrial fibrillation
Cardiomyopathy
Sickly cell disease
Migraines
Obstructive sleep apnea
Lupus
Rheumatoid arthritis

Question 20

what focused assessments should be performed on a pt who presents with possible CVA

Answer 20

Gag reflex
Respiratory pattern
Blood pressure
Carotid exam
Gross neurological deficits (cranial nerves)
Mental status (sensorium)
NNHS score

Question 21

what imaging study is necessary to diagnose CVA to differentiate between hemorrhagic and ischemic

Answer 21

CT scan – view tissue

Question 22

beneficial diagnostic studies in identifying cause of CVA

Answer 22

MRI – view vessels
carotid ultrasound – carotid bruit/blockage
EKG – AFIB

Question 23

emergent treatment of ischemic stroke

Answer 23

tPA

Question 24

goal of tPA

Answer 24

dissolve clot; restore blood flow to brain regions affected by a stroke

Question 25

what info is needed prior to administering tPA

Answer 25

time of onset of stroke symptoms

Question 26

How often should the patient be reassessed with tPA

Answer 26

every 15 minutes for the first 2 hours

Question 27

complication of tPA

Answer 27

worsening bleeding in the brain

Question 28

patients who CANNOT have tPA

Answer 28

- Symptoms started more than 3 hours ago - INR greater than 1.7 (warfarin) - Previous head trauma/injury less than 3 months ago - CVA less than 3 months ago - GI bleed less than 3 months ago - Pregnant - Hypotension (tPA will lower BP) - Thrombocytopenia - Major surgery less than 14 days prior - Foley catheter, IVs

Question 29

what should the nurse do if the patient could not have tPA and has ICP

Answer 29

mannitol

Question 30

Describe non-emergent medical and management treatment for those who had CVA

Answer 30

Treat the underlying cause of the stroke -- HTN, HLP, AFIB, and alcohol/tobacco use Use anticoagulants and platelet inhibitors for drug tx

Question 31

nursing considerations of post op carotid endarterectomy

Answer 31

Monitor for bruising and edema around the neck and monitor breath sounds Avoid disturbances of the incision Stroke, cranial nerve injury, infection, bleeding Neuro checks to assess for nerve damage as well as possible stroke

Question 32

ischemic stroke symptoms

Answer 32

confusion AMS loss of balance, coordination, dizziness perception disturbances emotional lability/depression inappropriate emotional response (PBA

Question 33

hemorrhagic stroke symptoms

Answer 33

sudden HA N/V sudden LOC seizures nuchal rigidity hemiparesis

Question 34

symptoms of both ischemic and hemorrhagic strokes

Answer 34

Hemiplegia – paralysis Hemiparesis – weakness Dysarthria – difficulty talking Dysphagia – impaired speech Expressive inability Receptive inability Hemianopsia – loss of half of vision field in eye on affected side Apraxia – can’t recall learned skills Agnosia – cant recognize an object

Question 35

4 complications of a hemorrhagic stroke

Answer 35

rebleed hematoma hydrocephalus (ICP) hypoxia

Question 36

nursing interventions rebleed

Answer 36

watch for bleed avoid anticoagulants

Question 37

nursing interventions hematoma

Answer 37

avoid anticoagulants

Question 38

nursing interventions hydrocephalus

Answer 38

CSF drainage ventricular shunt mannitol HOB at 30 degrees avoid hypo/hyperglycemia

Question 39

nursing interventions hypoxia

Answer 39

proper oxygenation/ventilation

Question 40

how to prevent vasospasm after hemorrhagic stroke

Answer 40

control BP with calcium channel blocker or triple h therapy

Question 41

CCB used for vasospasm prevention

Answer 41

Nimodipine (nymalize)

Question 42

what is triple H therapy and why is it used

Answer 42

hypervolemia (fluid volume expanders), induced hypertension, + hemodilution used to avoid hypotension (and hypertension)