Unit 2 Flashcards
(168 cards)
1
Q
Serena Williams, an international tennis star underwent a series of serious health problems. It started in Fall, 2010 when she cut her foot on a piece of glass at a restaurant. She underwent 2 operations to repair the foot. She had limited movement for 20 weeks first with a cast, followed by a walking boot for 10 weeks. In February, 2011 she was hospitalized for pulmonary embolisms (PE) in both lungs.
Which part of Vichow’s triad put Serena at risk for a DVT and PE?
A
vascular wall injury
The most obvious answer is vascular wall injury due to the trauma that incurred that led to her injury and subsequent surgery. Surgery alone causes vascular wall injury. You could also argue for venous stasis due to the immobility that she had for the 20 weeks when she was in a cast.
2
Q
Symptom of a DVT?
erythema at the area of the thrombosis
A
yes
3
Q
Symptom of a DVT?
swelling in one leg
A
yes
4
Q
Symptom of a DVT?
severe pain (10 out of 10)
A
no
5
Q
Symptom of a DVT?
Temp of 100 F
A
no
6
Q
Symptom of a DVT?
maculopapular rash at the area of thrombosis
A
no
7
Q
WBC count of 11,000 cells/mm3
A
yes
8
Q
What is the most serious risk for a patient with a DVT?
A
pulmonary embolism
Patients with a DVT can have all of the items listed (pain, blood thinners, another DVT and a PE). The one with the biggest consequence is a PE, because it can be deadly if is large enough or if there are many PEs. A PE interferes with the ability for gas exchange in the lungs and can result in death.
9
Q
Which of the following patients has the highest risk of developing a DVT?
A
A pt who has a history of having a DVT
10
Q
True or False
A person with a PE can experience extreme shortness of breath, tachycardia, chest pain and a feeling of anxiety.
A
True
A patient has to have a DVT first before a PE develops. A PE is a DVT that has traveled (emboli) to the pulmonary arteries.
Symptoms of a PE include chest pain, fast heart rate, shortness of breathe, feeling of anxiety (or impending doom) and can be deadly if the pulmonary artery occlusion is large enough.
We treat patients with a DVT so that a PE is prevented. (We treat both DVT and PE.)
A way to prevent a DVT is through ambulation.
11
Q
Normal or hypertensive?
89 year old with a BP of 182/90
A
hypertensive
12
Q
Normal or hypertensive?
18 year old with BP of 118/72
A
normal
13
Q
Normal or hypertensive?
72 year old with BP of 145/92
A
Hypertensive
14
Q
Normal or hypertensive?
65 year old with BP of 145/92
A
normal
15
Q
The formula for arterial blood pressure is ____________X peripheral vascular resistance.
A
Cardiac output
Cardiac output X PVR= arterial pressure. You can take it a step further an look at what makes up cardiac output and what influences PVR.
16
Q
Modifiable Hypertension risk factors
A
Tobacco use, obesity, diet low in potassium, excessive alcohol use, oral contraceptive pill use
17
Q
Emily Sparks is a 39-year old female who has end stage renal disease (CKD stage 5) and is on dialysis. She was recently diagnosed with HTN. The nurse recognizes that she most likely has what type of HTN?
A
secondary
Emily most likely has secondary HTN as the end stage kidney disease can lead to HTN since the kidney is not functioning and can not eliminate wastes like it should.
18
Q
True or False
Dysfunction of the sympathetic nervous system, RAAS (renin, angiotensin, aldosterone system) adducin and naturietic peptides can result in increased peripheral vascular resistance and increased blood volume; two main causes of sustained hypertension.
A
True
19
Q
True or False
HTN can lead to blindness
A
True
HTN can lead to retinopathy, which can eventually lead to blindness.
20
Q
True or False
Kidney failure can cause HTN. HTN does not cause kidney failure.
A
False
Kidney failure can cause HTN because of fluid volume overload and HTN can cause nephropathy and increased pressure in the kidney causing dysfunction in the glomerulus and difficulty with filtration.
21
Q
Sustained hypertension for years can lead to ___________in the heart.
A
myocardial infraction, hypertrophy of left ventricle, heart failure, and angina
22
Q
Put the following in order from least pathogenic (1) to the most pathogenic (4).
- fibrous plaque
- fatty streak
- foam cells
- complicated lesion
A
3,2,1,4
The foam cells turn into fatty streaks, which develop into fibrous plaques, which have the potential to become a complicated lesion if the plaque ruptures.
23
Q
True or False
When a patient says “I was told I have 4 vessel occlusion” he is referring to atherosclerosis in his coronary arteries.
A
True
A plaque from atherosclerosis can result in:
1) progressive narrowing of the vessel resulting in occlusion (like in this example)
2) sudden vessel obstruction from plaque hemorrhage or rupture.
3) thrombois and formation of emboli
4) aneurysm formation caused by weak blood vessel walls.
24
Q
A patient complains of angina whenever he takes his morning walk with the dog. He tells his provider that his pain in his chest always come on when he reaches “Elm St”. The provider recognizes what is the underlying pathology in this situation?
A
Stable angina
This situation is characteristic of stable angina, which would be related to a fibrous plaque which is causing a decreased diameter in the blood vessel. It is predictable as the demand on the heart increases, the pain appears.. Stable angina is relieved by rest and/or nitroglycerin.
25
John Jacob Jingleheimer Smidht is a 68 year old male. He presents to the outpatient clinic with complaints of occasional chest pain. He is concerned because his Dad died from heart problems at an early age. He has a history of hypertension and “sugar diabetes” but doesn’t take any medications for them because he doesn’t feel like he needs them. He smokes 1/2 pack a day of cigarettes and has since he was 12 years old. “Hard to quit, when I’ve been doing it for so long”. He was told he needs to watch what he eats as his cholesterol was high the last time it was checked. On physical exam, you note that he is considered “obese” based on his body mass index and he has a waist circumference of 44 inches.
What risk factors does John have for coronary artery disease?
Smoking, cigarettes, family history, diabetes mellitus, high cholesterol
John has a lot of risk factors (smoking, family history, DM, high cholesterol). He does have a 44 inch waist. Most men with a large waist are "apple" shaped. Apple shaped is a higher risk factor for cardiovascular disease than the typical pear shape of women. I know we haven't discussed this yet---teachable moment.
26
True or False
A foam cell is an oxidized LDL (low density lipoprotein) that is consumed by a macrophage. This occurs early in the process of atherosclerosis.
True
27
Which of the following are some core components to atherosclerosis?
Narrowed blood vessels from the buildup of plaque
Behavioral and Genetic factors that lead to endothelial injury
High LDL levels. The LDLs become oxidized.
Plaque disruption can lead to a thrombus or an emboli which could mean a heart attack.
28
True or False
Atherosclerosis occurs only in the coronary arteries of the heart.
False
Atherosclerosis can occur in every blood vessel in the body. Common places are the abdominal aorta, coronary arteries, femoral and popliteal arteries (leads to peripheral arterial disease), carotid arteries and the arteries in the brain.
It is the same process, it just occurs in different part of the body.
29
When a patient develops peripheral arterial disease, are some expected findings?
history of dyslipidemia
shiny, pale skin
reports of intermittent claudication
PAD (peripheral arterial disease) is atherosclerosis in the peripheral arteries of the body.
Risk factors are the same for PAD as they are for coronary artery disease (CAD).
Symptoms include intermittent claudication, diminished or absent pulses, coolness of skin, pallor, and parathesias.
30
If a person assigned female at birth has angina, how might they present?
Extreme fatigue, heavy pain in the chest and down the left arm, shortness of breath, and nausea and heartburn
Typical angina presents as heavy type pain that is steady and centered in the precordial or substernal area with radiation to jaw, shoulder or arm. Anginal equivalents is a description of non-typical presentations of angina which includes dyspnea, diaphoresis, feeling faint/dizzy, extreme fatigue and heartburn.
Those assigned female at birth can present with either.
31
Put the following in the order from the least serious (1) to the most serious (4).
1. STEMI
2. unstable angina
3. non-STEMI
4. stable angina
4,2,3,1
stable angina--unstable angina---non-STEMI (non Q wave MI)-------STEMI (Q wave MI)
32
A patient arrives in the emergency room with chest pain and is diagnosed with a STEMI. Which of the following findings are expected?
increased cardiac enzyme (troponin), EKG changes with ST elevation and eventually a Q wave, and necrosis of the myocardium transmural (from endocardium to epicardium)
33
After _____________[x] minutes without oxygen, the cellular damage to the heart is irreversible.
20
34
A client has been diagnosed as having unstable angina without an MI.
The nurse expects the symptoms of ______based on what pathological occurrence ______ ? The nurse expects ______ of cardiac enzymes like troponin.
chest pain at risk or minimal exertion
Plaque disruption that has caused occlusion of a blood vessel.
no elevation
35
When a myocardial infarction occurs, what has happened?
necrosis of cardiac tissue
Ischemic death of cardiac tissue or necrosis of cardiac tissue occurs with an MI. That part of the cardiac muscle becomes noncontractile, necrotic and scarred leading to further problems.
36
Which of the following are symptoms of an MI?
Intense feeling of anxiety
heavy, constricting chest pain
nausea
suddenly feeling sweaty
shortness of breath
37
What happens to the heart after an MI?
After 2-3 months scar tissue has formed causing contraction and conduction issues.
There are a lot of complications immediately from an MI (chest pain, acidosis, electrolyte imbalances, contraction dysfunction, dysrhythmias and increase catecholemine affects).
After the MI, physiologically there are changes:
6 hours--blue and swollen (think hypoxia)
48 hours--grey with yellow streaks, neutrophils move in
8-10 days-granulation tissue
2-3 months--scar tissue and ventricular remodeling.
38
In heart failure, the heart is likely to be ______, so that the diameter of the heart ______ .
overstretched, decreases
39
The body tries to "fix" the problem of heart failure by compensatory mechanisms. How does the body compensate?
Increased heart rate
increased sympathetic nerve impulses
release of renin and aldosterone
The body tries a lot of compensatory mechanisms without any improvement. Strategies include: activating RAAS (water and Na retention), increased HR, increased peripheral vascular resistance.
40
Systolic heart failure, the heart has a problem with _____ . As a result, the ejection fraction ______ . A normal ejection fraction (EF) is 65%.
ejection, decreases
41
What is an example of high output heart failure?
Severe anemia
High output heat failure is not very common. Examples include severe anemia and thyrotoxicosis. Low output heart failure is much more common.
42
Left or right heart failure symptom?
cough of pink frothy sputum
left
43
Left or right heart failure symptom?
2+ ankle edema
right
44
Left or right heart failure symptom?
shortness of breath
left
45
Left or right heart failure symptom?
paroxysmal nocturnal dyspnea
left
46
Left or right heart failure symptom?
anorexia
right
47
Left or right heart failure symptom?
weight gain of 3 lbs overnight
right
48
Left or right heart failure symptom?
orthopnea
left
49
Left or right heart failure symptom?
dyspnea on exertion
left
50
Left or right heart failure symptom?
hepatomegaly
right
51
Which two pieces of information would be most important to know about a patient being admitted with heart failure?
BNP levels and ejection fraction
BNP is used for diagnosis of heart failure. The higher the number the worse the clinical situation. A BNP of 500 is diagnostic.
The EF of a patient tells you how decompensated their heart function is and gives a good idea of severity of the illness.
52
True or False
A person who develops heart failure may have symptoms that are more indicative of failure on one side (right or left) but eventually will develop symptoms of both right and left sided heart failure.
True
53
Which symptoms would the nurse expect to see in a patient with predominately right-sided heart failure?
loss of appetite or getting full easily
swollen feet and ankles
Signs of systemic congestion are much more common with right-sided heart failure and can include lower extremity edema, organ congestion (hepatomegaly) which can lead to abdominal fullness and anorexia and also jugular vein distention.
Pulmonary symptoms are much more common with left-sided heart failure (shortness of breath, PND, orthopnea, pink frothy sputum, crackles in the lungs).
54
After an automobile accident a client who is unconscious and exhibiting decerebrate posturing is brought to the emergency department. When assessing the client, what does the nurse expect to observe?
Hyperextension of both the upper and lower extremities
Decorticate: inward
flexion of the arms, wrists, fingers with adduction of the upper extremities, internal rotation and plantar flexion of the LE.
Decerebrate: outward
results from increased muscle excitability. Rigidity of the arms with the palms of the hands turned away from the body and the stiffly extended legs with plantar flexion of the feet.
Both are POOR PROGNOSTIC SIGNS—usually happens in stage IV.
55
A client is having a brain attack (CVA) is brought to the emergency department. The vital signs are P 78, R 16, BP 120/80. The change in this client’s vital signs that indicates increasing intracranial pressure (ICP) requiring notification of the practitioner is:
Pulse 50, Resp 20, BP 140/40
In stage 3, as the brain is beginning decompensation, vital signs start to change. Remember Cushing’s Triad: Increased systolic BP (up to 270 mmHg) with widened pulse pressure; irregular respirations and bradycardia. Widened pulse pressure is the difference between the systolic BP and the diastolic BP. Bradycardia occurs in a compensatory response because of the extremely elevated BP.
56
Initially after a brain attack (CVA), a client’s pupils are equal and reactive to light. Later the nurse assesses that the right pupil is reacting more slowly than the left and the systolic blood pressure is beginning to increase. The nurse concludes that these signs are suggestive of:
Increased intracranial pressure
In stage 3, pupillary changes start to occur. Initially the pupils are slower to react or react differently from each other. They then progress to pinpoint size. In stage 4, one pupil becomes dilated and one is pinpoint then eventually both are dilated (usually called fixed and blown by practitioners). Systolic BP starts to rise in stage 3.
57
The nurse is caring for a client with increased intracranial pressure. Which of the following assessment findings should the nurse report immediately?
Absence of pupillary response
Absence of pupillary response is always an abnormal finding and in someone with suspected IICP, this should be reported immediately. Vomiting tends to happen early, but it is usually not accompanied by nausea and tends to be projectile in nature.
58
When increased intracranial pressure occurs in the brain, what is the relationship between ICP and arterial pressure?
ICP = arterial pressure
impacts blood flow and the exchange of oxygen. This first starts to happen in stage 3.
59
Which of the following is options describe normal statements regarding intracranial pressure?
The first state of increased ICP, the body is able to compensate by displacing CSF and if often not even noticable.
Normal ICP is less than 15 mmgHg (5-15 mmHg is normal for testing purposes).
A decrease in level of consciousness is the earliest and most reliable sign of increased intracranial pressure.
The body compensates first by displacing CSF and is often not even noticeable.
During ICP, there is massive vasoconstriction to the point where the ICP equals the arterial pressure. Remember there is a increased blood pressure with a widened pulse pressure. Example 180/60 blood pressure.
60
A client with a head injury is admitted to the nursing unit. The following is found on physical assessment:
BP 180/50, pulse 48 beats per minute. Client opens eyes but does not respond verbally. The pupils are slow to respond to light. The breathing is irregular in pattern and the client has decorticate posturing.
What is this client most at risk for?
Brain Herniation
This patient is very advanced in displaying signs of IICP and is very high risk of brain herniation if it has not happened already. The patient is in stage 3 and looks like they are moving toward stage 4 where herniation occurs.
61
A ____ is an acute focal neurological deficit from an interruption of blood flow in a cerebral vessel due to thrombi or emboli or bleeding into the brain.
Stroke
A TIA can be described as a brief period of inadequate cerebral blood flow that has neurological deficits that usually resolve within hours (lasts no longer than 24 hours) and can be caused by platelets accumulating at the site of a thrombosis or from vasospasm.
62
The nurse is admitting a client diagnosed to have a CVA involving left-brain damage. The nurse is told that the patient has aphasia. What does this mean?
Difficulty either understanding what is said to them or difficulty in speaking
63
Which of the following factors put someone at increased risk for having a cerebral vascular accident (CVA)?
African Americans
Blood pressure readings consistently running 160/90 - 180/90
Alcohol use disorder
Afib
diabetes mellitus
64
What pathological changes occur with a stroke?
creation of a necrotic core surrounded by a prenumbra
cerebral edema
creation of lactic acid from anaerobic metabolism
65
A client is admitted with a hemorrhagic stoke. What does this mean?
The client had a cerebral artery rupture that led to bleeding
66
What is a common cause of an embolic stroke?
Afib
67
True or False
A person who has a seizure disorder always has convulsions. True or False
False
People with convulsions have seizures, but not all seizures have motor activity like convulsions.
68
Define absence seizure
Client has no movement, staring off and is not responsive to stimuli.
69
Define myoclonus
Brief muscle twitching of one part of the body. Often seen with a focal seizure.
70
Define status epilepticus
Seizure that is prolonged or lasts more than 5 minutes
71
Define Atonic
Person loose muscle control, muscles are weak or limp and ther person falls to the ground during a seizure.
72
What term would we use to call her experience of smelling "burnt toast"?
aura
73
What are some common etiologies (causes) of seizure disorders?
hypoglycemia, substance use disorder, epilepsy, stroke, and head injury
There can be a lot of causes of seizures:
unknown which is referred to as epilepsy as well as many secondary causes such as brain lesions, head injury, substance use disorder, metabolic imbalances, stroke, environmental stimuli, infections, Alzheimer's disease, etc.
74
The nurse is concerned about a patient presenting to the emergency room who has been seizing for 20 minutes and is in status epilepticus. The nurse expects which of the following findings in this patient?
Acidosis
In status epilepticus the patient doesn't have normal respiration. It can lead to hypoxia, increased pCO2 and respiratory acidosis. This can eventually lead to severe brain damage and death. I mentioned metabolic acidosis in the recording, which eventually happens with prolonged seizing.
75
True or false
All Alzheimer's disease is hereditary
False
Early onset Alzheimer's disease (diagnosed before the age of 50) has an inheritable genetic component, but this has not been found in all individuals with Alzheimer's disease.
76
which component of the Alzheimer's pathology has the greatest significance and therefore the subject of new drug therapy strategies?
abnormal tau proteins
The presence of abnormal tau is where the focus is. There is a great statement by one of the researchers. Amyloid plaque pulls the trigger and tau protein is the bullet in the gun.
77
Dementia or Delirium?
Patient becomes confused after being admitted to the hospital for hip surgery after falling at home.
Delirium
78
Dementia or delirium?
Family notices that the patient is becoming more and more forgetful. He went to the grocery store and got lost coming home
Dementia
79
Dementia or Delirium?
The patient was fine last week and now is hallucinating and seeing bugs crawling on the walls.
Delirium
80
Dementia or delirium?
This problem is non-curable and will eventually result in the patient being bed-bound and requiring total care.
Dementia
81
A nurse is performing the history and physical examination on a patient with Parkinson’s disease. Which assessments identified by the nurse support this diagnosis?
Low pitched monotonous voice, masklike facial expression, and nonintentional tremors
82
Alzheimer's disease, which is the most common type of dementia involves which of the following pathophysiological features?
apolipoprotien E4 mutation, presence of beta-amyloid plaques and neurofibrillary tangles made of tau, and decrease in acetylcholine
The presence of the apolipoprotien E4 mutation may be present, but is not always present in individuals with Alzheimer's disease.
83
The client with Parkinson’s disease has a nursing diagnosis of Risk for Falls, related to an abnormal gait documented in the nursing care plan. The nurse assesses the client, expecting to observe which type of gait?
Shuffling and propulsive
84
Define bradykinesia
Slow, shuffling gait related to excessive inhibition of movement; difficulty initiating movements
85
What are cog wheel movements?
Ratchet-like movements of arms; a form of rigidity
86
What is a mask like face?
Lack of facial expression
87
Define dysphagia
Difficulty swallowing
88
Excessive sweating, salivation (with drooling), lacrimation, constipation, and impotence is defined as what?
Autonomic manifestations
89
In Parkinson's disease there is a lack of _____ being made by the substantia nigra of the basal ganglia. The symptoms result from acetylcholine not having an opposing neurotransmitter resulting in jerky movements.
dopamine
90
What are the two pathophysiological processes that occur with Parkinson's disease?
accumulation of alpha-synuclein protein in the form of Lewy bodies and loss of dopamine
We focused primarily on dopamine loss but we also know that there is an accumulation of alpha-synuclein protein in the brainstem, spinal cord and brain.
91
What are the cardinal symptoms of Parkinson's disease
bradykinesia, rigid movement, tremor at rest, postural/gait instability
92
The two hallmark events that occur when a patient is having an asthma attack is:
Bronchoconstriction and inflammation
93
True or false
Uncontrolled asthma with frequent attacks can lead to long term bronchial remodeling and chronic obstructive pulmonary disease (COPD).
True
This happens is a small population of people with asthma.
94
Which of the following situations is ominous and is the worse case scenario of a patient with asthma?
patient with a silent chest (no wheezing) and a pCO2 of 70 mmHg
Normal symptoms of asthma attack include wheezing, dyspnea, chest tightness, tachypnea, tachycardia, anxiety, cough and accessory muscle use (intercostal muscle retractions). When they are hyperventilating, they are more prone to respiratory alkalosis, but when they tire out and their respirations slow down, they retain pCO2 can become acidotic. At that point, they are not moving air at all and their chest becomes silent (no breath sounds). Bad sign. Remember that people die from asthma attacks every day and we need to act quickly and recognize a serious condition.
95
Chronic Bronchitis or Emphysema?
Patient has productive cough with a lot of thick tenacious sputum
Chronic bronchitis
96
Chronic Bronchitis or Emphysema?
Respiratory rate on the low side (12-14/min)
Chronic bronchitis
97
Chronic Bronchitis or Emphysema?
Works hard to breathe with higher respiratory rate (24/min) and pursed lip breathing
Emphysema
98
Chronic Bronchitis or Emphysema?
Greater Ventilation/perfusion mismatch (VQ) resulting in more hypoxemia
Chronic bronchitis
99
Chronic Bronchitis or Emphysema?
Barrel chested
Emphysema
100
Chronic Bronchitis or Emphysema?
thin, low weight individual
Emphysema
101
Chronic Bronchitis or Emphysema?
cyanosis common
Chronic bronchitis
102
Chronic Bronchitis or Emphysema?
Assumes the tripod position to help breating
Emphysema
103
Both emphysema and chronic bronchitis can result from cigarette smoking, but
_______ can be from a genetic deficiency in alpha-1 antitrypsin. In ___________hypertrophy of mucus glands, globlet cells and airway epithelium occurs. In
________ there is a last of elastin either from inflammatory cells (from cigarette smoking) or from lack of alpha-1 antitripsin. As patient with COPD advances, patients start to lose their normal respiratory drive that occurs from high pCO2 levels, so we have to be careful when giving them oxygen.
Emphysema, chronic bronchitis, emphysema
Both emphysema and chronic bronchitis can result from cigarette smoking, but emphysema can be from a genetic deficiency in alpha-1 antitrypsin. In chronic bronchitis, hypertrophy of mucus glands, globlet cells and airway epithelium occurs. In emphysema there is a last of elastin either from inflammatory cells (from cigarette smoking) or from lack of alpha-1 antitripsin. As patient with COPD advances, patients start to lose their normal respiratory drive that occurs from high pCO2 levels, so we have to be careful when giving them oxygen.
104
What is Dead air space?
Situation where there is adequate ventilation, but poor perfusion (Ex: pulmonary embolism)
105
What is a shunt?
Situation where there is adequate perfusion, but not ventilation (Ex:pneumonia, COPD)
106
Define hypoxemia
Reduced oxygen in arterial blood
107
Define hypoxia
decreased oxygen of cells in the tissues (could be related to problems with oxygenation, anemia or necrosis)
108
Define hypercapnia
increased levels of carbon dioxide in the blood
109
Define oxyhemoglobin dissociation curve
The ease that hemoglobin gives up oxygen and accepts carbon dioxide. (Ex: state of acidosis, hgb has decreased affinity for picking up oxygen).
110
A patient is diagnosed with right lower lobe pneumonia, which is a type of _________pneumonia. Pneumonia is most often caused by
__________, but can also be caused by injurious agents like smoke, aspiration of gastric contents or respiratory suctioning. A patient who develops pneumonia in the hospital is said to have ________ pneumonia. This type of pneumonia is 90% of the time bacterial in origin and multi-drug resistant.
Lobar pneumonia, S. pneumoniae, nosocomial pneumonia
lobar: consolidation in a part of all of the lung of a lobe.
bronchopneumonia: patchy consolidation involving more than one lobe of the lung
S.pneumoniae is the most common infectious agent. Pneumonia can be cause by bacteria, viruses and fungi.
Community acquired pneumonia is referring to the types of organisms that are most often found in the community versus the hospital or nursing home.
Nosocomial refers to hospital acquired pneumonia and infections occur after 48 hours in the hospital and are usually bacterial and antibiotic resistant. VAP=ventilator associated pneumonia is an example.
111
Why do patients with pneumonia have compromised gas exchange?
Inflammatory process leads to the accumulation of WBCs, causes capillary leak, edema and exudate in the alveoli.
These fluids collect in and around the alveoli and the alveolar walls thicken. Both events seriously reduce gas exchange and lead to hypoxemia interfering with oxygenation and tissue perfusion.
112
The nurse recognizes which of the following as symptoms of pneumonia?
Resp 28/min, cough with productive purulent sputum, and pleuritic chest pain
113
True or False
A person presents to the health department because she finds out that she was exposed to a person with active TB infection one week ago and is afraid that she has TB. The nurse correctly expects her purified protein derivative (ppd) test to be greater than 15mm in induration.
False
It takes time for the cellular immunity to kick in and mount a positive antibody response to this exposure (remember Hypersensitivity Type IV). This can take up to 10 weeks to happen and at the earliest is 2 weeks. Once that time has passed, her ppd should be positive. If she was a healthy individual with no known TB contacts, greater than 15 mm in induration would be considered positive. Because she had contact with a known active TB case, then greater than 5 mm induration is considered positive.
114
When the tuberculosis bacilli enter the lungs, the body responds by:
phagocytes and macrophages engulf the bacilli and eventually wall it off by forming a granuloma. As the inside macrophages in granuloma die off, it develops a caseous (cheese like consistency) necrosis and it eventually forms a ghon complex, which can be seen on X-ray.
115
True or False
TB is only found in the lungs.
False
TB is primarily a pulmonary infection, but can be found in lots of different areas in the body, such as the brain, prostate, intestine, etc.
116
Which of the following individuals has active TB and is infectious?
positive ppd and positive sptutum culture and has had a 10 lb weight loss, chronic cough and low grade fevers in the afternoon.
117
According to the Monro-Kellie hypothesis, if there is an increase in brain tissue, then what will occur in response as a means of compensation?
The blood volume and the CSP displace to accommodate the increased tissue volume.
118
If a patient has IICP stage 3, the nurse expects what change in vital signs?
Blood pressure of 210/120 mmHg
There is an increase in the pulse pressure. The systolic blood pressure goes up in an attempt to perfuse the brain and the systolic pressure is lower.
119
Which of the following symptoms should be reported to the provider for a patient with a head injury from playing football?
Patient's conversation is not making sense.
120
If a baby has increased ICP, what might the nurse see?
bulging fontanelles
121
If a patient with IICP is having some strange positioning of the body with the flexion of extremities inward. What does this mean?
The patient is in stage 4 (herniation).
122
A patient has stroke that comes on all of a sudden and cuts off blood supply to the brain. The patient has a history of irregular heart rhythm (atrial fibrillation). This patient most likely had what type of stroke?
Stroke from an emboli
Atrial fibrillation causes turbulent blood flow in the heart leading to the formation of clots in the heart. The clots can travel (emboli).
123
A patient is having symptoms of a stroke. The patient reports the stroke symptoms came on suddenly and started with a very bad headache. This is most likely what type of stroke?
hemorrhagic stroke
124
A patient had a TIA. Which statement by the patient needs further clarification?
Since all my symptoms went away, I am no longer at risk for a stroke.
124
Which patient is most at risk for a stroke?
A 70-year-old man with a 10-year history of diabetes and hypertension.
125
A patient came to the ED with a new onset CVA and underwent diagnostic testing that identified the area of the prenumbra. The nurse understands the significance of this as being:
If blood can be re-perfused to the prenumbra, this area of the brain can be saved from necrosis.
126
A nursing student sees a person at Ingles who he suspects is having a stroke. Which of the following symptoms are suspicious of a stroke?
Inability to pick up a grocery bag, uneven smile, garbled speech, and arm drift
127
A patient is said to have hemiparesis. What does this mean?
weakness on one side of the body
128
When a stroke occurs, the nurse recognizes that the lack of perfusion causes which of the following pathophysiological changes?
Tissue injury from free radical formation and toxic metabolites build up.
Failure of the Na/K pump which results in cellular swelling and damage.
Localized acidosis due to lactic acid production that occurred from anaerobic metabolism.
129
Which of the following statements is TRUE regarding the symptoms of a stroke?
The symptoms of a stroke are based on which artery has occlusion of blood flow.
130
What does it mean if a patient has ipsilateral pupil dilation?
One pupil is large and the other one is small, and they don’t change with light.
131
The nurse is caring for a patient in stage 4 IICP. What does the nurse expect to see?
Decerebrate posturing and Cheyne-Stokes breathing
132
A patient has a seizure for the first time. What is the next step?`
Investigate any possible causes for the seizure.
Seizures can be primary (epilespsy) and have an unknown cause or can be secondary to something else. It is important to figure out why the person had the seizure and treat the cause first.
133
The nurse is caring for a patient with a seizure disorder. What is a helpful question to ask the patient to help the nurse plan the care for this patient?
Do you have some type of aura before your seizures?
This is helpful for the nurse to know, so if the patient relays that he/she is having the aura (seeing, smelling or hearing something) then the nurse can prepare for the seizure and try to make sure the patient is safe. Just like in the video of “burnt toast” the man jumps in and catches her before she hits her head on the ground.
134
If a patient is diagnosed as having a “focal” seizure, what does the nurse understand this to mean?
One side of the brain is affected.
Focal means one side of the brain; generalized means both sides of the brain are involved.
135
A patient is determined to have a secondary seizure. Which of the following things can cause a seizure?
Low blood sugar, Na level of 120 mEq/L, glioblastoma, overexhaustion, and CVA
136
A patient is in status epilepticus. What complication is expected?
hypotension
137
What is the most common type of dementia?
Alzheimer's
138
What are the two essential pathologies related to Alzheimer’s disease?
Tau and amyloid
Amyloid plaque pulls the trigger and tau protein is the bullet in the gun
139
Which tends to occur first in Alzheimer’s pathology?
Amyloid plaques
The plaques tend to happen before the tangles.
140
What neurotransmitter is found in low levels in the brain with Alzheimer’s?
acetylcholine
This is because there is an enzyme (choline acetyltransferase) that results in a decrease in the amount of acetylcholine that is available.
141
What seems to be the cause in people who have early onset Alzheimer’s?
Genetics
142
One of the symptoms of Alzheimer’s disease is “sundown syndrome”. What is this?
increased confusion in the evening and night and clearer congnition during the day
143
Which of the following individuals would be considered “delirious”?
A patient with acute confusion after being admitted to the hospital.
144
A patient has Parkinson’s disease. The nurse recognizes that this patient should have what 3 cardinal symptoms?
Tremor at rest, shuffling gait, rigid movements
145
Manipulation of what neurotransmitters are helpful to improve symptoms of Parkinson’s disease?
Increase dopamine and decrease acetylcholine
146
Which symptom is common with Parkinson’s disease
masklike face, uncontrolled sweating and salivating, and short shuffling gait
147
Which of the following describes what occurs with a seizure?
One or more parts of the brain becomes hyperexitable.
148
What are typical clinical presentations of someone with dementia
Wandering or getting lost, Apraxia-difficulty performing familiar tasks such as getting dressed, Difficulty with abstract thinking, Difficulty with remembering to eat, Rapid mood changes such as becoming paranoid or scared for no apparent reason.
149
What is one of the most consistent risk factors for delirium?
dementia
150
If gas exchange occurs in the alveoli, which of the following can impact gas exchange?
pulmonary embolism, pneumonia, viral bronchitis, and pulmonary edema
151
If a pulmonary embolism occurs, which definition best fits?
Ventilation without perfusion
152
A patient has a high level of carbon dioxide on their ABG. What is this called?
Hypercapnia
153
If a patient lives in a nursing home and gets pneumonia, what is this called?
community acquired pneumonia
There is not enough information in this stem to classify it any differently than just community acquired pneumonia.
154
A patient is coughing up sputum that is thick and white in nature. The nurse understands what is in the sputum?
Inflammatory cells that have phagocytized the invader
155
A patient has a RLL infiltrate. What does that mean?
The patient has pneumonia in his right lower lobe of the lung.
156
What are expected symptoms in a patient with pneumonia?
cough, sputum production, fever, and pleuritic chest pain
157
A patient tells you that he is “dyspneic” What does that mean?
short of breath
158
A patient with active TB is admitted to the hospital. What type of isolation should he be placed on?
airborne
159
How do we know that cellular immunity has started working in someone infected with TB?
They have a positive PPD test.
Cellular immunity helps to contain the bacilli in the lungs but it takes 2-10 weeks for this to occur. The production of antibodies against TB is what is seen with the positive PPD.
160
The body works to contain a TB infection by forming a:
Granuloma
161
A person has been exposed to someone with TB and gets infected. What is most likely going to happen?
latent TB infection
Most individual’s immune system can contain the infection and they don’t develop active disease. Only 5% develop active disease. More likely in those with an immune system that is not fully functioning (HIV, AIDS, young, old, sickly).
162
Which of the following individuals who has latent TB is at risk of having reactivated TB?
HIV positive, 80 years old, and a Patient with rhuematoid arthritis who is on a TNF-alpha drug
163
A patient received the BCG vaccination as a child. Which screening test is recommended for this patient to determine TB infection?
Quantiferon Gold blood test
164
When a granuloma forms, what happens to the TB bacilli?
The bacilli become dormant
165
What distinguishes asthma from COPD?
Asthma is a reversible lung disorder that is often triggered by an allergen.
166
Which of the following would have the most VQ mismatch and therefore would have greater cyanosis?
Patient with primarily chronic bronchitis
167
Which of the following symptoms are seen with patients with COPD with primarily emphysema symptoms?
Prolonged expiration, barrel chested, and pursed lip breathing
