Critical Care Exam Iii

Front 1

An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical psychosocial and spiritual

Back 1

Palliative Care

Front 2

What is the Goal of Palliative Care

Back 2

To prevent and relieve suffering, To support the best quality of life. Regardless of Age, Stage of disease.

Front 3

An RN assisting with Palliative Care needs a High knowledge of Pain & Symptom Control, True or False

Back 3

True

Front 4

List the four psycho social components of Suffering

Back 4

Physical, Emotional, Spiritual & Psychosocial

Front 5

List two things that are ways to provide effective care for a dying individual

Back 5

Adequate knowledge base & Attitude or Behavior

Front 6

When a RN is assisting a PT with the dying process does this palliative care RN need to understand Death is a natural part of life? True or False

Back 6

True this falls under attitude

Front 7

True or False Transfusions can be a part of Palliative care

Back 7

True

Front 8

Ventilation is part of Palliative Care True or False

Back 8

False Generally not Palliative

Front 9

Control of Dyspnea is Palliative Care True or False

Back 9

True

Front 10

Providing Emotional and Spiritual Support is reflective of Palliative Care True or False

Back 10

True

Front 11

Assisting with CPR is an important Palliative Care function True or False

Back 11

False Generally not Palliative

Front 12

Controlling Nausea and Vomiting is a function of Palliative Care True or False

Back 12

True

Front 13

What is the #1 Problem in having the Necessary conversation

Back 13

Silence

Front 14

A Palliative Care RN should always have these two P’s in Mind

Back 14

Perceptive regarding change & Proactive in communication with family.

Front 15

List the following challenges in the Final Days

Back 15

Functional decline in ADLs, Loss of Appetite, Can’t Swallow, Increased Discomfort, Sleeping more, Confusion, Concern for family and friends

Front 16

A PT has become restless in his final days, what type of medication can the RN give

Back 16

Benzodiazepine

Front 17

This type of medication is given to Palliative Care PT with Pain or with Dyspnea….what is

Back 17

Opioid

Front 18

A family member asks if the Opioids are contributing to the dying process, the best response by the RN is, A. with excessive opioid dosing we would see pinpoint pupils, B. the patient would code or C. gradual slowing of respiratory rate

Back 18

A & C

Front 19

List the three types of breathing patterns most common in the final hours

Back 19

Cheyne-Stokes, Rapid Shallow, Agonla /Ataxic

Front 20

Absence of brain stem reflexes is a criteria used to establish brain death True or False

Back 20

True

Front 21

Corneal and Cold Calorics is a test to establish what in healthcare

Back 21

Brain Death

Front 22

The proper term for Life Support is

Back 22

Mechanical Ventilation

Front 23

AND is an acronym for

Back 23

A Natural Death

Front 24

True or False A Living Will, Durable Power of Attorney and a Lien Release are Advanced Directives

Back 24

False on the Living Will & DPOA

Front 25

Which State in the USA has made Assisted Suicide Legal

Back 25

Oregon

Front 26

As a Palliative RN what is most important for the remaining family members

Back 26

Resources for Support in the Community and Referral Groups.

Front 27

CT stand for

Back 27

Computed Tomography

Front 28

True or False a CT can be done with or without contrast

Back 28

True

Front 29

When using Contrast what is the primary function of the RN, r/t patient care

Back 29

Check for Shellfish/ Iodine Allergy

Front 30

When assisting with a LP the RN knows the doctor will insert the needle at ________ th lumbar vertebrae into the subarachoind space

Back 30

3-5th LV

Front 31

This is contraindicated with ICP, what is

Back 31

Lumbar Puncture

Front 32

After a LP how long will the patient have to remain prone

Back 32

2-3hours

Front 33

What is the number one reported complication with LP

Back 33

Headache

Front 34

The RN is treating a PT for Complication with LP. The RN can administer which of the following Fluid Replacement, Analgesic, Blood Patch

Back 34

Fluid Replacement, Analgesic Only Dr. must do Blood Patch.

Front 35

How much of the cardiac output is needed for Brain function ___________%?

Back 35

15-20%

Front 36

What percent of the blood glucose is used by the brain ______%

Back 36

20%

Front 37

True or False An RN completes a Neuro assessment he has checked the following LOC, Motor, Pupillary Reflexes, VS & I/O

Back 37

False , everything except I/O, this not a part of Neuro assessment

Front 38

What is the highest GCS (Glasgow Coma Scale) Score

Back 38

15

Front 39

List the important pupillary features of the eye assessment

Back 39

Size, Shape, Reaction to light, Comparison of one pupil to the other.

Front 40

Cranial Never V is the

Back 40

Corneal Reflex

Front 41

Explain Cold Calorics

Back 41

small amount of cold water placed in the inner ear canal

Front 42

What is the reaction that should occur with cold calorics if the PT is in a coma

Back 42

Both eyes tonically deviate toward the cold water.

Front 43

What is the reaction that should occur with cold calorics if the PT has a brain injury or death

Back 43

The eyes should move away from the cold water and slowly back

Front 44

True or False In motor function symmetry is the most important factor

Back 44

True

Front 45

An individual arrives in the ED with sleep awake cycles, arousal but no interaction with environment & no local response to pain. This PT GCS is <3, what is the state Moderate, Severe, Vegetative

Back 45

Vegetative State Less then 3

Front 46

PT is in a coma

Back 46

unconscious state. No meaningful response, no voluntary activity, PT state is Moderate, Severe, Vegetative

Front 47

If my PT has one pupil that is larger than the other she has ______________/

Back 47

Anisocoria

Front 48

__________ posture results from damage to the upper brain stem. In this posture the arms are abducted and extended with the wrist pronated and the fingers flexed. The legs are stiffly extended with plantar flexion of the feet

Back 48

Decerebrate

Front 49

Brain’s ability to change the diameter of blood vessels to maintain cerebral blood flow is __________?

Back 49

Autoregulation

Front 50

A patient presents with edema and swelling of the optic nerve this is called

Back 50

Papilledema

Front 51

What are the three classic signs of Cushing’s Triad

Back 51

Bradycardia, Hypertension, Bradypnea seen with pressure on the medulla as a result of brain stem herniation

Front 52

How often should Neuro, LOC & GCS check be completed by the RN

Back 52

Every Hour

Front 53

What are some situations related to PT care that increase ICP

Back 53

Suctioning, Turning, Bathing, Head Flexion, Valsalva Manuever

Front 54

True or False a DO NOT MOVE PATIENT sign should be posted on the door of the Patients room with an EVD

Back 54

True

Front 55

True or False The EVD and Lumbar Drain both have a leveling point of (0) zero?

Back 55

False The EVD has a leveling point of zero, Lumbar Drain has no leveling reference point.

Front 56

As an RN if I wish to Drive CPP through manipulation of ICP what can I use

Back 56

Vasopressors, Fluids, CSF Drain.

Front 57

What steps/elements can I take or use as the RN to minimize the increase of ICP

Back 57

Sedation, Opiates, barbiturates, propofol, Osmotic Agents, Ventriculostomy, Positioning, Paralytics

Front 58

If I use a Sedation/or Paralytic to assisted my PT with increased ICP what mechanized can I used to measure the level of sedation

Back 58

Train of Four looking for 2-3 impulses

Front 59

LICOX Catheter measures what two things

Back 59

Temperature & Oxygen Level

Front 60

What is the normal range for PbtO2 (brain tissue oxygen)

Back 60

20-40mm Hg

Front 61

True or False Hypoxia, Decreased ICP, Decreased Temp & Decreased CPP/MAP all Decreased Brain O2

Back 61

False Hypoxia, Increased ICP, Increased Temp & Decreased CPP/MAPP drive a decreased in Brain O2

Front 62

Barbiturates decrease or increase the need for O2 to the brain

Back 62

Decrease

Front 63

True or False Hypoxia is bad for the brain

Back 63

True

Front 64

List commonly used vasopressors

Back 64

Dopamine, Norepinephrine, Nesoynephrine, Vasopressin

Front 65

Intubation occurs when an individual has a GCS of ________

Back 65

< or = 8

Front 66

What is the desired temperature for a PT with ICP

Back 66

Normothermia

Front 67

True of False Increased PEEP in an ICP PT will Incr. cardiac output, Incr. vent , Incr. ICP.

Back 67

True

Front 68

EBP provides results that indicate if early gut feedings are started the risk for __________is decreased

Back 68

Sepsis

Front 69

A PT has just come from ED a Dx of Dehydration. You have an order for fluids and an order for vasopressors. When will it be safe for the RN to begin Administration of the vasopressin? ASAP before any other activity or after the PT has received adequate hydration

Back 69

After the PT has received adequate hydration

Front 70

Increased Temp & increased metabolic rate also increases _____ _________ consumption

Back 70

brain oxygen

Front 71

The PT in Neuro has begun to shiver, the RN knows this is not good for the PT what action can she take

Back 71

Meds: Acetaminphen, Mag Sulfate, Meperidine, Sedation, Neuromuscular Blockade

Front 72

A PT presents “Too Wet” with decreased urine output, wt gain, confusion, NA <135, SIADH is the primary root cause. True or False

Back 72

True

Front 73

Tx for SIADH is

Back 73

Restrict Fluids, Pitressin, Diuretics, Serum Osmolarity,

Front 74

A MICU PT is on the Vent his eyes are partially closed how can the RN prevent injury

Back 74

Tape eye closed, provide eye drops, provide ointment.

Front 75

What is needed every 2 hours to prevent VAP

Back 75

Oral Care

Front 76

How do RN’s prevent DVT

Back 76

Heprin Drip or Lovenox Injections

Front 77

An opening of the skull is

Back 77

Craniotomy

Front 78

An excision of a portion of the skull is

Back 78

Craniectomy

Front 79

A Repair of a cranial defect using a plastic or metal plate is

Back 79

Crainoplasty

Front 80

Circular opening are known as

Back 80

Burr Holes

Front 81

Infratentorial Cranial Surgery PT has returned PCAU for recovery what is key related PT positioning? The HOB should be at what degree

Back 81

The HOB should not be elevated, allow PT to lie flat

Front 82

This cranial approach is usually used for pituitary surgery what is _________________?

Back 82

Transphenoidal

Front 83

Ceberal edema peaks at which timeframe post intracranial surgery 12, 24, 48, 72 hours

Back 83

24 Hours

Front 84

A patient with a neurologic disorder is at risk for disuse syndrome due to musculoskeletal inactivity and neuro impairment. Which nursing intervention facilitates function, Repositioning or Keep body in neutral position

Back 84

Keep Body in Neutral Position

Front 85

What is Colnus

Back 85

Colnus occurs when the foot is abruptly dorsiflexed

Front 86

Which of the following terms refers to difficulty reading Agnosia or Alexia

Back 86

Alexia

Front 87

Bleeding between the dura mater and the arachoid membrane is Epidural, Subdural, Extradural

Back 87

Subdural Hematoma

Front 88

What is bleeding between the inner skull and the dura, compressing the brain underneath

Back 88

Epidural Hematoma

Front 89

What is the term for weakness in both legs and the lower part of the trunk

Back 89

Paraparesis

Front 90

A GCS of less then & is generally interpreted as

Back 90

COMA

Front 91

True or False The use of cocaine can cause insults and abnormalities most common causes of ischemic stroke?

Back 91

True

Front 92

Which of the following is an approaching sing of death

Back 92

Irregular breathing pattern

Front 93

What are the following immediate complications with a spinal cord injury Respiratory Arrest, Paralegia, Spinal Shock

Back 93

Respiratory Arrest, & Spinal Shock

Front 94

Homonymous hemianopsia refers to

Back 94

blindness in the right or left halves of the visual field of both eyes

Front 95

What is the normal ICP pressure _____ - _____ mmHg

Back 95

10-20mmHg

Front 96

True or False the Aura of a migraine headache usually last less than an hour

Back 96

True

Front 97

A posttraumatic sz generally occur 1-2 days, 1-4 days, 1-7 days after the event

Back 97

1-7 days of injury

Front 98

A type of comprehensive care for patients whose disease is not responsive to cure is

Back 98

Palliative Care

Front 99

Aneurysm rebleeding occurs most frequently during which timeframe after the initial hemorrhage, 48 hours, first week, , first 2 weeks

Back 99

First 2 Weeks

Front 100

An osmotic such as mannitol is given to PT with ICP why?

Back 100

To reduce edema, and dehydrate the brain to lower ICP

Front 101

Which cerebral lobe controls abstract thought Frontal, Temporal, Parietal, Occipital

Back 101

Frontal

Front 102

What word describes jerky, rapid, involuntary or purposeless movement of the extremities or Chorea or Bradykinesa

Back 102

Chorea

Front 103

Which of the following is inaccurate manifestation of Cushing Triad Bradykinesa, Bradypnea, Tachycardia & Hypertension

Back 103

Tachycardia

Front 104

Later Signs of increased ICP include increased pulse rate, narrowed pulse, decreased BP or projectile vomiting, select the best answer

Back 104

Projectile Vomiting

Front 105

Thrombolytic therapy should be initiated within what timeframe for ischemic stroke to have the best outcome 3, 6, 9, or 12 hours

Back 105

3 Hours

Front 106

Taking Warfin and Garlic supplement can greatly increase INR which increased the risk of

Back 106

bleeding

Front 107

What is the most common cause of spinal cord injury MVA or Sports

Back 107

Motor Vehicle Accidents

Front 108

A Halo sign is highly suggestive of CSF Leak True or False

Back 108

True

Front 109

The dynamic equilibrium of cranial contents is called the what ______-_______ hypothesis

Back 109

Monro-Kellie

Front 110

Secondary Epilepsy is related to brain tumor, acute alcohol withdrawal, electrolyte imbalance, drugs True or False

Back 110

True

Front 111

List trigger factors for SZ

Back 111

Increased Physical Activity, Hormonal Shift, Stress, Fatigue, Alcohol, Caffine, Some Chemicals, Medications

Front 112

How do you DX a SZ

Back 112

R/O cerebral mass, EEG, MRI

Front 113

Absent SZ typical occur during which age range childhood, adolescent, adulthood

Back 113

Childhood

Front 114

Describe SZ precautions

Back 114

Standby O2, Suction, IV access, Side rails up, Bed in lowest position

Front 115

A Post op nurse is performing a pain assessment on client, she should do which of the following, check v/s, client report of pain using pain scale, nonverbal communication

Back 115

Client report of pain using pain scale

Front 116

A Patient present to ED with severe eye pain with blurred vision, a dx of angle-closure gl aucoma is made the nurse should anticipate the admin of IV osmotic diuretics, Corticosteroid drops, IV epi

Back 116

IV osmotic diuretics

Front 117

A client presents within 2 hours to ED after a embolic cerebrovascular accident, what medication should the nurse anticipate giving

Back 117

TPA Tissue Plasminogen Activator

Front 118

A client has been dx with a basilar skull fracture from a fall from a ladder, what findings need to be reported to the doctor

Back 118

clear drainage from the nose, ICP above 20

Front 119

When caring for a client post cataract surgery how long should the pt sleep upright

Back 119

24 hours

Front 120

When a pt is taking Dilantin what education information is key

Back 120

The pt should take the medication everyday at the same time to maintain therapeutic levels.

Front 121

A PT with a detached retina will have see what exactly: Complete Blindness, Flashes of Bright Light, Photophobia

Back 121

Flashes of bright light

Front 122

A client who is recovering from a cerebrovascular accident has right-sided homonymous hemianopsia. To help the client adapt the nurse need to communicate which of the following: Check the PT checks for food on the right side after eating, Provide Client with large eating utensils, Remind PT to consciously look at both sides of the meal tray

Back 122

Remind PT to consciously look at both sides of the meal tray

Front 123

A right hemispheric stroke lend to which: Aphasia, Impulsive Behavior, Inability to read

Back 123

Impulsive Behavior

Front 124

Sudden loss of function resulting from disruption of blood flow supply to part of the brain is called what

Back 124

Brain Attack

Front 125

What is the most common type of Ischemic Stroke…Large or Small Artery

Back 125

Small Artery one or more vessels are impacted

Front 126

What is the root cause of Cryptogenic Shock

Back 126

Cause Unknown

Front 127

The Brain must have these two things and does not store these items

Back 127

Oxygen & Glucose

Front 128

The Brain Needs constant blood flow True or False

Back 128

True

Front 129

Ischemic Strokes are what % ______

Back 129

85%

Front 130

Hemorrhagic are what % ______

Back 130

15%

Front 131

What is the Penumbra region

Back 131

area of low blood flow r/t infarction

Front 132

How do you DX a SCI

Back 132

Xray, CT bone, MRI soft tissue

Front 133

What is the most common type of SCI 48%

Back 133

MVA

Front 134

What gender is more likely to have a SCI Male or Female

Back 134

Male

Front 135

Bruising and Bleeding into the tissue is a

Back 135

Contusion

Front 136

DAI or Diffuse axonal injury occurs with what type of trauma

Back 136

Shaken Baby, Shearing of Brain

Front 137

A tear in the cord, permanent injury is a

Back 137

Laceration

Front 138

Severing of the cord with complete loss of function below the level of the injury

Back 138

Transection

Front 139

A temporary loss of function is a

Back 139

Concussion

Front 140

Falling on ones head would be considered what type of injury

Back 140

Axial Loading Compression

Front 141

A GSW (GUN SHOT WOUND) is an example of what type of trauma

Back 141

Penetrating

Front 142

List the NSG Intervention to prevent 2nd Injury related to SCI Trauma

Back 142

Airway Mngt, Oxygenation, Ventilation, F/V Mngt, ICP Mngt, DVT prevention, Pneumo Prevention, Skin Integrity,

Front 143

True or False there is no TX for Linear FX

Back 143

True

Front 144

True or False Depressed FX may require surgery

Back 144

True

Front 145

True or False Basilar FX involve the base of the skull and can leak CSF from Nose, Ear

Back 145

True

Front 146

True or False When a PT presents with a Basilar FX an NG is always required

Back 146

False NO NG!!!

Front 147

With a Basilar FX what S/S should the RN be looking for in assessment

Back 147

Bleeding Behind Ears, Blood Clotting, Swelling Around the Eyes.

Front 148

What are the Modifiable Risk to Prevent Stroke

Back 148

HTN, A Fib, Smoking, Alcohol Use, DM Control, Diet, Exercise, TIA warning, Periodontal Disease,

Front 149

What are the Non-Modifiable Risk to Prevent Stroke

Back 149

>55 Age, Male, African American

Front 150

What are two types of Meningitis

Back 150

Bacterial & Viral, Bacterial is most common

Front 151

Which common meningitis organisms is each to treat Strep, Neisseria, Hemophilus

Back 151

Neisseria

Front 152

What the clinical presentation signs of Meningitis

Back 152

Fever, Nuchal Rigidity, Photophobia, Rash, SZ, HA, Irritability, Kerning&Brudzinki

Front 153

What medication is used to Treat Encephalitis

Back 153

Acyclovir

Front 154

True or False blood can damage brain tissue if a hemorrhage occurs

Back 154

True

Front 155

Micrographic is a manifestation of what disease

Back 155

Parkinson’s

Front 156

What is the drug of choice for Parkinson’s

Back 156

Levodopa

Front 157

What does DNR stand for =

Back 157

DO NOT RESUSCITATE, This is a free b! HAHAH! Hope you got it right!

Front 158

LOC is =

Back 158

Level of Consciousness

Front 159

A nurse is caring for a client with SCI. Which of the following changes to the PT baseline requires immediate attention, Temp 100.5, Systolic from 130 to 100, Decreased bowel sounds, Flush Face & chest

Back 159

Flush Face & Chest

Front 160

A Pt has returned from Brain Surgery, both eyes are edematous, what NSG interventions should the RN use to reduce the swelling

Back 160

Elevate the HOB and apply cold compress.

Front 161

This can be used to study a tumors blood supply or obtain info about a vascular lesion what is

Back 161

Cerebral Angiography.

Front 162

What is the position of the LICO in the Brain

Back 162

It is placed in the White Matter

Front 163

When CSF is extracted and it is pink or blood tinged this is a sign of what type of brain bleed

Back 163

Subarachnoid Hemohrrage

Front 164

Most PT are perscribed this anti SZ med bgore surgery to reduce the risk of SZ what is

Back 164

Dilantin or Cerebyx

Front 165

This corticosteroids is given to reduce cerebral edema if a patient has a brain tumor what is

Back 165

Decadron

Front 166

What is the first sing of increase ICP

Back 166

A Change in LOC

Front 167

What is the goal of postoperative management

Back 167

Detecting and Reducting cerebral edema, Pain, SZ prevention, Mntr ICP, Neuro Status

Front 168

Incr. pressure on the frontal lobe or deep midline structure may result in _______ -_______ respirations

Back 168

Cheyne-Stokes

Front 169

Flexion or adduction of the upper extremities, internal rotation of the lower extremities ans plantar flexion of the feet is an example of

Back 169

Decorticate

Front 170

Aphasia in Auditory receptive region is r/t damage in what area of the brain

Back 170

Temporal lobe

Front 171

Visual aphasisa is r/t damage in what area of the brain

Back 171

Parietal - Occipital area

Front 172

List the s/s of Upper Motor Neuron Lesions

Back 172

Loss of Voluntary Control, Increased Muscle tone

Front 173

List the s/S of Lower Motor Neuron Lesions

Back 173

Loss of voluntary control, Decreased muscle tone, Flaccid muscle paralysis, Muscle atrophy, Absent or decreased reflexes

Front 174

What is a complication of pituitary ablation through the transsphenoidal approach & what is the TX

Back 174

diabetes insipidus & vasopressin

Front 175

Which of the following neurotransmitters inhibits pain and transmission Serotonin, Enkephalin, Dopamine

Back 175

Enkephalin

Front 176

Which term referes to shifting of brain tissue from an area of high pressure to an area of low pressure Autoregulation or Herniation

Back 176

Herniation

Front 177

Ischemic stroke and Cerebrovascular accident are all names for what

Back 177

"BRAIN ATTACK

Front 178

Lacunar Stroke is a Large or Small Atery Stroke

Back 178

Small Atery

Front 179

True or False penubra region is ischemic brain tissue that can be salvaged with timely intervention

Back 179

True

Front 180

The Penubra area can be revitalized if given what drug with in 3 hours of the episode

Back 180

TPA Tissue Plasminogen Activator

Front 181

What is Hemiplegia

Back 181

paralysis of one side of the body

Front 182

What is Hemiparesis

Back 182

weakness of osne side of the body

Front 183

True or False Homonymous Hemianopsia will alway return after the stroke

Back 183

False it can be temporary or pernament

Front 184

S/S of Left Hemispheric Stroke

Back 184

Paralysis or Weakness on Right Side, Right Visual Field Deficit, Aphasia, Altered intellectual ability, Slow Cautious behavior

Front 185

S/S of Right Hemispheric Stroke

Back 185

Paralysis or weakness on left side of body, Left Visual Field Deficit, Spatial Deficit, Increased distractibility, Impulsive behavior & poor judegement, Lack of awareness deficits

Front 186

Once TPA is administered how long before a PT can begin anitcoagulation therapy again

Back 186

Not for the Next 24 Hours

Front 187

What are the contraindications for TPA, When can it not be administered

Back 187

> 3 hours after TIA, a PT who is anticoagulated, or PT who has had intracranial pathology perviously TIA STROKE, HA Trauma

Front 188

How is the TPA dose calculated

Back 188

By Weight 0.9mg/kg

Front 189

Explain Admin of TPA

Back 189

Max dose 90mg, 10% bolus IV push 1 min, 90% 1hr IV infusion pump