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2024 NURS 104 EXAM 2 WITH CORRECT ANSWERS
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2024 NURS 104 EXAM 2 WITH CORRECT ANSWERS
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2024 NURS 104 EXAM 2 WITHCORRECT ANSWERS
Brain Tumor cause - CORRECT-ANSWERSIdiopathic
Which of the following statements about comfort care is accurate?
a. Withholding and withdrawing life-sustaining treatment are distinctly
different in the eyes of the legal community.
b. Each procedure should be evaluated for its effect on the patient's comfort
before being implemented.
c. Only the patient can determine what constitutes comfort care for him or
her.
d. Withdrawing life-sustaining treatments is considered euthanasia in most
states. - CORRECT-ANSWERSb. Each procedure should be evaluated for its
effect on the patient's comfort before being implemented.
The goal of comfort care is to provide only treatments that do not cause pain
or other discomfort to the patient.
Primary vs Metastatic Brain Tumors - CORRECT-ANSWERSPrimary - do not
get metastasize; get bigger and push on things; slow growing
Metastatic - spread
Infratentorial Brain Tumor - CORRECT-ANSWERSBrain tumor arising from
underneath the tentorium sheath of the cerebellum
Affects cerebellum and brain stem
Supratentorial Brain Tumor - CORRECT-ANSWERSBrain tumor arising from
above the tentorium sheath of the cerebellum
Affects cerebrum
Brain Tumor S/s - CORRECT-ANSWERSHeadache, N/V, changes in LOC,
seizures (often times the first sign), visual disturbances
May develop papilledema and hydrocephalus
Brain Tumor diagnosis - CORRECT-ANSWERSCT, MRI, CT or MRI guided
biopsy, audiometric studies, mapping of visual fields
,Meds for Brain Tumors - CORRECT-ANSWERSCorticosteroids -to suppress
immune system
H2 receptor antagonists or H+ ion pump inhibitors with corticosteroids
Anticonvulsants -can be prophylactic
Mannitol -to lower ICP
Stool softeners
Brain Tumor Surgery - CORRECT-ANSWERSBiopsy is the first step
If Tumor is accessible, craniotomy is performed.
RN Mgmt for Brain Tumor - CORRECT-ANSWERSProvide info on testing
Positive approach
Nursing care and symptom relief during chemo and radiation
Post op Supratentorial Craniotomy Positioning - CORRECT-ANSWERSHOB 30
degrees
Neck in neutral spine
Pillow may be placed under head and shoulders
No turning restrictions
Avoid extreme flexion of upper legs or neck
Allowed OOB as tolerated
Post op Supratentorial Craniotomy Nutrition - CORRECT-ANSWERSNPO for
24H
IV fluids given slowly
If no N/V, and can protect airway, pt is given clear liquids
Diet progressed as tolerated
Post op Supratentorial and Infratentorial Craniotomy Elimination are the
same - CORRECT-ANSWERSFoley
Possible bladder retraining post foley removal if necessary
Diuretics and pain meds can cause constipation, causing valsalvas
maneuver, which can increase ICP.
Stool softeners, etc to avoid constipation
Post op Supratentorial & Infratentorial Craniotomy F&E Balance are the same
- CORRECT-ANSWERSIntake is balanced with output
Strict adherence to fluid restrictions when ordered
Serum electrolyte and osmolarity levels monitored
_____ is a powerful influence when the decision-making process is dealing
with recovery or a peaceful death.
a. Hope
b. Religion
c. Culture
,d. Ethics - CORRECT-ANSWERSa. Hope
Hope is a powerful influence on decision making, and a shift from hope for
recovery to hope for a peaceful death should be guided by clinicians with
exemplary communication skills. Ethics, religion, and culture can influence
the decision process regarding care and end-of-life decisions.
The patient's condition has deteriorated to the point where she can no longer
make decisions about her own care. Which of the following nursing
interventions would be most appropriate?
a. Obtain a verbal DNR order from the physician.
b. Continue caring for the patient as originally ordered because she
obviously wanted this.
c. Consult the hospital attorney for recommendations on how to proceed.
d. Discuss with the family what the patient's wishes would be if she could
make those decisions herself. - CORRECT-ANSWERSd. Discuss with the family
what the patient's wishes would be if she could make those decisions herself.
If the patient is not able to make end-of-life decisions for herself, her family
members should be approached to discuss the next steps because they may
have insight into what her wishes would be.
The two basic ethical principles underlying the provision of health care are
a. beneficence and nonmaleficence.
b. veracity and beneficence.
c. fidelity and nonmaleficence.
d. veracity and fidelity. - CORRECT-ANSWERSa. beneficence and
nonmaleficence.
The two basic ethical principles underlying the provision of health care are
beneficence and nonmaleficence.
A patient was admitted to the critical care unit several weeks ago with an
acute myocardial infarction and subsequently underwent coronary artery
bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has
been unresponsive. An electroencephalogram shows no meaningful brain
activity. The patient does not have an advance directive. Which of the
following statements would be the best way to approach the family
regarding his ongoing care?
a. "I will refer this case to the hospital ethics committee, and they will
contact you when they have a decision."
b. "What do you want to do about the patient's care at this point?"
, c. "Dr. Smith believes that there is no hope at this point and recommends
DNR status."
d. "What would the patient want if he knew he were in this situation?" -
CORRECT-ANSWERSd. "What would the patient want if he knew he were in
this situation?"
Approaching the family and asking what they know about the patient's
wishes and preferences is the best way to begin this discussion. Emotional
support for the patient and the family is important as they discuss advance
care planning in the critical care setting.
A patient was admitted to the critical care unit several weeks ago with an
acute myocardial infarction and subsequently underwent coronary artery
bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has
been unresponsive. An electroencephalogram shows no meaningful brain
activity. After a family conference, the physician orders a DNR order, and
palliative care is begun. This means:
a. the patient will continue to receive the same aggressive treatment short
of resuscitation if he has another cardiac arrest.
b. all treatment will be stopped, and the patient will be allowed to die.
c. all attempts will be made to keep the patient comfortable without
prolonging his life.
d. the patient will be immediately transferred to hospice. - CORRECT-
ANSWERSc. all attempts will be made to keep the patient comfortable
without prolonging his life.
When palliative care is begun, the primary goal is to keep the patient
comfortable by continuing assessments and
managing symptoms that might cause pain, anxiety, or distress.
A patient was admitted to the critical care unit several weeks ago with an
acute myocardial infarction and subsequently underwent coronary artery
bypass grafting surgery. Since a cardiac arrest 5 days ago, the patient has
been unresponsive. An electroencephalogram shows no meaningful brain
activity. The patient is placed on a morphine drip to alleviate suspected
operative pain and assist in sedation. The patient continues to grimace and
fight the ventilator. What nursing intervention would be appropriate?
a. Increase the morphine dosage until no signs of pain or discomfort are
present.
b. Increase the morphine drip, but if the patient's respiratory rate drops
below 10 breaths/min, return to the original dosage.
c. Gradually decrease the morphine and switch to Versed to avoid respiratory
depression.
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