NURS 201 Exam 1 2024/2025
Questions with Correct Verified
Solutions, Rated A
1. Heat exhaustion and key assessments/findings - ANS ✔- Gradual
loss of salt and water in a hot environment
- NO significant dysfunction of the CNS
- 37-40 ⁰C (100-104 ⁰F)
- Excessive sweating
- Cool, pale, clammy skin
- Tachycardia and/or hypotension
- Muscle cramps, weakness, dehydration
2. Exertional heatstroke and key assessments/findings - ANS ✔-
Failure of the heart-regulating mechanisms of
the body
- Profound CNS dysfunction -confusion, delirium, bizarre behaviour, coma,
seizures
- >40.6 ⁰C (105 ⁰F)
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Nurs&201 Exam 1
, - Anhidrosis
- Red, hot, dry skin
- Tachypnoea, hypotension, tachycardia
- Throbbing headache
3. Review nursing interventions to manage heat exhaustion - ANS
✔- Move to a shaded or air-conditioned area
- Rehydrate with cold water or sports drink
IV fluid if unable to drink
- Get help if rapid improvement does not occur
- Monitor T, P, BP, RR, mental status
4. Review nursing interventions to manage heat stroke - ANS ✔-
Assess ABCs and level of consciousness
- IV NS to replace fluid losses and maintain adequate circulation
- Call 911 or get help
- Monitor VS, ECG, CVP, LOC, I&O (acute tubular necrosis)
- Medications: anticonvulsant, potassium, sodium
bicarbonate, benzodiazepines
5. Seizure prevention from heat stroke/heat exhaustion - ANS ✔-
Reduce the body temp 39.2 ⁰C (102 ⁰F)
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Nurs&201 Exam 1
, - Cool sheets and towels
- Ice applied to the neck, groin, chest, and axillae
- Cooling blankets
- Immersion in cold water bath
- Cooling process should stop at 101 ⁰F
- Place the patient supine with their feet elevated
Review nursing interventions to manage mild to severe
6. hypothermia (in adults and infants) - ANS ✔- Remove wet
clothing, rewarm, IV fluids, cardiac
monitoring, prevent complication
- Monitor VS, CVP, Glucose level, urine output, arterial
blood gas, chest x-rays
- Temperature monitored with thermistor
- Continuous ECG monitoring - cold-induced myocardial
irritability leading to V-fib
- Avoid rubbing or massaging affected areas
- Elevate extremities but keep on bedrest
- Heated humidified oxygen
- Administer analgesics and anti-inflammatory agents
- Stop all IV potassium administration during rewarming (Released from
the cells as compensatory mechanism)
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Nurs&201 Exam 1
, - Resuscitation may be needed
7. Rewarming - ANS ✔- Passive or active external rewarming - mild
hypothermia
- Passive: over-the-bed heaters
- Active: forced-air warming blankets
- Active internal (core) rewarming - for moderate to severe hypothermia
- Cardiopulmonary bypass
- Warm fluid administration
- Warmed humidified oxygen
- Warmed peritoneal lavage
- Rapidly rewarm affected areas in circulating warm water(102-104 ⁰F) for
30-40 minutes
8. Risk factors of hypothermia - ANS ✔- Exposure to cold
environment
- Immersion in cold water
- Lack of adequate clothing, shelter, heat
- Older adults, Infants, Concurrent illnesses
- Geographic location
- Alcohol ingestion (systemic vasodilation)
- Some medications (phenothiazine)
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Nurs&201 Exam 1
