Exam (elaborations)
PNR 408- FINAL EXAM with Complete Solutions/ Correct-Verified Answers
- Course
- Institution
PNR 408- FINAL EXAM with Complete Solutions/ Correct-Verified Answers
[Show more]
Seller
Follow
Content preview
PNR 408- FINAL EXAM with CompleteSolutions/ Correct-Verified Answers
The nurse is caring for a client admitted for evaluation and surgical removal of a brain tumour.
The nurse will plan interventions for this client based on knowledge that brain tumours can lead
to which of the following complications? (Select all that apply.)
a)Vision loss
b)Cerebral edema
c)Pituitary dysfunction
d)Parathyroid dysfunction
e)Focal neurological deficits - ANSWER A, B, C, E
Brain tumours can manifest themselves in a wide variety of symptoms depending on location,
including vision loss and focal neurological deficits. Tumours that put pressure on the
pituitary can lead to dysfunction of the gland. As the tumour grows, clinical manifestations of
increased intracranial pressure (ICP) and cerebral edema can appear. The parathyroid gland is
not regulated by the cerebral cortex or the pituitary gland.
The nurse is providing care for a client who has been admitted to the hospital with a head injury
and who requires regular neurological vital signs. Which of the following assessments are
components of the Glasgow Coma Scale (GCS)? (Select all that apply.)
a)Judgement
b)Eye opening
c)Abstract reasoning
d)Best verbal response
e)Best motor response - ANSWER B, D, E
,The nurse is caring for a client who has been receiving scheduled doses of phenytoin and begins
to experience diplopia. Which of the following assessments should the nurse complete
immediately?
a)An aura
b)Nystagmus or confusion
c)Abdominal pain or cramping
d)Irregular pulse or palpitations - ANSWER B
Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity,
which include neurological changes such as nystagmus, ataxia, confusion, dizziness, or slurred
speech.
Which of the following characteristics of a client's recent seizure is congruent with a
complex partial seizure?
a)The client lost consciousness during the seizure.
b)The seizure involved lip smacking and repetitive movements.
c)The client fell to the ground and became stiff for 20 seconds.
d)The etiology of the seizure involved both sides of the client's brain. - ANSWER B
The most common complex partial seizure involves lip smacking and automatisms (repetitive
movements that may not be appropriate). Loss of consciousness, bilateral brain
involvement, and a tonic phase are associated with generalized seizure activity.
The nurse is caring for a client admitted with a spinal cord injury following a motor vehicle
accident. The client exhibits a complete loss of motor, sensory, and reflex activity below
the injury level. Which of the following syndromes should the nurse recognize that the
client is experiencing?
, a)Central cord syndrome
b)Spinal shock syndrome
c)Anterior cord syndrome
d)Brown-Séquard syndrome - ANSWER B
About 50% of people with acute spinal cord injury experience a temporary loss of reflexes,
sensation, and motor activity that is known as spinal shock. Central cord syndrome is
manifested by motor and sensory loss greater in the upper extremities than the lower
extremities. Anterior cord syndrome results in motor and sensory loss but not loss of
reflexes. Brown-Séquard syndrome is characterized by ipsilateral loss of motor function and
contralateral loss of sensory function.
Which of the following clinical manifestations should the nurse interpret as
representing neurogenic shock in a client with acute spinal cord injury?
a)Bradycardia
b)Hypertension
c)Neurogenic spasticity
d)Bounding pedal pulses - ANSWER A
Neurogenic shock is due to the loss of vasomotor tone caused by injury and is characterized by
hypotension, bradycardia, and hypothermia. Loss of sympathetic innervation causes peripheral
vasodilation, venous pooling, and a decreased cardiac output.
The nurse is caring for a client admitted one week ago with an acute spinal cord injury. Which
of the following assessment findings would alert the nurse to the presence of autonomic
dysreflexia?
a)Tachycardia
b)Hypotension
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller KenAli. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
83100 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now