Nokea
A husband visiting his wife in the hospital suddenly becomes confused and has difficulty with speech and starts slurring his words. The physician caring for his wife recognizes this as a cerebrovascular accident. What would you expect the physician to do?
- A. Administer TPA since this is within 3 hours of the CVS.
- B. Assess if the husband had an ischemic or hemorrhagic CVS.
- C. Tell the husband to go home, get rest, and to call the physician in the morning if the symptoms continue.
- D. Admit the husband and place him on bed rest.
Correct Answer: B
Rationale: It's critical to determine the type of stroke (ischemic or hemorrhagic) before treatment.
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If an individual suffers a traumatic event and has a neurological disorder that means they may be unable to recall anything from the moment of the injury or to retain memories of recent events. This is known as:
- A. anterograde amnesia
- B. retrograde amnesia
- C. postevent amnesia
- D. antenatal amnesia
Correct Answer: A
Rationale: Anterograde amnesia refers to the inability to form new memories after the onset of amnesia, often due to brain injury or trauma. This condition severely impacts an individual's ability to retain information about recent events, while memories from before the injury may remain intact. It is commonly associated with damage to the hippocampus, a brain region critical for memory formation and consolidation.
You are caring for a patient who has just had open carpal tunnel release surgery. The surgeon has requested that the patient's hand and arm remain elevated above the level of the heart after the surgery. This is to
- A. Reduce lymphatic drainage.
- B. Reduce postoperative swelling.
- C. Restrict hand movements.
- D. Decrease possibility of nosocomial infection.
Correct Answer: B
Rationale: Elevation reduces swelling by improving venous and lymphatic return.
A 78-year-old woman has a physiologic change related to aging in her joints. What is an appropriate nursing intervention related to common changes of aging in the musculoskeletal system?
- A. Encourage rest to eliminate fatigue
- B. Provide all care for the patient to ensure that care is completed
- C. Encourage eating enough calories to avoid the risk for impaired skin integrity
- D. Have the patient exercise to maintain muscle strength and avoid the risk for falls
Correct Answer: D
Rationale: Exercise helps maintain strength and balance.
The following are true about parathyroid hormone:
- A. it is an 84 amino acid peptide hormone
- B. it increases calcium absorption from the gastrointestinal tract
- C. it acts on a cell surface receptor that increases intracellular cyclic AMP
- D. all above
Correct Answer: D
Rationale: Parathyroid hormone (PTH) is an 84-amino acid peptide that increases calcium absorption from the gut, mobilizes calcium from bones, and reduces calcium excretion by the kidneys. It acts via a cell surface receptor that activates cyclic AMP signaling.
A patient who has been admitted to the medical unit with new-onset angina also has a diagnosis of Alzheimer's disease. Her husband tells you that he rarely gets a good night's sleep because he needs to be sure she does not wander during the night. He insists on checking each of the medications you give her to be sure they are the same as the ones she takes at home. Based on this information, which nursing diagnosis is most appropriate for this patient?
- A. Decreased Cardiac Output related to poor myocardial contractility
- B. Caregiver Role Strain related to continuous need for providing care
- C. Risk for Falls related to patient wandering behavior during the night
- D. Ineffective Therapeutic Regimen Management related to poor patient memory
Correct Answer: B
Rationale: The caregiver's strain is evident from his description of needing to constantly monitor the patient.