Nokea
Which of these patients in the neurologic ICU will be best to assign to an RN who has floated from the medical unit?
- A. A 26-year-old patient with a basilar skull fracture who has clear drainage coming out of the nose
- B. A 42-year-old patient admitted several hours ago with a headache and diagnosed with a ruptured berry aneurysm
- C. A 46-year-old patient who was admitted 48 hours ago with bacterial meningitis and has an antibiotic dose due
- D. A 65-year-old patient with an astrocytoma who has just returned to the unit after having a craniotomy
Correct Answer: C
Rationale: A stable patient receiving antibiotics is more appropriate for an RN floating from another unit.
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Anti-diuretic hormone (ADH):
- A. is synthesized by the posterior lobe of the pituitary gland
- B. is released by neurosecretion
- C. its secretion is increased by a low plasma osmolarity
- D. increases the permeability of the distal convoluted tubule
Correct Answer: B
Rationale: ADH is synthesized in the hypothalamus and released by the posterior pituitary via neurosecretion. Its secretion is increased by high plasma osmolarity or low blood volume. ADH increases water reabsorption in the distal convoluted tubule and collecting ducts by increasing their permeability to water.
The patient with migraine headaches has a seizure. After the seizure, which action can you delegate to the nursing assistant?
- A. Document the seizure.
- B. Perform neurologic checks.
- C. Take the patient's vital signs.
- D. Restrain the patient for protection.
Correct Answer: C
Rationale: Taking vital signs is a routine task that can be delegated to a nursing assistant while documenting seizures and performing neurologic checks require more specialized knowledge.
A drug that affects both divisions of the autonomic system is going to bind to, or block, which type of neurotransmitter receptor?
- A. nicotinic
- B. muscarinic
- C. α-adrenergic
- D. β-adrenergic
Correct Answer: A
Rationale: Rationale for Correct Answer (A):
1. Nicotinic receptors are present in both sympathetic and parasympathetic divisions of the autonomic system.
2. Drugs affecting both divisions target nicotinic receptors to modulate autonomic functions.
3. Binding or blocking nicotinic receptors can impact both sympathetic and parasympathetic activities.
Summary of Incorrect Choices:
B. Muscarinic receptors are specific to the parasympathetic division, not affecting the sympathetic division.
C. α-adrenergic receptors are specific to the sympathetic division, not influencing parasympathetic functions.
D. β-adrenergic receptors are also specific to the sympathetic division, not impacting the parasympathetic division.
To prevent strain on Mr. Tucker's back muscles, which nursing action is INAPPROPRIATE?
- A. To place him on bed pan, logroll using a turning sheet
- B. When lying on his side, flex upper leg and place a pillow between his knees
- C. When lying on his back, place pillows under entire length of his knees
- D. To turn him on his side, gently turn his shoulders and upper trunk first, prop with a pillow, then turn his pelvis and lower limbs
Correct Answer: D
Rationale: Turning the pelvis and lower limbs last can strain back muscles.
Which assessment finding best supports the diagnosis of dissociative amnesia with fugue? The patient states:
- A. I cannot recall why I'm living in this town.
- B. I feel as if I'm living in a fuzzy dream state.
- C. I feel like different parts of my body are at war.
- D. I feel very anxious and worried about my problems.
Correct Answer: A
Rationale: The correct answer is A because the key feature of dissociative amnesia with fugue is the inability to remember important personal information. In this case, the patient cannot recall why they are living in the current town, indicating a significant gap in memory. Choice B describes a feeling of disorientation, not memory loss. Choice C suggests dissociative identity disorder, not dissociative amnesia. Choice D focuses on anxiety, which is not a primary symptom of dissociative amnesia with fugue.