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ATI-MedSurge-NeurMus

ATI-MedSurge-NEUROMUSCULAR

QuestionAnswer
phenytoin (Dilantin), should be administered? should be taken at the same time everday to maintain therapeutic levels
If a rash develops while taking phenytoin (Dilantin), pt. should? report to HCP
Phantom limb pain should be treated as ________ real pain
Neurontin (Gabapentin) is used for? Tx of neuropathic pain
Post-OP amputation, pt. reports pain in residual limp, nursing priority? treat the pain
Labyrinthitis and Ménière’s disease are... inner ear problems
Labyrinthitis is? an infection of the labyrinth, secondary to otitis media
Ménière’s disease is? is a vestibular disease with a triad of symptoms – tinnitus, unilateral sensorineural hearing loss, and vertigo
Ménière’s disease, pt. teaching? - move head slowly to decrease vertigo
Intracranial pressure S/S? - restlessness - the Cushing Reflex (HTN/ widened pulse) -
Positive Romberg sign It indicates that the patient is excessively reliant on his vision to maintain balance. The problem may lie in the vestibular or proprioceptive systems
Positive Babinski’s sign No Response: Indicates damage to the peripheral nervous system, muscles, or tendons within the region. Flexion: the toes all curve inwards. This is the normal response with functional CNS
To determine pt. pain severity, nurse should use? Pt. report of pain on a standardized pain scale
Rheumatoid arthritis usually occurs? (bilaterally / unilaterally) bilaterally & symmetrically
Osteoarthritis usually occurs? (bilaterally / unilaterally) unilaterally
Deviation of Rheumatoid arthritis is usually seen in? small joints
alendronate (Fosamax) is prescribed for? osterporosis
When should alendronate (Fosamax) be administered? before breakfast, pt. should sit upright for 30 min. after administration
If pt. in is in a balances suspension skeletal traction experiences muscle contractions, what is a nursing priority? check position and weight of ropes
Osteoarthritis, S/S? crepitus, decreased ROM, involvement of larger joints, joint pain that resolves w/rest
Knee and hip arthroplasty is used to treat? osteoarthritis, rheumatoid arthritis
Total hip arthroplasty, dislocation precautions? use: elevated toilet set, straight chairs w/arms, abduction pillow bet. pt.legs while in bed -externally rotate the client’s toes -don't cross less -don't flex hips >90 deg.
Casts can be slit on one side (____) or both Sides (____) univalved / bivalved
If compartment syndrome is suspected, priority nursing action? Report finding to HCP
Open-angle glaucoma, is? the aqueous humor outflow is decreased due to blockages in the eye’s drainage system (most common type)
Angle-closure glaucoma, is? the angle between the iris and the sclera suddenly closes causing a increase in IOP
In emergency care of angle-closure glaucoma, nurse should anticipate to administer? IV osmotic diuretics (rapidly reduce IOP)
Pupillary (constriction / dilation) is the effect to facilitate the flow of aqueous humor constriction
Mydriatic ophthalmic drops cause pupillary(constriction / dilation)? dilation
IV Epinephrine cause pupillary (constriction / dilation)? dilation
Micturition reflex is the? relaxation of the urethral sphincter in response to increased pressure in the bladder
Micturition reflex, can be stimulated by pulling on pubic hair, stroking the inner thigh
Credé’s maneuver is done to? downward pressure on the bladder to manually express the urine
Valsalva maneuver is performed by? attempting to forcibly exhale while keeping the mouth and nose closed
Valsalva maneuver is done to? evaluate the condition of the heart
Post-OP craniotomy nursing action? elevate head of bed 30 deg, to reduce risk of intracranial pressure
Pts. with retinal detachment, usually report? flashes of bright light or dark floating spots
The onset of retinal detachment is? abrupt, vision loss without pain
A Basilar skull fracture involves? a portion of the skull extending into the brain cavity
A Basilar skull fracture, can result in? cerebrospinal fluid leakage, report to HCP
Glasgow Coma Scale, <8 associated with severe head injury and coma
Glasgow Coma Scale, 9 - 12 indicates a moderate head injury
Glasgow Coma Scale, >13 reflects minor head trauma
Cheyne-Stokes respirations breathing hyperventilation followed by apnea
CPAP Continuous positive airway pressure
BiPAP Bilevel positive airway pressure
PaCO2 of pt. on mechanical ventilator should be maintained at? @ 35mm Hg
Respiration of pt. on mechanical ventilator should be checked every? 1 to 2 hrs.
3 types of ventilator alarms are ____, ____, and ____. volume, pressure, apnea
Amyotrophic lateral sclerosis, is also know as ____ ____ ____. Lou Gehrig's disease
Amyotrophic lateral sclerosis (ALS) is? a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement
The greatest risk to ALS pt. is? respiratory compromise due to paralysis of respiratory muscles
Death due to ALS usually occurs within? 3 to 5 years of diagnosis
Hemianopsia is? a condition in which a person can see only to one side, the left or right
When feeding pt. w/hemianopsia, nurse should encourage pt. to? move visual field (head) to see full plate
Prior to feeding pt. w/CVA, nurse should assess? swallowing and gag reflexes
Food should be placed where in mouth of pt. w/CVA in the back of the mouth on the unaffected side.
Pt. w/CVA should be positioned how when eating? upright position and swallow with the head and neck flexed slightly forward
Tensilon (Edrophonium chloride) test is? an injection of edrophonium chloride used to diagnosis Myasthenia Gravis
Plasmapheresis is? a blood purification procedure used to treat several autoimmune diseases
Myasthenic Crisis, S/S respiratory muscle weakness, Myasthenic symptoms, hypertension, temporary relief w/Tensilon
Myasthenic symptoms include? weakness, incontinence, fatigue
Cholingeric Crisis, S/S muscle twitching, Cholinergic symptoms, hypotension, no relief w/Tensilon, relief w/Atropine
Cholinergic symptoms include? Hypersecretions (nausea, diarrhea, respiratory secretions) and hypermotility (abdominal cramps)
A lumbar puncture is also known as a ____ ____. spinal tap
Post-OP lumbar puncture pt. should lie flat for 4 to 8 hrs.
An Embolic CVA is an? ischemic types of stokes are caused by a thrombus or embolus
For an emergency Embolic CVA, nurse should anticipate administering? Tissue plasminogen activator (Alteplase)
Recombinant Factor VIII, is administered in pt. with? hemophilia
Nitro-Bid-IV (Nitroglycerin), is administered in pt. with? angina
Lidocaine is administered in pt. with? ventricular dysrhythmias
Sinemet should be administered with (high / low) protein foods? Low, high-protein foods reduce absorption
Sinemet S/E orthostatic HTN, dark urine, takes weeks for Therapeutic Effects
Guillain-Barre syndrome, greatest risk is? Respiratory failure
Created by: fluency